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The waiting game

GPs still in favour of mass resignation despite support package

Exclusive Almost half of GPs are still willing to submit undated resignations, despite the multibillion-pound ‘Forward View’ announced by NHS England last week.

A Pulse survey of 524 English GPs found that 45% would still support mass resignation from the NHS due to the current state of general practice, while a further one in four are undecided.

This is only a small decrease on the 49% who said that they would be willing to resign their contracts in December 2015.

The Special LMC Conference in January voted for the GPC to canvass support for submitting undated resignation letters if the Government fails to implement a ‘rescue package’ for general practice within six months.

Last week, Pulse exclusively revealed that the GPC was still considering the threat of mass resignation following the announcement of the General Practice Forward View, which committed £2.4bn extra funding a year by 2020 plus a £500m support package.

Today’s poll reveals that GP support for the so-called ‘nuclear option’ is maintained, with the percentage of GPs ruling mass resignation out decreasing from 35% in December to 29% today.

The number of GPs who are undecided has increased, with a separate question revealing that 48% of GPs are unsure on their support of the Forward View. Of the rest, exactly the same number support the Forward View as oppose it. 

GPs said that the Forward View didn’t provide enough emergency funding.

Dr Ben Garland, a GP partner in north London, said: ‘I was waiting to see what it contained. Three make or break points were ignored: Crown indemnity; new money now to stave off disaster; stop all cost dumping from secondary care. As none of these have occurred I have announce my resignation as of August 2017, aged 56.’

Dr Robert Addlestone, a GP partner in Leeds, said: ‘It’s a difficult question. The public might not support us if we resign en masse, but as time goes on and they can’t get an appointment to see a GP maybe the penny will drop eventually and they will understand the dire state of general practice.’

However, Dr Elizabeth Jones, a GP partner in Norfolk, said: ‘I am not sure what this would achieve. We live in a different world than the 1960s when mass resignation was threatened. And the private providers are hovering like vultures.’

GPC chair Dr Chaand Nagpaul last week told Pulse that ‘the clock was still ticking’ on the potential for mass resignation.

He said: ’We will make sure we hold NHS England to account to deliver on [the proposals], but it is weak in terms of immediate help for practices and that’s something we will be lobbying for and negotiating for in coming months.’

On the other hand, the RCGP warmly welcomed the Forward View, describing it as perhaps the ‘most significant announcement for general practice since the 1960s’.

Do you support the General Practice Forward View?

Yes: 26% (137)

No: 26% (137)

Don’t know: 52% (250)

Following the announcement of the General Practice Forward View, would you support mass resignation from the NHS due to the current state of general practice?

Yes: 45% (233)

No: 29% (155)

Don’t know: 26% (136)

The survey was launched on 28 April 2016, collating responses using the SurveyMonkey tool. The 24 questions asked covered a wide range of GP topics, to avoid selection bias on one issue. The survey was advertised to readers via our website and email newsletter, with a prize draw for a Samsung HD TV as an incentive to complete the survey. A total of 524 GPs answered this question. 

Readers' comments (32)

  • Jezza will thank the juniors for their support if we do.

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  • I'm all for action - but what do I do if I resign? I still need to pay the bills

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  • You cardigans are all gutless...talk the talk , we'll see if you can walk the walk!

    Nowhere to run or to hide....you are finished!
    Thank you Lord HUNT

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  • Dear GP Partner at 3.49.

    Public will still need GP. We all will have to start providing services directly to public and they will pay for each contact till government makes some sort of deal. Surely there will be some period of anxiety but at least we will find definitive solution and get paid properly for job we do and efforts we put in.

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  • "Anonymous | GP registrar29 Apr 2016 3:53pm

    You cardigans are all gutless...talk the talk , we'll see if you can walk the walk!

    Nowhere to run or to hide....you are finished!
    Thank you Lord HUNT"

    Congratulations on the award for cramming the most cliches into one post without actually saying anything! Fabulous work!

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  • Anonymous | GP Partner29 Apr 2016 3:49pm

    i think private GPs financially do well ? google private Gp rates to see. this is in-spite of competition of the free at the point of use NHS.

    as demand further increase with shrinking supply more will turn to independent private GPs. No doctor should worry about being out of a job. There is also locum demand or careers allied to healthcare. The UK is short of STEM grads so really you can choose what you want to do. The main issue that is raised by friends who are partners is that they are tied into a difficult contract i.e. premises, staff or lease and this is the barrier not job prospects.

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  • If we all left we could provide our services privately and knowing our patients do a Robin Hood......

    Working for any employer- THEY will take their margins, whilst we mustn't cos we were brought up to be doormats?
    Anyone one else disagree?

