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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)

  • @Anonymous | Sessional/Locum GP30 Dec 2015 11:53am

    'GP training is a joke. Nobody fails as a registrar however rubbish they are.'

    GP training is a joke only because it fails to prepare trainees for real life. As for failing registrars I have seen many get the chop, especially IMGs. Maybe you come from an area where all trainees are white British and from the usual social strata.

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  • I seldom post here but feel need to comment.
    I suppose at my age I am one of the old farts living in past. I have worked all my days in rural practice often undertaking tasks and roles that are not the norm for urban colleagues as locality necessitates different approach.
    If about money I would not have done what I did but it was also about what I felt was a vocation & yes at times a real privilege to be part of others lives.
    Things are however different now, there is more pressure, less respect often both from colleagues as well as from the public, less satisfaction with the role and all adds up to lead to dissatisfaction and anger.
    However when deciding what the next steps are we need to ask several questions:
    Is the action we wish to take legal?
    Are we prepared for the consequences from colleagues, from government & from the public?
    Will we be united - the juniors have shown what unity can achieve but do we have the same mindset?
    Many of my generation are reaching the point in our lives where giving up is a realistic option and that will leave the younger members of the profession in positions of leadership & control - is this what you want?
    Final thought be careful what you ask for .. You may just get it and live to regret it.

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  • @ Hal Maxwell

    Respect for all you have done.However, you are now overtaken by time and are simply postponing the inevitable.

    I wish you a happy retirement.

    PS: the answer is yes.

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  • Have not been able to do all the work on my desk for the entire year. Despite working weekends going in early cutting back on appointments etc
    Abused on a daily basis
    Every Tom Dick and Harry sending forms to be filled in by the GP eg witnessing signatures for pensions....
    Have cut back on house calls but still the demand is there
    Tried to examine an old lady no light no help etc waste of time had to send her to casualty
    Writing scripts daily for OTC meds, bread, moisturising cream...
    Daily arguments about viral infections and no need for abs
    Demand huge every muscle ache urti needs an urgent appointment and don't get me started on " smelly diarrhoea "!
    No hospital follow ups. Every letter do this do that do the heart surgery. Can't get patients seen urgently
    . Send them to casualty then sent home again. Late diagnosis, worse outcomes.
    No time for the really sick patients
    Hign indemnity, pension contributions now 30%
    Ponzi scheme anyhow.
    GPC had better come up with something but I doubt it
    Monopoly employer. Weak doctors.
    Of course it is about money. Goodwill has long gone
    If I want to work for charity I can work for MSF not gb gov!

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  • GPC better get their act together this time or they will be signing their own redundancy .What the point of a national representative body when the national contract is being broken up by HMG and by commissars acting on the inside.A continued fragmenting car crash in action.

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  • Una Coales

    @Janine, brilliant synopsis! Now do take care of yourself. The NHS is not worth dying for. Remember work life balance. Let's hope the BMA pull up their socks else they may see their optional £400/year membership nosedive.

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  • Una Coales

    Even though some NHS GPs are hoping the BMA will come to their rescue and offer a ballot on industrial action or mass resignation, based on my experience trying to get this through last summer, in my opinion, chances are close to NIL!

    For GPs who must stay in the UK and work for family or carer reasons, there is another way and that is by becoming a private GP with a consulting room or an online GP with a virtual consultation. Today as I sat in traffic behind a red bus, a HUGE ad stood in front of my was an ad for I was intrigued as would the public to read of a consultation with rx for only £10. I went home and looked up the website. 2 GPs, one a female Imperial College grad and past GP partner in Kent had not only developed the concept, conducted market research, but also arranged for ads on red buses, underground and digital! Amazing!

    It means that if you decide not to hold your breath for the BMA to save your life, you might wish to inform 200 of your patients you are setting up on your own and if you want more clients, think red bus advert!

    I am optimistic that we can save general practice in this country but it has to transform into an accessible modern affordable and competitive self pay concept if PMI is too expensive for the public.

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  • Una Coales

    I fear establishments like the RCGP and BMA may have outdated themselves as grassroots Generation Y GPs may survive without paying optional membership fees, and it is smart young Asian GPs who are revolutionising general practice in this country by transitioning like dentists, despite RCGP CSA exam results suggesting Asian UK GPs are not as bright, as they seem to be failing an actor CSA exam up to 4 times more than whites. In life, GPs are not judged on their acting abilities, but their clinical acumen and with an open market, they will have plenty of customers because they do know medicine!

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  • Plan B was a brilliant plan that Jon Reggler put together based on the fees being charged in Guernsey.

    If it hadn't been buried by the BMA (say Hi JC and SF) it would have found widespread approval from the profession and would have saved UK GP from the present Sh*tstorm that was entirely predictable.

    I resigned from the BMA and NHS GP when the vote came out. I've had a great and very profitable career since then.

    Never trust the BMA or the GPC in looking after the professions interests.

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    Lets see what 2016 will bring... i predict that if you follow the govt and RCGP "leaders" like prof SF, MB and even CG there will be more misery, more burnout, more paycuts, more bureaucracy and more nonsense headlines such as

    prof SF "we've failed as a profession"

    mb "its never been a better time to be a GP"

    CG " we need an all salaried service (despite me owning dozens of practices)"

    with these plonkers in charge its do as i say and not as i do!!!

    if your under 35 let this be the year where you resign and take back your god given freedom and autonomy

    Refuse to carry the can any longer. Pull out of the nhs pension scheme, emigrate or locum and get paid your due. The above post regarding sounds see there are alternative models out there, different ways of thinking... the old foggies want the status quo

    let 2016 be the year you walk the walk and take back your dignity and fight for your pride!!!

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