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LMCs conference 2012: LIVE BLOG

16.40 As the conference draws to a close, so our coverage from Liverpool comes to an end. There's been a lot of consensus on many issues, perhaps too much for those that like a good ding-dong, but also a few heated debates, and a large amount of anger at the Government and GMC. There's certainly enough to keep the GPC busy for the next 12 months. Liverpool, you've been kind. Until next time.

GMC accused of 'shocking complacency' over revalidation

Dr Fay Wilson: 'It's time to stand up and be counted'

GP leaders demand right to charge for non-NHS services

'Please listen before we run out of GPs':

Laurence Buckman opens LMCs conference

More from the LMCs Conference 2012

Welcome to Pulse's LMCs Conference live blog for 2012. Stay tuned today and tomorrow for all the latest news from the conference floor.


16.40 As the conference draws to a close, so our coverage from Liverpool comes to an end. There's been a lot of consensus on many issues, perhaps too much for those that like a good ding-dong, but also a few heated debates, and a large amount of anger at the Government and GMC. There's certainly enough to keep the GPC busy for the next 12 months. Liverpool, you've been kind. Until next time.

16.00 GPs reject call from Northumberland LMC's Dr Jane Lothian to attempt to define core GP services to try and stem flow of unresourced work from secondary care. GPC negotiator Dr Chaand Nagpaul says it would be 'an impossible task' - and says GPs should instead focus on defining blatant non-core work being dumped on primary care.

15.30 QOF QP indicators are interfering with GPs capacity to deliver 'traditional primary care tailored to individual needs', say LMCs. Narrowly voted through Yes- 53% No - 40%.

15.20 QOF is next up on the agenda. Dr Paula Cowan from the Wirral is not a fan of the Quality and Productivity's less about QOF, quality and outcomes, and more about 'quashing our freedom'. Nicely done.

14.55 Onto IT. The LMCs Conference expresses its concern at the imminent demise of the GP systems of choice agreement and the 'apparent lack of a credible replacement'. LMCs vote unanimously to call on GPC to ensure there is 'a credible network support organisation for IT in the NHS that will ensure compatible development across NHS organisations.' They also want GPC to ensure there is freedom for practices to choose or change a national clinical system.

14.50 Potentially divisive motion which says salaried GP model contract is 'financially onerous for practices', and 'many partners feel its terms are too favourable to employed GPs' is lost. GPs sticking together on that one.

14:17 Motion 117 is passed, that conference 'deplores the current trend for GP contractors employing large numbers of salaried doctors who have limited opportunity for career development'.
14:04 Revalidation must not go ahead without adequate arrangements for remediation that fully cover all types of GPs, LMCs have voted.
13:45 Dr Stephen Bassett, a lawyer and GPC member opposes the motion, saying 'This isn't a legal fight, it's a political fight. It's a fight for the LMCs. I would urge colleagues to use LMC's to be the vehicles that change minds.' GPC representative Beth Mc Carron-Nash sums up by agreeing there is no legal basis for advanced appraisal. She said 'Advanced appraisal does not exist. We must have consistency for appraisal and standards for appraisers.' The motion is passed.

13:40 A motion delaring that enhanced appraisals introduced early by PCTs 'have no legal basis' is being debated. Dr Rachel Tinker, member of Derby and Derbyshire LMC, says that although some PCTs are taking it on themselves to demand extra information, such as audits, from GPs, there is no contractual basis for GPs to produce the extra evidence asked for by PCO's.

11.50 Delegates follow the lead of the Scottish LMCs conference and unanimously back a call for Atos-run work capability assessments to 'end with immediate effect', and be replaced with 'a rigorous and safe system that does not cause avoidable harm to some of the weakest and most vulnerable in society'.

11.45 Motion 101 from Dr Greg Place is lost after advice from GPC chair Dr Laurence Buckman, who said moving from current funding arrangements that pay GPs according to workload to instead focus more on health inequalities would be 'impossible to deliver' in the current financial climate.

11.35 On to contract negotiations. Dr Greg Place from Nottingham wants LMCs to vote in favour of the GPC redoubling its efforts to negotiate a new national contract with 'fair, but realistic' transitional funding relief arrangements. 

Dr Place says: 'It's not [just] important now but for the future of general practice.'


11.15 A big call - and one very much in tune with Pulse's Say No to 30% campaign. GPs have narrowly backed a motion recommending the disengagement of GPs from clinical commissioning be included in any industrial action.


10:21 Motion hoping Liverpool will become a regular fixture carried, but only as a reference. Ergo, it's not clear where next year's conference is going to be. Dr Mike Ingram is among many GPs impressed: 'Liverpool has been fantastic. We should be looking what's best for conference. There are alternatives to London which we should pursue for the future.'

