'Concerned about safety? Refuse to register any more patients'
GPC chair Dr Chaand Nagpaul speaks with Pulse editor Nigel Praities at Pulse Live in London
Q Should we be reading the last rites for general practice?
No. I didn’t become chair of the representative body for gps to see it sink and die a death so actually I believe that it is certainly not, we’re not reading the last rites. We need to be fighting and doing what we can to resurrect general practice but more importantly looking to the future.
Q Some GPs feel politicians are leading a campaign against general practice. Is it that they don’t get it, or do they actively want to get general practice to a low ebb so they can do what they want with it?
I think there is some foolishness in looking at the way the NHS functions. Politicians have pandered to populist ideas; they’ve looked at casualty front end, they’ve looked at hospital issues. They’ve not looked at the root bases upon which they can have a sustainable NHS. These are short-term electoral timescales that politicians work within, so we’ve seen an NHS highly politicised, and that’s part of the problem we’ve got at the moment.
We’ve got policies that are completely diametrically opposite – on the one hand we’re saying we don’t have enough GPs, we understand you’re under pressure, we know we need 8,000 more GPs, but in the same breath saying ‘Why can’t you open seven days a week?’ ‘Why can’t you offer 48-hour appointments?’
We can’t have it both ways: if you don’t have enough GPs, you can’t have a service that’s pandering to that sort of access.
Q How will you be voting and why?
I attended all three political party conferences this year as part of my job, and I walked away feeling absolutely cynical.
There was no sense of promise – as I said earlier I was witnessing what I felt was a surreal rivalry when you had the two main parties saying that we desperately needed more GPs, and in the same breath, making these ridiculous pronouncements that we could somehow offer a level of service that no other nation in the world offers.
So I actually have not decided. What I think is much more important is for the populist politics to be taken out of the running of the NHS, and to have a sensible, measured approach. We can’t be planning a health service every few years to serve the political needs of the government in power.
But just so you know, I have met all the main political parties. I’ve also met the health adviser for UKIP – it was a very memorable one hour, and I certainly won’t be voting UKIP.
Q What’s the solution to reducing the amount of unresourced work GPs face?
We produced and very much promoted this – a workload management paper that’s gone out to all practices – some very simple things, and yes, you can say no.
In terms of transfer of work from secondary care, the BMA has put templates out that practices can use, and you can actually say no to these things.
CCGs are pivotal in this. I wrote to every single CCG board member, I sent them a copy of our workload management paper, and I’ve said to them, ‘Your job needs to be about supporting GPs, supporting practices, and putting an end to un-resourced workmanship’.
Q Lots of people here [at Pulse Live] who have practices that can’t take on any more patients – they’re full. Would you advise practices to say ‘We’re full – that’s enough’?
If a practice with 10,000 patients has lost two partners and can’t recruit, and you’re trying to run a list with two doctors down and a third one who may have gone off sick, if you are concerned about the quality and safety of care, the right thing to do is to say I’m not going to register any more patients. If there’s anything to be learned from the Francis enquiry, it is about doing the right thing to maintain safe care.
Q Do you think the contract needs to be renegotiated? Do you think it needs to be a local contract, or based on cost per appointment?
No, it’s much more complex than that. , in our workload guidance we have a full list of services that are and aren’t services. In any one area I would expect and would hope that GPs together, and their CCG, start to say ‘well if this is being provided and it’s not in your contract, it needs to be resourced’.
We need enough assistance that makes sure that that work, when it’s transferred, is resourced as part of the transfer. If you have a service that is moving out of hospital into general practice, you need to at that moment in time make sure that resource transfers into general practice.
Q But surely the open door is a problem.
Yes, it is a problem. I would like CCGs to be putting in place the systems to close those doors.
Q From April, a lot of CCGs are going to be taking on co-commissioning within primary care. In some areas there need to be more QOFs and breaking… […?] the GP contract. Under what circumstances would you recommend that GPs accept these local contracts ?
GPs should be careful about not to end up in a worse position than they are in now. So for instance, if you are going to continue to be performance managed on the QOF data set, if you have to work harder and do more for the same pay it doesn’t quite make sense. That’s one of the real risks
I don’t think that having a piecemeal local arrangement, where GPs are at the vagaries of local arrangements, is going to be good for the profession.
Q A big problem in general practice is workforce. Do you think that things like golden handshakes and having a better returner scheme are going to solve the problem we’ve got?
No, it’s not going to solve the problem because the way I see it, I see the situation you described earlier, like a haemorrhage – you need to get a sticking plaster, you need to get a dressing, you need to arrest the bleeding. What you don’t want to do is bleed to death.
These initiatives will go some way in helping some doctors return to general practice, But ultimately there’s only one thing that will actually work when it comes to improving workforce: the job has to be manageable, it has to be rewarding, and people will need to want to become GPs.
Q According to the RCGP, there has never been a better time to be a GP.
I won’t comment on others’ announcements but I would say that I’m determined that we need to get to the place where general practice is a rewarding career option.