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  • Anonymous | GP registrar29 Apr 2016 3:53pm

    'You cardigans are all gutless...talk the talk , we'll see if you can walk the walk!

    Nowhere to run or to hide....you are finished!
    Thank you Lord HUNT'

    Whereas posting as anonymous really shows him.
    Of course there is the issue that most of my patients could not afford even the small amount we would charge for an appointment - this is why the NHS was set up.

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  • @Peter Mcevedy | GP Partner29 Apr 2016 5:42pm

    They could if taxes were reduced in line with the amount the government would suddenly save by not having to pay for GPs themselves.

    I wonder if that would actually happen though....

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  • The support package is NOT a 'support package' . It's a burden that will generate more demand without any increase to core funding. You GP's have been seriously short changed!

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  • You cardigans are all gutless...talk the talk , we'll see if you can walk the walk!

    Nowhere to run or to hide....you are finished!
    Thank you Lord HUNT

    At least it seems the juniors amongst us have the stomach for a fight with the government!!!!!

    It will be same old same old the way things currently are with GP leadership, if you keep voting for the past you cant expect to have a future...... and if you're under 35 and still wants a future then

    "DITCH THE COUNTRY COMRADES"!!!! the cardigans only care about themselves !!

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  • My resignation is done, dated and submitted. Now for locum land.

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  • Support package? 500M on extended hours - how's that support? 500M 'ring-fenced' for 5000 additional GPs that won't be spent - how's that support?

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  • If it on offer from the Government, it is never good for you. If it's a new contract they are going to force on you, it is definitely bad for you. Good for the Junior doctors, I went and stood on their picket line this week as a retired doctor with a neck slung Edwards stethoscope to their Littmanns. What lovely people they are.

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  • The e-mail from Maureen - rcgp -claims she is happy and delighted with the offer. She appears to be totally disconnected with GPs. Is this her personal opinion or its members?

    RCGP should do a survey on members before she can claim this offer is positive!!! So lets have the evidence!

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  • For those who have not seen it......


    Dear Colleague,

    It's just over a week since NHS England launched the GP Forward View, which we believe is the most important development for general practice for many years: possibly since the 1960s.

    This is a turning point for general practice, and the culmination of three years hard lobbying by the College through our Put patients first: Back general practice campaign to make the Government and decision-makers recognise the pressures that our profession is facing, and what must be done to alleviate them.

    The GP Forward View is recognition of how essential our service is to a strong, sustainable NHS, and faith in the excellent work you do.

    Inevitably, not everyone agrees, but feedback has been positive. Overwhelmingly so.

    It's been a very long time since I have seen such optimism from within our profession and a real sense that the future bodes well for general practice and patient care.

    The message that really stood out for me was on Twitter: "I feel quite emotional re announcement today. Maybe we ARE valued and maybe we CAN move forward and improve things for patients."

    Contrary to some of my critics on social media, I am not naive. I know that this is the beginning, not the end and I know that there is a lot of work to do to ensure that the proposals in the GP Forward View are implemented effectively, in the best interests of our profession.

    The College will be helping to oversee the roll out of the package of measures through working alongside the BMA and NHS England on a new Advisory Oversight Group. The College will also publish an annual assessment of progress against the ambitious plans.

    Be assured, if we feel the roll out of the GP Forward View is going off track or is losing momentum, in any way, we will raise this as a matter of urgency with NHS England and be candid about progress against the plans with our members.

    I'm sure a small minority of you will be reading this with your head in your hands, burning with frustration over my optimism. But, seriously, do you really think relentless pessimism about the future of our profession, when we have just seen the most positive announcement on the future of general practice in many years, is a better option?

    I am optimistic, and I'm proud to be - and you should be too because you have all played a vital part in getting to where we are today: with a bright future ahead of us.

    I'm not averse to criticism. Indeed, it is essential in moving forward, shaping ideas, and some of you have genuine concerns.

    One of which is about where the 5,000 GPs by 2020 are coming from. This target was always going to be challenging, but that's not to say we shouldn't aim for it - and it just underlines how important it is that we continue to do everything possible to 'recruit, retain and return' as many GPs as possible.

    This is the opportunity for us to really start promoting general practice for the exciting, diverse and rewarding career that it is.

    Another concern has been that the increased investment promised in the GP Forward View is not new money. It's not - the NHS budget has not increased - but it is new money for general practice and that is what the College has been calling for since we launched our Put patients first campaign on the day I became Chair; a greater share of the NHS budget to reverse years of decline.

    We called for 11% thinking it was aspirational, but that it was essential to aim high, and we have near enough got it: up to 10.7% by 2020 in fact. Some of you on Twitter think that this won't make a difference - I fundamentally disagree.