10:11 Dr James Kelly from Kent LMC is trash-talking Kenny Dalglish and Liverpool in general. He does not want the conference to return to here next year...but he is followed by the scousers....cue the wigs. It's ON.




09:35 Debate on the CQC kicks off. Dr Brian McGregor, member of North Yorkshire LMC, proposes that registration should not incur any expense on practices, standards should be appropriate to primary rather than secondary care, and evidence-based criteria should be used when establishing which practices receive a visit. Dr Steve Alvis, member of Gloucestershire LMC and the GPC's Dr John Canning both speak in favour of the motion and it is passed unanimously. Full story here.


09:00 Votes coming up on the CQC, GP training and pensions today. Keep tuning in to find out the latest








17:15 Time for some extra motions. Motion 439 now, which is about the use of NHS Shared Business Services to provide CCG finance and accounting functions. Dr Bob Morley from Birmingham LMC wants GPs to back a motion condemning the decision to force CCGs to accept commissioning support from the join DH-Private venture. Dr Morley, always good value for a sound-bite, doesn't hold back in his contempt for the NHS Commissioning Board's decision. 'This decision shows [the assertion that CCGs have the freedom to decide] to be a total sham. I'm no expert in the finer points of European procurement law, but I do recognise bullshit when I hear it.' His choice words obviously worked, as the motion is carried unanimously.




17.00 A divisive one this. Dr Nimish Shah from Morgannwg LMC proposes motion 84, which calls on GPC to negotiate a change to the GMS contract to allow patients to receive treatment not funded by the NHS from their own GPs on a private basis.Dr Greg Place from Nottinghamshire LMC, disagrees, saying 'some lines shouldn't be crossed'...including this one.But after an electronic vote the motion is narrowly passed.

16:58 On to care pathways. Not the most evocative of NHS terms, but an important one no doubt. Dr Ellen Nolan of Shropshire LMC says pathways are being used as a smokescreen for rationing and are being imposed upon GPs, taking away their professionalism. She asks reps to back motion 83, which claims 'the increasing proportion of decision algorithms, protocols and tick box referrals undermines the established role of the British GP as their patients' advocate, and threatens the intelligent and compassionate delivery of care tailored to individual needs. Motion is carried.


16:25 How do we solve the GP recruitment crisis? The debate on primary care workforce opens with a lively speech from young Hertfordshire GP Dr Sarah Khan. Dr Khan illustrates the difficulties in attracting young doctors to general practice by saying she was considered a 'total freak' at medical school for pursuing a GP career from the outset.

16:20. Now onto a debate on primary care workforce. Dr Sarah Khan from Hertfordshire proposing motion which wants to actively promote general practice, but ensuring current standards are not lowered to address recruitment and retention problems.

16.17 Dr Tom black delivers his first conference speech as chair of Northern Ireland GPC. Premises are a huge issue in the province, he says - and while funding is available he warns of the need to avoid 'white elephants'.


Created with flickr slideshow.

15:51 Commissioning over, it's time for the reports from the Celtic nations - reports which normally celebrate how much better they have it than their poor English counterparts. First up, GPC Scotland chair Dr Dean Marshall...

15:40 GPC negotiator Dr Chaand Nagpaul takes to the podium on behalf of Edgware and Hendon Division, for another anti-privatisation broadside. Motion 72 insists that CCGs should 'support local NHS services as preferred provider' and should only consider alternative providers 'after establishing that local NHS services are unwilling or unable to improve services to requisite standards'.

15:31 We're still on commissioning. Dr Stephen Hardwick, from Lancashire Coastal, is proposing motion 71, which calls for commissioning support services to 1) be NHS led 2) not be sold to the private sector 3) be managed directly by CCGs working in cooperation with other CCGs 4) be retained in-house by CCGs where possible and 5) always be chosen by CCGs and not influenced from above. In essence, it's another anti-privatisation motion. 'If we're forced to have privatisation, then competition is an absolute necessity,' he concludes.

15:02 Proceedings are dramatically interrupted after one delegate towards the back of the auditorum collapses.Conference is temporarily suspended, amid calls for an ambulance and GPC negotiator Dr Peter Holden (who as BMA lead on emergency preparedness and a qualified air ambulance crew member is certainly well qualified to respond). Fortunately, though, after a couple of minutes the chair announces that the GP in question has 'come around' - and debate on commissioning resumes.


14:55 Motion 66, warning of 'increased potential for conflicts of interest' and calling for more GPC guidance, is passed in all four parts. 'Conflict of interest is going to start being important - not least the first couple of cases that are presented to the media,' says Dr Nigel Watson, chair of the GPC commissioning and service development subcommittee.


