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BMA backs 'illegal' GP commission​ing boycott if patient care put at risk

The BMA will consider balloting GPs on a potential boycott of engaging with CCGs if clinical commissioners are prevented from making decisions that are in the ‘best interest for patients’.

The potential boycott, voted for at the BMA’s Annual Representatives Meeting in Edinburgh on Monday, aims to empower clinical commissioners to stand up to political interference that could end up harming patients

GP leaders said a boycott would have ‘huge ramifications’ for the future of clinical commissioning. There have been many attempts at igniting a boycott of the commissioning process - most notably over the dispute around reforms to pensions that eventually led to doctors taking industrial action - but this represents the first time that such a proposal has received widespread backing from the BMA, despite interventions from the chair of council, who said such a boycott may be ‘illegal’.

The conference also voted for a motion to begin a campaign to repeal Section 75 of the Health and Social Care Act, which compels CCGs to put services out to tender unless they can prove there is one possible provider.

Delegates at the ARM voted in favour of the motion stating that ‘if CCGs are prevented from making decisions in the best interests of patients, the BMA should consider balloting GPs on withdrawal from engagement with CCGs’, despite BMA chair Dr Mark Porter arguing that GPs disengaging with CCGs may be ‘illegal’.

Dr George Rae, chief executive officer at Newcastle LMC, who proposed the motion, told Pulse: ‘There are growing concerns that the new structures in the Act are not delivering right across the country genuine clinician-led commissioning. The BMA has to monitor any interference with and challenges to CCGs making a decision.

‘This is a “consider” scenario. But if we did consider it, and did decide to go ahead, it will have huge ramifications with legal aspects, contractual aspects and financial aspects.’

The GPC has previously fought against suggestions to use GP disengagement from CCGs as a political tool after some BMA members called for this action in a bid to block the Health and Social Care Act coming into force. It also showed reluctance to industrial action when it voted against taking industrial action over the GP contract imposition.

However, GPC negotiator Dr Chaand Nagpaul said that, in this case, GPs must expose instances where the patients’ best interests are not the priority. He said: ‘Our belief is that GPs on CCGs must at all times be aware of their professional duty and make decisions in their patients’ interests and where there is political pressure, or any pressure otherwise, that is constraining GPs from making decisions and policies in the interests of patients our view is that CCGs should challenge it, and should expose it. We actually would hope that it doesn’t even go as far as a ballot but in fact CCG leaders should challenge, or not parttake or comply with any policies or decisions which they believe are working against patients’ interests.’

The BMA also voted in favour of repealing the Health and Social Care Act and launching a specific campaign against Section 75 because it will ‘fragment patient care’ and further open up the NHS to private interests.

Dr Porter said he did not want to see a return to PCTs and SHAs, but that a vote to repeal the Health Act was about reacting against the ‘noxious’ direction the government is taking the NHS in.

The House of Lords rubberstamped the controversial Section 75 regulations earlier this year despite criticisms from the BMA, NHS Clinical Commissioners and CCG leaders, who fear they will hamper CCGs’ freedoms.

Dr Nagpaul, who proposed the motion regarding section 75, said: ‘Section 75 breaks a commitment made to GPs they would not be forced to us competitive tendering. It represents a broken promise to GPs that they will be able to commission in the way they want, with their populations in mind. It forces CCGs to competitively tender for servives unless they can prove there is only one provider who can do it, which is unrealistic as they would be scared of a legal challenge if they decided only one provider was fit for purpose.

‘This is enforced competition, CCGs will be looking over their shoulders to ensure they are following process. A process which is expensive and bureaucratic and diverts time and effort away from commissioning. The 111 debacle was partly because of forced competition.’

On the chances of it happening, Dr Nagpaul added: ‘We’re currently in Scotland, where there is no Section 75, so it’s perfectly possible to repeal this Act. The BMA Council will now look at how to run the campaign to keep visible opposition to the Section 75 regulations. There’s a general election coming up and the party in opposition has said ostensibly it would repeal Section 75 so we must keep this opposition up.’

Motions in full

103. Motion by the Agenda Committee
Motion to be proposed by the North East Regional Council: That this Meeting, in respect of Commissioning by Clinical Commissioning Groups (CCGs) believes that:

  1. CCGs should be locally accountable not centrally directed;
  2. CCGs should have freedom to commission services in ways that best meet the needs of their populations;
  3. CCGs should have autonomy on the procurement of services for their patients;
  4. CCGs should be entitled to review the commissioning decisions of their predecessor PCTs;
  5. the BMA should monitor interference with and challenges to CCG decision-making;
  6. if CCGs are prevented from making decisions in the best interests of patients, the BMA should consider balloting GPs on withdrawal from engagement with CCGs.

128. Motion by the Agenda Committee

Motion to be proposed by the Edgware and Hendon Division: That this Meeting believes that Section 75 of the Health and Social Care Act 2012 and its regulations remain incompatible with assurances given during the passage of the Act and subsequently; and:

  1. will obligate competitive tendering for NHS services;
  2. will fragment patient care;
  3. will increase privatisation of NHS care;
  4. calls for a campaign to repeal Section 75 of the Act and its regulations.

129. Motion by the Agenda Committee
Motion to be proposed by the Lambeth and Southwark Division: That this Meeting asserts that the Health and Social Care Act 2012 is bad for patients, bad for the NHS, and bad for the public. This Meeting demands the repeal of the Health and Social Care Act 2012 and calls for a co-ordinated campaign to achieve that aim.

 

Readers' comments (4)

  • Unfortunately it would break the contract terms that all GP practices were forced to sign up to in the new contract, that they would cooperate with CCGs. On the other hand, I think GPs and GP practices could legitimately argue that they were forced to sign up to terms they didn't agree with, which would make it not illegal at all to start boycotting the commissioning process. Since a boycott probably won't affect patient care, this may be a sensible route to take.

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  • Since majority of our engagement with the CCG takes place outside of our contracted hours (in my locality, meeting is held in the evening) and we are not renumerated for work that's done in hours, we could decline to have further input until this is addressed.

    ONly problem is, we will always have politically motivated GPs who will not take part in boycotting for their own gain.

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  • Vinci Ho

    When you look at history , the difference between hero and zero is only a fine line . Do the 'right ' thing at the 'right' place at the 'right' time is all about a bit of luck .You might have only one chance . Question is 'have you got the guts to take the shot??'
    Right or wrong, only history will give the verdict eventually.........

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  • Just bide your time.If Labour wins there will probably be another set of changes.Andy Burnham has been speaking about the possibility of handing the commisioning role to local councils with the CCG acting in an advisory capacity only.Such is the political football that we inhabit!

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