    Last week's announcement means that of the £8bn of additional recurrent investment each year for the NHS pledged by the Government for the period up to 2020, around 30% will be going to general practice by the end of the current parliament.

    Of course we can always want for more, but what we have got is a guarantee of a 14% increase over the next five years, which equates to an additional £2.4bn of recurrent investment each year by 2020. How can that not make a difference?

    Our independent financial analysis of the GP Forward View offers clarification and should answer some of your questions over the money side of things, and we have put together some helpful infographics and a list of FAQs. If you have any questions that aren't answered, let us know and we will add to this.

    Claims made on social media that to benefit from the NHS England package, we and our teams will have to offer seven day services, or 'jump through hoops', are simply untrue. Whilst some of the announced money is tied to services not in the core contract - a large proportion of it is, so we will all benefit.

    We know that things are tough now, and another criticism of the GP Forward View is that this doesn't help GPs tomorrow. But 10 years of neglect of our service is not going to be reversed overnight.

    Change, unfortunately, takes time, particularly when you're dealing with an institution as large and complicated as the NHS.

    However, there are a whole host of measures being rolled out from this financial year, through a half a billion pound Sustainability and Transformation Fund.

    In fact, our one off campaign newsletter - being posted out to all members over the next couple of days - to mark the launch of the GP Forward View lists the key short term initiatives.

    Many of the short term measures are very much based on the College 'wish list' that we have been discussing with NHS England over the last few months - and will offer support to practices and GPs, particularly those struggling the most, over the next 6-12 months.

    The GP Forward View also takes strides to reduce bureaucracy, and has been welcomed by key figures such as Professor Martin Roland and Sir Sam Everington - both of whom who have written in the BMJ this week that these measures need implementing as a matter of urgency.

    The GP Forward View is excellent but it doesn't deliver absolutely everything that we want. There are still other things we're calling for. Whilst proposals in the document to make CQC inspections less burdensome are welcome, we would still like to see the inspection regime halted until general practice is back on its feet.

    Clearly, not all of the GP Forward View measures and investment will be rolled out immediately. But from the messages I've received over the last week, this has brought a lot of you up from a very dark place.

    The GP Forward View gives us hope for the future of our profession, for our individual careers, and the care we deliver to patients.

    Of course, there is still much to do both with the roll out of GP Forward View in England and the elections in the devolved nations next Thursday (see more below).

    But again, I reiterate how proud we should all be of what we have achieved together through the Put patients first: Back general practice campaign and how proud I am to be leading such an influential College at such an important time for general practice.

    Best wishes,
    Maureen

    I retired a year ago at 54. The answer to the FAQ. "Why should I not retire early?" Made me laugh out loud!!!

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  • Why should GPs delay their retirement?
    The GP Forward View gives a clear signal from the NHS that the experience and commitment of older GPs is hugely valued and that they have taken on-board warnings from the College that workload is becoming unmanageable.
    NHS England has set out a significant programme of investment to increase the general practice workforce by 2020, including 5,000 more doctors, but also at least 5,000 members of the wider workforce including, clinical pharmacists, practice nurses, and mental health therapists. In addition the GP Forward View outlines plans to increase the financial compensation available through the current GP retainer scheme, before introducing a new, further improved, scheme from next year.


    Hahahahaha!

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  • Almost all of the document refers to "primary care" and not "general practitioner".

    What does this mean? We know DoH will not fulfill the 5000 more GP promise. We know the document will increase the overall workload (If we had enough GPs, it might reduce the work load/person. But we haven't).

    So, the document is pushing towards super-surgery with few GPs, lots of nurse practitioners, PAs, pharmacists and junior doctors forced into working in primary care. All run soomthly by managers. Where have we seen this before? Could it be the modern NHS acute trusts where 80% are in deficit?? Or perhaps some of the private OOH providers??

    Either way, I very much doubt normal GPs will see much, if any of this money. It might slightly reduce our workload though - if you are still in business and not taken over by a large co-operative by then

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  • 5.42 pm yesterday
    We may wear cardigans, but we earn over £200000 pa
    And get £320 per patient
    Why ,please tell me why should we resign .
    You need to grab the dosh do some work

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  • The offer from the government is a joke. It's a shame the college put their stamp on it. My membership is now cancelled RCGP for selling out so easily

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  • Dr Maureen Baker of RCGP must keep her personal opinions - personal. She needs to validate any RCGP stance as opinions of the majority of the members and is evidence based. or Shut up!

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  • Dr Maureen Baker is quite correct.

    This package will save General Practice and the NHS and must be fully backed.