14:51 Off-topic, but it's worth recording that a few minutes ago an important notice flashed up on the big blue screen dominating proceedings. 'Please can the two GPs who have not paid for their curry last night make themselves known to Dr Kumar,' it read. You have been warned. Both of you...

14:50 Dr Neil Modha from Cambridge LMC proposes the next motion, which wrestles with the tricky topic of commissioning conflict of interest.

14:37 We're into a massive section of motions on commissioning, due to last for 80 minutes in total. GPC negotiator Dr Chaand Nagpaul says that GPs involved in commissioning feel they are commissioning in a 'straitjacket'.



14:17 Motion which affirms that: 'attempts to drive down costs in secondary care, by unresourced transfer of work to primary care, puts at risk the physical and mental health of already overstretched primary care teams' is carried unanimously, after advice by Dr Nigel Watson. Elementary.



14:01 Now on to debate on 'primary and secondary care interface'. Leeds GP Dr Annette Bearpark gives examples of work being inappropriately dumped on GPs by hospitals without resource. Dr Bearpark calls the current situation 'unmanageable and simply unsafe'.

13:00 And as conference breaks for lunch, delegates have time to digest the morning's votes on the BMA's handing of the NHS reforms and the publication ofthe risk register, and Dr Laurence Buckman's warning GPs could walk away over NHS cuts.

12:50 Votes on the revalidation section will be held tomorrow, and so we're on to practice boundaries. Dr Jacqueline Applebee from City and East London LMC proposes a motion calling for the practice boundary pilot in her area and elsewhere to be abolished 'as it has been proposed without any clear criteria for assessment and threatens the provision of equitable health care, benefitting the fit and mobile to the detriment of the sick'. Dr Mark Bermingham, from Derby and Derbyshire LMC, agrees, saying that as a rural GP the pilots fill him 'with a great deal of fear'. But Dr Gill Beck from Buckinghamshire warns: 'This is a pilot and this pilot is actually part of our 2012 contract settlement.' 'It's voluntary - just say no,' she adds. 'If you do not volunteer to participate, it will wither on the vine.'

GPC deputy chair Dr Richard Vautrey reveals the GPC and Londonwide LMCs met on Thursday with officials to discuss evaluation of the pilots. But despite him asking delegates to reject the motion, or carry it as a reference, they go ahead and pass it anyway.

12:46 Loud applause for a challenge to the GMC on why it pays for private health insurance for its staff - as first revealed by Pulse in January.Professor Lewis admits it is 'contentious', but argues that 'the other side of the coin is that the GMC is a major organisation, and there are issues around retention of staff.' 'The total cost of this package is 0.7% of the total staffing budget', he points out, but adds that 'it is one of several issues the new [GMC] council will want to consider.'




12:42 Despite some delegates starting to filter off to lunch, GPs are still lining up to fire questions and comments at Professor Lewis. Dr Bill Beeby, GPC member and a GP from Middlesbrough, has a robust response to a common analogy: 'I wish we'd stop comparing ourselves to airline pilots,' he says, 'Flying an aeroplane is desperately easy compared to practising medicine.' Read the full story here.

12:23 It's been an extended, well-mannered, debate, after a lengthy presentation from Professor Malcolm Lewis, but some of the motions to be voted on shortly point to real grassroots anger aimed at the GMC. Dr Simon Bradley from Avon LMC tackles the GMC's condemnation of doctors self-prescribing for minor illnesses as 'unprofessional behaviour'.

He says: 'As GPs we are meant to respect patients, we are meant to recognise the rights of patients as expert patients to manage their own illnesses,' he says. 'The GMC's blanket and insensnitive approach breaches our rights as expert patients.'

11:54 Professor Malcolm Lewis, GMC council member, has finally arrived in Liverpool so the revalidation debate can commence, and he begins with an apology for his late arrival after a rather protracted journey.The delay is a not-unhelpful metaphor, he says though. 'I'm here - and revalidation will soon be too.'

11:44 Dr Andrew Mimnagh calls for a unanimous vote for the motion, as a 'weathervane for our feeling'. But delegates propose a  'move to next business' - LMC conference jargon for 'dodging the issue'  - and after an electronic vote, the move to next business is passed. Cue sighs of relief in Richmond House and Downing Street.

11:40 Politics is like wetting yourself in dark trousers, says Dr Alun Griffiths from Bradford and Airedale LMC, speaking against the motion. How so? 'You get a nice warm feeling and no one notices...'

11:36 There will be speakers against this motion, no doubt - and quite possibly the GPC. But Dr Adam Skinner from Kent LMC's not one of them, even though he pretends to be: 'Lansley can't be allowed to resign,' he tells conference. 'Resignation's too good for him. Something lingering in boiling oil I fancy.'

