Is it time for the GPC to get militant?
Grassroots GPs have had enough and are demanding change, but how will the profession’s leaders respond, asks Jaimie Kaffash
GP leaders will attend a crisis meeting at the end of January, and many are intending to use it to demand a change in tack from the GPC.
After a year that saw the financial pressures on GP practices intensify, with some being forced to close their doors, grassroots GPs have had enough. After pressure from LMC leaders, the GPC has granted them a ‘special conference’ on 30 January. This meeting will look at how to ensure a ‘safe and sustainable’ GP service and will determine future GPC policy.
The last LMCs special conference, held in 2003, helped bring in the 2004 GP contract, but this one is likely to be a more fractious affair. Pulse has learned LMCs are considering a number of controversial motions, with those related to industrial action expected to ruffle feathers.
The conference comes as some members of the GPC are proposing that the executive team walk out of negotiations over the new GP contract. GPC insiders have told Pulse that the Government has ‘brought very little to the table that is going to make a big difference’ and is instead looking at implementing a new DES from April that would pay practices for providing seven-day access as part of networks – something the GPC has insisted it will not let happen.
Unless GPs are prepared to take action, the Government will do nothing
Negotiations are ongoing and the GPC executive team has refused to comment on rumours about what has been discussed. But the success of the junior doctors in using the threat of strike action to force the health secretary to return to the negotiating table has stiffened the resolve of some.
Former GPC negotiator Dr Peter Holden says he has put forward motions to Derbyshire LMC that will call on GPs to consider the ‘nuclear option’ of industrial action or signing undated resignation letters. His motion comes after a Pulse survey of 900 GPs showed nearly half would support mass resignation in protest at the state of general practice.
Dr Holden says: ‘This is the nuclear option. We have to give the Government a time-limited opportunity. When it refuses to engage in sensible discussions and refuses to implement the emergency measures that are needed, then we can consider industrial action’.
Dr Holden adds that the profession must follow the GPC and LMCs if they decide on this course of action – ‘unlike in 2013’, when only one in four practices took part in industrial action over pensions.
Other LMCs are supporting the call. Shropshire LMC, alongside several others, has proposed a motion to demand the GPC ‘canvass the willingness of GPs to submit undated resignations’ if the Government does not urgently implement measures to relieve the ‘intolerable pressures’ on practices. The LMC also said the use of ‘sanctions’ should now be considered and that the GPC should ‘explore the realistic options for industrial action’.
Dr Ian Rummens, medical secretary of Shropshire LMC – which proposed the emergency conference – says: ‘Inability to recruit means practices are failing across the country, which risks de-stabilising neighbouring practices and the prospect of meltdown in the very near future. We believe that, unless GPs are prepared to take action, the Government will do nothing until it is too late.’
resignation box 580x360px - Cover story December 2016
All these motions will have to be accepted by the conference committee for debate later this month. Chair of the conference Dr Guy Watkins, chief executive of Cambridgeshire LMC, says: ‘The conference is being called now because of a belief by LMCs and the GPC that current Government and NHS England policy and negotiations over contract changes for 2016 fail to address these issues, and the risk to a safe and sustainable service for our patients is intolerable.’
Dr Tom Black, chair of the Northern Ireland GPC, says the conference will be far from ‘routine’. He says: ‘There’s a real need for a special conference and needless to say I read Pulse’s survey results with interest. I wouldn’t be surprised if the motions were about big themes – there’s no point in having a special conference about routine matters.’
Dr Jane Lothian, medical secretary of Northumberland LMCs, said she was intending to be ‘vocal’ at the conference: ’Our talented GPs are leaving around the age of 40 and those in their 50s are rushing for the exit.’
Dr Helena McKeown, vice-chair of Bath and North East Somerset, Swindon & Wiltshire LMC said they were intending to focus on ’workload and the safe nature of what we do’. ‘I have suggested we can’t any longer afford the inefficiency of home visits,’ she added.
Former GPC chair Dr Laurence Buckman is dismissive of suggestions of industrial action, but he says the conference will make a difference simply by taking place: ‘A big meeting in public is the way of raising this in front of the press and patients to get them to understand more. There has been publicity from the BMA and the RCGP, but this meeting is going to ramp it up.’
The GPC is responding to calls for something to be done in two ways: first, by pushing the Government to stop the annual contract negotiation process; and second, by focusing on reducing the non-contractual work GPs do.
GPC deputy chair Dr Richard Vautrey told Pulse the GPC wants to use the conference to look at how to limit services GPs provide: ‘We want LMCs to come forward with really clear solutions we can take to Government and say: “You have to do this otherwise practices will have to start limiting what they do to deliver a safe and sustainable service”.’
There are signs LMCs are taking notice, with Essex LMC submitting a motion demanding practices are supported ‘to work only within their safe work limits’.
‘It is time for the Government and NHS England to listen,’ Dr Vautrey adds.
NHS England has shown some movement, allocating an additional £300m a year to general practice from April, although what this is to be spent on is not yet clear, and the GPC has already called it ‘inadequate’.
Also, from 2017, GP practices will be tempted away from the national GP contract with more funding under a new voluntary deal that will be available to large practices or groups that will provide seven-day access and more specialist care in the community. This puts additional pressure on the GPC to secure a good deal this year, otherwise all this revolutionary talk could be for nothing.
What motions have been put forward?
That conference believes it is now time to rein in all the locally negotiated bolt-on services for central negotiation to strengthen the GMS contract and general practice.
That conference believes there will be no solution to the crisis facing general practice until practices are given the necessary tools and support to work only within their safe workload limits and NHS England commits to reducing local micro-management and unnecessary bureaucracy.
That conference demands: the Government urgently implements measures to relieve the intolerable pressures on general practice; requests the GPC to canvass the willingness of GPs to submit their undated resignations if a speedy and appropriate response is not forthcoming; believes the use of sanctions should now be considered; and requests that the GPC explores realistic options for industrial action.
A motion giving the Government a ‘time-limited opportunity’ to engage in sensible discussions and implement emergency measures, or face the threat of industrial action and a mass submission of undated resignation letters from GPs (under consideration as Pulse went to press).