    The government has kept it's word. There was no top down reorganization of the NHS, no rowing back on the 2004 contract, and HEE will comfortably deliver the 5000 extra qualified GPs they have promised. The evidence for 7 day routine and emergency care as delivered by that great man Prof Keough is overwhelming and clear cut. The government and NHS England can be trusted to deliver 7 day NHS with existing staff numbers and no extra funding because of the brilliant management skills that they have. With time junior doctors will realize that their pay will not go down and their hours will not be cut under the watchful eye of CQC and our dear friends such as Prof. Fields. The RCGP has been instrumental and trustful in the past and skillfully handled the MRCGP 'scandel'. Where others such as the RCP have struggled handling their exams the RCGP have shown all the others how to it. Dr Baker has been instrumental in supporting grassroots GPs by always championing patients and calling for Physician Assistants, Mental Health workers, Pharmacists etc. By shoring up demand and bringing in anyone except GPs we are sure that the survival of the profession will be achieved.

    So stop being so cynical.

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  • An opinion is only a opinion. But the true test for Dr Baker is what RCGP members thinks. I have not seen this!!!

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  • Vinci Ho

    Even though I have never been a MRCGP,I can understand the predicament you are under , Maureen , as the chair of the college in this most extraordinary time of our history . Our profession needs a political solution to stop its demise(some would say the death sentence was already here). So if this package ,investment(but not new money as you said) is the solution , we should inject some optimism into it.
    But given the track record and intention(s) of the last and current governments,caution must be the only word in your head when you first saw the details of this package . Trust on these politicians by the frontline colleagues had diminished to the minimum and somehow needs to be restored legitimately first and I am not sure the way this announcement was made , had qualified this prerequisite . As I said , the Treasury's acknowledgment to the public is essential .
    Then it also begs the question of what is your contingency plan if these promises do not materialise. I think we have a right to know.
    To say this battle is over if this package delivers , would still be intelligence-insulting. Yes , the longer we confront our common enemy may have more 'collateral damages' which in our case , directing to patients . One can argue the public support on our junior colleagues' industrial actions will start evaporating soon. However ,the danger of becoming unclear what we are fighting for would soon translate into a split within ourselves ,i.e. , civil war. (For those sci-fi fans , please watch Batman versus Superman: Dawn of Justice and the just released Captain America: Civil War. These arguments are standing out strong). The fortress is more easily conquered from inside than by outside force.
    In fact , civil wars as well as conspiracy theories are the current , fashionable aspects of politics.
    The weakness of this government is well exacerbated by the split and mutiny as result of the looming EU referendum. The opposition party is also well fragile and only needed one deluded ex-London mayor bringing clandestine anti-Semitism to the surface(defending a junior MP blindly )to throw the whole party into chaos and turmoil.
    I was listening to the conversation between Murnaghan and Hestletine this morning on Sky News. Even the latter had to honestly admit that Tories only just managed to win the last general election simply because Cameron was more popular than the Conservative party at the time.
    Every move made by this government inevitably is met by scepticism and caution. There is no exception to this package.....

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  • Judging by the comments on Pulse I suspect the poll refelcts teh views of online readers. Not sure it is representative at all of the wider profession. Certainly not even part of the conversation in our area about the best way to move forward given all the pressures etc

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  • Not sure the private providers will be interested - not a lot of evidence they can make any money on it.

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  • It is not a simple as partnerships would be responsible for premises bills, redundancy for staff etc etc and HM government know this and will more than likely call our bluff

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  • Delusional disorders are actually manageable long term...though not fully treatable!

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  • I worked 15 years as independent private Dr.
    And very successful. Because affordable fees, and what I thought a good service: no waiting list, much more time to examine patients and discuss their treatment...so very often no need for specialist referral. Or if so, letter to the NHS family Dr, with the patient's consent. In case of emergency of course I would send them to A&E...
    There was such a demand, that I wondered why not more such independent Drs! Money was not a problem, even for poor people, because they had the TRUST... But of course I had to deliver good medicine, with good results! I had the challenge to be always up to date, and honest. If not, patients would desert my premises!
    No publicity, only word of mouth!!!
    SO COURAGE GP's, GO INDEPENDENT PRIVATE!

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  • So guys lets walk the talk.

    Lets all resign en-mass. United we stand.

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  • We would not charge per consultation home visit whatever
    One payment per year to cover everything
    Children free ( good karma )
    We decide our " list size"
    It's win win win
    Come on everybody you have nothing to lose but your chains ( apologies to Trotsky

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  • 3.49, do not despair.

    I've resigned as a partner and from November I start as a salaried doctor with a very carefully negotiated contract that will get me out of the door on time and with a normal BP. Senior partner did the same last year - both of us feel like a weight has been lifted.

    There are always options, and i'll still be paying the bills in November.

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