11:33 Another huge motion this, calling for the resignation of Prime Minister David Cameron and health secretary Andrew Lansley, and the honour of proposing it goes to Sefton LMC chair Dr Andrew Mimnagh.


11:31 Conference passes motion 53, proposed by those anti-health bill militants at Kent LMC, which 'deplores the Government's attempts to cover up the true consequences of the Health and Social Care Act by refusing to publish the 'risk analysis'


11:25 The keynote speaker for the revalidation debate which was meant to form the centrepiece of this morning's proceedings is still delayed on the train, which means we're currently about an hour ahead of schedule and will have to come back to it later. 'Another warning about the privatisation of state-run services,' deadpans conference vice-chair and Hertfordshire GP Dr Mike Ingram.

11:19 Dr Chaand Nagpaul, GPC negotiator, asks for part five to be 'taken as a reference', which is LMCs conference jargon for a motion which can be supported but then safely ignored. Parts one to four are passed. Part five is not taken as a reference, and is close, so goes to the first electronic vote of the day. It's lost though.

11:13 After a rather tense debate, we're on to slightly less controversial matters - a five-part motion warning about the likely effects of the Health Act. But while parts one to four, which warn in various ways about the possible impact on GPs and patients, seem straightforward, part five might be a wild card - it calls on 'every English GP practice to consider withdrawing from involvement in CCGs'.

11:01 Dr Buckman speaks on the motion and accepts as GPC chair and a BMA Council member he is one of the targets of the criticism. 'I'm quite willing to take it on the chin,' he says. But he delivers a detailed rebuttal, citing the BMA's extensive work on the bill, and urges delegates to reject the motion.
BMA chair Dr Hamish Meldrum also speaks, also urging delegates to vote against the motion to avoid 'infighting and squabbling'. The motion is lost. Read our full story on the vote here.


10:59 Anger against the BMA hierarchy is palpable - but GPs are lining up to defend the BMA too. Dr Fay Wilson, former LMCs Conference chair and a GP in Birmingham, insists BMA leaders have been 'wide awake from the start about the malignant aspects of the bill'. 'We led the opposition to the bill,' she insists.

10:56 GPC member Dr David Wrigley also speaks in favour of the motion, claiming that BMA leaders believed the bill 'didn't matter'.'A message must be sent to the leadership,' he says, quoting Dr Hamish Meldrum's original description of the bill as a 'curate's egg'.

'This bill wasn't a curate's egg - it was a very badly smelling egg,' he says.

10:54 The revalidation debate has been delayed, so we're straight into some of the more controversial motions - and little is more controversial that one from Kent LMC which 'reprimands the BMA leadership for taking so long to wake up to the malignant effects of the Health and Social Care Act'. Dr Paul Hobday from Kent LMC delivers an impassioned speech in favour of the motion, and calls for conference to deliver the BMA hierarchy 'a slap on the wrist'.




10:10 Finally, Dr Buckman pays tribute to BMA Chair Dr Hamish Meldrum, who stands down this summer. Sustained applause. Click here for the full text of his speech.


10:08 Dr Buckman ends on pensions, to growls of support, and urges GPs to vote in the BMA industrial action ballot. GPs could be 'forced to walk away' from NHS in 'meltdown', Buckman warns

10:06 Dr Buckman calls for 'sophisticated solutions' to workforce problems, and pleads: 'Please someone listen before we run out of GPs'. That part of the speech may have been written before our story yesterday that Andrew Lansley has announced a 20% rise in GP trainees...


10:04 Dr Buckman is working his way through a laundry list of GPC concerns - and its a long list. Practice boundaries, 111, CQC and now revalidation. Multisource feedback is a 'silly idea that will waste our time and money', he says, to cries of 'Hear, hear'


09:57 Dr Buckman gives a nod to those who criticised the BMA for not doing enough to oppose the health bill. 'I understand that there are those who are disappointed that we did not stop the bill but we cannot do that in a democracy'.

09:55 Big laugh breaks the ice as Dr Buckman describes how GPs are 'fed up hearing about other people's visions for our service'. 'People who have visions need injections,' he says

09:54 'Sadly...' says Dr Buckman, after that uncharacteristically upbeat start. Here comes the 'but'...
09:53 Dr Buckman talks of a 'few rays of light in these dark days', citing four-year GP training and the GPC's 100th anniversary

09:49 Dr Laurence Buckman has just stepped up to deliver his address wearing a lovely gold medalion

09:29 Good morning. The LMCs Conference is about to start and we are poised to bring you the latest updates. Click here to look at the full agenda for today. If you want us to feed back on the results of any motions, then let us know at or tweet us @pulsetoday

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