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GPs go forth

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

nagpaul 3x2

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)

  • The time for millitancy has passed. Now is the time for action.

    The NHS choir going to No1 should give us hope that the nation will grasp what we're trying to do. Get the message right & fight back on social media - that's the bit we can out-flank the DH on. Win the war there first, and then you can use the industrial action to lever the negotiations. GPC needs to get the horse before the cart on this. They've tried negotiating first then moaning about the result. First set the discourse in public by mobilising the most trusted, and one of the smartest proffessions and then TELL them what they will do. Don't ask permission, make them beg.

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  • the picture is great - reminds me of a cross between Frank Spencer and Citizen Smith - which neatly summarizes the approach of the GPC :)

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  • Now is the time for the GPC to shine

    GPs (grassroots anyway) have been demanding something be done for years-- something that has largely fallen on deaf ears

    We've had posters and members of the GPC on these threads before.....now is the time where we expect action;

    anything less than results now will show us what they represent

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  • Vinci Ho

    Major spoilers of 'Star Wars: The force awakens' follow:
    Read a few rather critical and negative reviews about The Force Awakens , on top of many good ones. Somehow , people have missed a very important point the director, J J Abrams , wanting to bring onto table: it is for our next generation(s). About the same age as me , Abrams was brought up in an environment of TV production settings as both of his parents were TV producers . He lived through a golden era of sci-fi movies , in front and behind the scenes . Fascinated by the original Star Trek , of course Star Wars in 60's and 70's , he ended up directing the latest two Star Trek movies and now The Force Awakens.
    The criticism on these movies were deliberately bringing back old 'stuff' for nostalgia to an extent of almost plagiarism. Some people called The Force Awakens a over 2 hours movie trailer instead .
    I can only disagree strongly. While the movie was obviously made trying to please everybody , I think the director has a wish to let our younger generations to experience what we, ourselves, experienced as 'mind blowing' as a kid and that can only be achieved by watching a brand new film rather than asking them to dig out the DVDs or Blu ray discs of the old films. I was eleven years old when my mother took me and my sister to watch episode IV: A New Hope. Even the old cinema had closed down now but what I saw was mind changing , what is the Light against the Dark side, perhaps what is 'just'??
    More importantly , the Jedi way, the gatekeeper (remember this word in own GP land?) of the Republic.
    Sadly, in this new movie(officially episode VII),all Jedi apart from one , Luke Skywalker, ceased to exist . Thanks to the good work of the emperor framing the Jedi plotting to overthrow the republic and hence wiped them all out in Episode III(Hello, Agent Hunt, sounds familiar?).
    It is about our next generation(s). Even the big baddy , Kylo Ren, was just a confused kid trying to work why his grandad , Darth Vader, failed to achieve what he set out to do .
    We have the responsibility to repackage what was 'gold' in our era and create opportunities for our youngsters to relive what were the core values and honours in our profession. It is not just about the money. Even JJ Abrahms had only 200 million dollars as a budget to make The Force Awakens.
    Of course, our youngsters always have choices , stay or leave.
    But I could not help dropping tears when Harrison Ford, Han Solo , walked into Millennium Falcon again after so many years away and said,'Cheewie, we are home!'
    Can we make general practice our home again??? I don't know but we have to fight for our next generation(s) Jedi to exist.......

    ''We are not going to end the day like this''
    Joy
    Inside out

    Happy New Year , everybody

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  • Una Coales

    Great read @Vinci. I feel like a dinosaur having watched the first Star Wars film oh so many eons ago.

    We have hope as long as Generation Y doctors know how to organise, share information (refuse to be gagged) and ask help from the public via strike action.

    http://www.theguardian.com/society/2015/dec/29/junior-doctors-implement-strike-action-plans-nhs-government-talks-falter?CMP=Share_iOSApp_Other

    As predicted, the ACAS meeting seems like a stall, no major progress and it seems strike action may finally proceed next month. We GPs and now NHS consultants watch with baited breath to see if public pressure on their MPs will finally bring about a fair and safe contract for all or we watch the final nail on the NHS coffin. Now it is shared responsibility for the preservation and integrity of health service in this country.

    We are not alone. We were never alone. We have 65 million patients in this country. It is time they stood up to save general practice, as you say the last dying breed of jedis.

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  • the younger generation can only prevail once the older generation have moved on (subtle hint) BUT the older masters always want someone in their own image to replace them and are always keen to be around to lend 'advice'. we need a clean break with new blood - that is the only way.

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  • Amongst all the blaming of Hunt, let's all remember that the whole country has been complicit in the fantasy that is the NHS, politicians of all breeds, patients and doctors. Without a sensible funding model healthcare in the UK will continue to descend into chaos. Continually gazing at the past through nostalgia impregnated glasses is not an answer, nor is the panacea demanded by so many of pouring more and more money into the pit.
    If the profession needs to grow a pair and take the blame for demanding the end of this national religion then so be it - we know the politicians never will.

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  • I want to scream every time I hear the term "GP leaders." Who the **** are these people? Sleeping on the job for at least the last 10 years!
    RCGP = an academic institution full of sycophants. It is not a trade union and does not represent GPs, and yet, with no opposition, the media refers to its hierarchy as leaders. Wind your necks in and get your core task sorted. GP training is a joke. Nobody fails as a registrar however rubbish they are. I've seen it. Just like the ridiculously onerous appraisal requirements concocted by these zealots, assessment is all about the process and nothing to do with producing and maintaining good doctors.
    And what of our actual trade union the BMA? Where have our elected leaders taken us? Supporting federations and networks (the obvious pathway to absorbing practices into single provider organisations) and inviting pharmacists to cherry pick our work. Now they are all running around in a panic realising that everyone is jumping ship leaving those less adventurous or near retirement, holding a very septic baby. So they will all meet in January, the established hierarchy, much of which will be retired over the next few years. And why? To work out how they can make their last few years bearable and not give a hoot about the long-term legacy.
    And last week we learned that it has been mandated that half of all practices will "voluntarily" give up their contracts to join networks where they can take on even more risk on behalf of the government. No autonomy and no assurance that you will earn any money if some other provider fails and let's down the network. Thanks leaders.
    Be careful comrades. Think about our so called leaders, what they really are and their motives. Do not listen to these self-serving people. Ditch your contract and refuse the even worse one about to be offered. Make 2016 the year of dignity. A year when you decide that working your backside off in some trashy building held together by woodchip wallpaper and living under the constant threat of complaints, is not the reason you have worked so hard.
    We deserve better working conditions, support and resources, fair remuneration and respect. Our leaders have failed to deliver any of these.

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  • Anonymous | Sessional/Locum GP30 Dec 2015 11:53am - Now you're talking. The new contract is only worth taking if we control the terms. Federations only work for us if they are a means to respond in a united way and fight back - not simply a contracting model for taking on more work.

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  • Just out of curiosity what was the "Plan B Nuclear Option" last time? I think it will be the junior doctors who will change things

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