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The waiting game

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

    (1) Perhaps it is about money . At least , it is superficially essential . But I would say it is about money and Respect . One can argue both will end up with the same conclusion anyway.Respect , like continuity of care , is not a measurable virtue . More importantly , it is mutual , a two way traffic. You respect me , I respect you. But if the government has decided to treat the medical profession like garbage , a natural , large scale ,confrontation is only just predictable.
    (2) As far as these politicians are concerned, abstract and unmeasurable virtue(s) are all expendable as they do not provide political and economic gain. Even worse , the propaganda spins in a way that there is no other alternative as the country will end up like Greece otherwise . I am no economist (never wants to be) but I only believe everything goes in a cycle and nothing is absolute. Recklessly chasing after some economic figures , willing to sacrifice all virtues , is not different from us treating just the BP readings or 10 years CVD risk without considering people as individuals . Ultimately , the virtues of the social norm are well eroded by this government being single-minded on reaching surplus in economy in 2020.
    (3) The irony is this disrespectful , bullying attitude of these politicians actually backfires.What goes around , what comes around . 'Every action of man on earth is watched by the 'boss' up in the sky'.
    The calamity of the third runway in Heathrow brought the dramatic story of the Tory London mayor wannabe literally 'put a gun' on the head of Cameron to stop the project , with a threat of resignation . The only UKIP MP turned against his leader only 7 months after the general election when he jumped ship from Tory Party.Even the Birmingham Labour MP said she would stab her party leader on the front , not the back. This is toxic. One can also argue the head of CQC said what he said out of pure disrespect of the majority (not minority!) of our comrades.
    (4) But then again, ''if the top beam of the house is not proper , the lower beams will be all distorted '' as Chinese said. Those with no virtue holding high positions in a hierarchy spread evil through the most. Osbourne's economic 'solution' coupled with this act of disrespect and contempt,is a blue-print easily copied by employers in public or private sectors. Patients and friends working in the latter clearly described stories to me in disgust. People are so unhappy including us , of course. The country is well divided with two polarities : the rich with power and the poor with none(middle class simply is vanishing).
    We had to spend so much more effort and money in last 5 years to 'stabilise the ship' in our practice that I can understand why some partners could easily go for 'shortcuts' . At the end , everybody was pi**ed off.
    (5) As far as the younger generation(s) is concerned , there is always a group who wants to do medicine from day one and it is certainly not about money.They need to know the pros , cons and uncertainty of this toxic reality. At the end , they make a decision to go ahead. I would say , 'respect and support'. Yes, what about after the training ? Should I stay or should I go? I remember Clash's lyrics vividly:
    'If I go there will be trouble
    An' if I stay it will be double
    So come on and let me know'
    The answer is never easy and straight forward. Every individual's circumstances are different. Pasture is only greener for A but not necessarily for B . So often it also involves leaving your loved ones and family. Again , we should respect the final decision as it was thought through weighing the beauty against the beast.
    (6) For me , there are only three groups of people as far as NHS is concerned, (a) still believe in NHS , (b) serious doubts (c) stop believing . As I said in the past , I would just walk if I wake up tomorrow not believing what I am saying and doing . I suppose that leaves the people in (a) trying to convince (b) to stay. Can they do that? I do not know. But I do know they need to fight this war so hard to stop the government disrespecting our profession. Hence , as I always say , those who are willing to stay , young or old , deserve respect and admiration . Yes, we need more young heroes to uphold this flag......

    Have a good Christmas

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  • Vinci Ho

    Just watched Pixar's Inside out the third time. The meaning of the film is far reaching and deeper than any other animation movie. Watch it if you can......

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  • Vinci Ho

    And by the way,
    Congratulation to NHS choir
    Christmas number one 2015
    Don't stop believing (as in Journey's song)!!!!

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  • I suggest that now is a good time for all colleagues to join with the groundswell of grassroots opinion that is gaining momentum on Social Media.

    "GP Survival" on facebook and twitter is a good starting point.

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  • I would suggest that every GP regardless of age status etc starts looking at their careers and making alternative plans, whatever they may be, based on their own interests;

    some in this thread have indicated that they regard this "extraordinary meeting as the last hope of general practice".... whereas i believe that if you pin your hopes on this making any difference to your working lives you are at best foolishly naive.

    The path of general practice has already been decided. The decision makers have included the government and also those in power who have looked the other way whilst these monumental changes have taken place;

    Rather than argue who is to blame, take a stand for yourself, and your family, whatever it may be.

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  • I do wish that Drs Ho, Coales and Co. stopped trolling the GP profession.

    The situation is far from bad and there are plenty of GP partners out there who do know what they are doing.

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  • Una Coales

    Next month will be 2 years since the tragic suicide of an overworked Liverpool GP partner. He was very proud of his young adult children, a daughter who attended Oxford university and a son Cambridge. This will have been the second Christmas spent without their father. The agenda committee of the BMA annual representative meeting of June 2014 refused my emergency ballot to take into consideration Pulse's ballot on mass resignation and ballot its GPs. In the audience were Liverpool GPs and an ED consultant who had tried in vain to resuscitate him. They were eager to hear my emergency motion. But no, the agenda committee refused and so no debate was held and his death was not heard.

    His death and that of other GP partners will not be in vain. Based on my experience with the BMA, I too believe that they will remain inactive, all talk but no actions. Save yourself. If you find you cannot keep going as we have seen our belove Phil Peverley struggle with the insurmountable work load, then take a break, retire early or emigrate. Forget the managers who crack the whip or the Chair of the RCGP who says it is the best time to be a GP. We all know it is not. Make 2016 the year you put yourself and the future of your children first. The NHS is not worth dying for. GP is just a job. Happy New Year.

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  • Una Coales

    Edit: beloved Phil Peverley

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  • @practice manager 2:52

    I belive you to be the troll. Dr Coales speaks the truth and has done for years. What you really want to do is censor her and others like her for telling it how it really is. As for Dr ho, how can you call him a troll? He never offends, he's confuscious' 21 st century reincarnation with some batman and Star Wars mixed in for good measure.

    The situation in the UK particularly England is dreadful. I know because I've resigned a partnership, moved abroad and had no fewer than 7 of my colleagues, friends and family follow me. Most of these were GP partners and not just newly qualified either, 2 were in their late 40s with teenage children in top independent schools.

    Perhaps like our beloved so called leaders you depend upon the status quo to remain in your position. The facts speak for themselves and even your gorbellion hyperbole can't sugar coat the facts on the ground. I have yet to speak to anyone who has jumped ship who regrets it, even those that remain for the most part do so because of circumstances..............

    Yes it's definitely never been a better time to be a GP, as long as your away frol England

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  • 2:52 a.m.....Have you forgotten your medication?? If this is not thew time to speak up, then we are truly finished...RIP

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