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Gold, incentives and meh

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

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Nagpual 3x2

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

resignation box 580x360px - Cover story December 2016

Burning issues

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?

Wolverhampton LMC

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.

Essex LMCs

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.

Shropshire LMC

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.

Derbyshire LMC

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).

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Readers' comments (62)

  • Vinci Ho

    Cannot recall any Christmas more 'peaceful' than this.
    Historic time......

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  • No, it's LONG PAST time. I fear we may be to late to save her, Ca'pn.

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    The time to be militant has long since passed.

    this is nothing more than window dressing and faking action.................

    the younger lot wont be fooled any longer!!!!
    when you should have fought you older bunch didnt, happy with your fat cat pensions and your secure partnerships, you sold us down the river!!!

    well i've got news for you, i moved abroad and many more like me have followed and we have a life in the sun, can make 150k for fun and still have free time, sunshine, big houses fast cars!!! why the hell would we come back?? what would we come back for and what would we come back too???? answer....NOTHING

    the poor souls who remain can locum and earn what they are due and not the pathetic paltry sums partnerships now command....and even if they do make decent money look at what they make the monkeys dance to for their reward!!!!

    GP land in the uk is an embarrassment......

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  • If standing up for your rights is being 'militant' then one may use the term. Care needs to be taken when playing with words considering that those opposing war in Syria were deemed by the PM to 'be supporters of ISIS' - one might as well end up being dubbed a terrorist after wanting a militant approach.

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  • Took Early Retirement

    GPC is incapable of "getting militant". I guess, in a way, the GPC is the reason for my early departure, so, in a perverse way, I should be grateful to it.

    Merry Christmas, from Retirement Land.

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  • The first thing to realise is that our job is now far too busy. The next thing is to stop this continual GP bashing that we are subject to by the GMC, The government and the media.

    The main reason that we are so busy is the increased demand from our patients for access, whether this is a home visit or a face-to-face consultation. At this point I would like to look at an analogy: cars are now far better quality and cheaper in real terms. This has happened because of the development of computers and robotic technology. Modern health care has advanced enormously since the start of the NHS in 1948. Quite clearly it has become impossible for doctors to deliver the number of consultations that are now expected of us. I would suggest that many of our consultations could be performed by computer protocols. Patients will not like this, much in the same way that people do not like having to use IT to book hotels and flights. They prefer the old days of a personal service through a travel agent. Nevertheless people have now become used to this form of service delivery. Of course health care is not directly analogous and many symptoms patients present with are difficult to put into a particular diagnostic category. As doctors we are used to dealing with this. There will always be a degree of uncertainty, but it is clear that central government funding for healthcare will not be limitless. Consequently much of the care that we deliver will have to be computerised if no more funds are available. Many GP practices now deliver telephone consultations and this has allowed greater volumes of consultations to take place. In addition many GP practices now do not do home visits unless really required. If patients still want to have this level of access that we currently endeavour to deliver, with great difficulty and stress on our behalf, then quite clearly this is something that they will have to pay for. This is much the same as with airlines. If people want a personal service rather than booking themselves on the Internet, they have to pay so much per minute to speak to somebody.

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  • What I am suggesting is utilising software such as instant medical history, which was developed in the states. This takes a full computer generated medical history from patient and gives a differential diagnosis. This can be tweaked with necessary investigations or can go straight to issuing a prescription.

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  • Anonymous | Other healthcare professional23 Dec 2015 5:53pm

    Your post sums things up. Older GPs didn't go into GP to earn £150K and 'drive fast cars'. GPs are relatively well paid still in relation to historic remuneration - pay isn't the issue. The issues are more related to feeling undervalued, not respected, and being dumped on with work from everywhere compounded by micromanagement.

    I think your comment reflects a cultural issue that is as much of a threat to the profession as anything the government is doing.

    And before anyone says it, I am not a cardie wearer, I want to earn a decent living and do a job that is professionally satisfying. GP has never been the branch of medicine to go into to get rich. Maybe you should have trained as a surgeon.

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  • @ 5:53 I agree that you wrot that and would add that only an ejjjet would hav written it

    The point raised here is that the profession has been divided because of self interest mainly from a more senior cardigan wearing bunch;

    i qualified in 2008 and wanted a partnership and looked from over 2years. Many of my colleagues were offered "salaried with a view to a partnership posts" which were $50-%60k when the partners were on 2-3 times this.

    exploitation is the moral of the story and the tide has now turned!!!!

    take the issue of pay away and what we were offered back then would now require 1.5 days work for where we are now

    remind me again why should i come back!!?????????

    perhaps so i can train as a surgeon i guess


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  • to put things in perspective re salaried vs partnerships - we have always encouraged GPs to become partners in our practice but for the last decade we have had difficulty recruiting as a large number of GPs leaving training were not interested in investing in partnerships and taking on the risk and responsibility that comes with this. Consequently we have ended up with salaried GPs who have been very good but they don't do what we do. They don't spend significant amount of time making sure the practice runs effectively, they don't deal with HR issues, they don't go to employment tribunals, they don't have to do extra sessions to cover long term sickness or gaps in workforce when a GP leaves, they don't attend business meetings in their own time and they don't have £50k of their own money invested in the practice. Therefore they are paid less than what we take.

    I agree that there have been practices that cut costs by using a lot of salaried GPs and not paying them a decent rate and this has created a divided profession. However as always there are 2 sides to the story.

    my argument is that as GPs we don't do ourselves any favours as a profession when we feed the Daily Wail with stories about 'greedy GPs' - earning £150k and driving fast cars living it up in the sun. Good on you if thats what is right for you and your family. My argument is that if this life is the expectation of young GPs then no wonder you are all leaving and no wonder we are in the mess we are in.

    Lets move the debate away from money and focus on the issues that effect our daily working life .

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