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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)

  • If the profession of General Practice is to consider "industrial action" we must define precisely what we want in terms of a new contract. What is it about General Practice that needs altering. There have been many good suggestions such as improvement on pension terms , pay . Fundamentally we are over worked , under appreciated . The General population bless them , have not been given Government guidance as what is appropriate to bother their GP with.
    Thus we are asked to sign all sorts of forms see all sorts of trivia and we are not able cope with the demands of the truly ill. We need more GPs and the job is unattractive.
    If we take industrial action it needs to be graduated and thought out. What is the point of sending undated resignation letters if the BMA havnt given guidance as to what to do if the Gov calls our bluff.
    We need clear guidance before this course of action is taken, what the consequences financially will be. Clearly we can operate an insurance based GP but there will be a period of great difficulties with the likes of Virgin on the sidelines. Options such as chambers in large federations of private GP are clearly likely.
    I would suggest a graduated approach with industrial action ramping up from minor to major action , non compliance with CQC, appraisal etc. days of action, emergency only work working towards resignation if the Gov. does not agree to real and advantageous changes in our contract.

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  • We see 90% of all NHS consults on 7% of the budget. We are rated THE BEST PRIMARY CARE by the COMMONWEALTH FUND.
    HOWEVER In no particular order
    A 50% pay cut per item in 10 years [ fall in relative pay and increased workloads]
    A corner shop profession [ Stevens]that has failed. [Field]
    We dot provide proper mental health [ Cameron]
    We should be reported to the GMC for too many antibiotics [ NICE}. Too many people get knee surgery [ because we refer too many, even though it is the surgeons who do the operation]
    This complaint from the Orthpods baffles me!!!
    We do not refer people early enough in cancer, but we refer too many people anyway !!!.

    We are not prescribing enough HRT and not doing enough to prevent falls, obesity, heart disease, stroke, alcoholism and gambling.
    We are not doing enough Fe NO tests for asthma.
    We displease Professors Grant, Thomas { Merrion].
    We have not done enough penance !!

    Why, oh why do we stay in this pile of utter garbage.

    To 1057 , the dentists showed us the way.

    And since we have failed the NHS, we MUST, SHOULD, ABSOLUTELY LEAVE.

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  • Being a GP in the UK is an impossible job. What other profession would work in a system so understaffed that you are set up to make mistakes and that the mistake may lead to a conviction for manslaughter. ANY other group of proffesionals would immediately go on strike.
    Of course we should strike. This job is completely intolerable.

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  • General Practice.
    What a bl***y miserable life!

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  • Una Coales

    http://www.dailymail.co.uk/money/pensions/article-3371776/What-need-know-pensions-2016.html

    My daughter asked me why does the BMA not let GPs strike like junior doctors? Good question. Now has anyone got an answer?

    Perhaps because the government has protected older GPs pensions for 10 years, allowed them to draw final salary scheme pensions, have a generous cap of £1.8 million, tax free lump sum withdrawal of up to £450,000 on top of an annual payout of up to £78,000? For the rest of us 'plebs', the government has decided the £34 BILLION pension debt is too big for them to handle in the context of owing the public £1.5 TRILLION pounds, and they will claw back as much as they can. On the cards, consideration of one tax of 30% on all pension withdrawals, consideration of removal of the 25% tax free lump sum (big ouch), capping annual pension allowance to £10,000 from £40,000 for big earners, cap of £1m pension (hm at 30% taxation that means withdrawing £700k which just about covers a mortgage?) and removal of final salary scheme has already taken place.

    Might be worth considering putting your money into a fixed rate bond savings account yielding a steady income and with no wait until you are 70 to cash out the bond but rather 1-2 years?

    Or better yet emigrate to a country with low taxation and a public deficit that does not equate in the trillions...ahem Canada and Australia?

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  • In 1947 a terrible mistake was made when primary care was made part of the NHS when only secondary care should have been part of a free at point of care service
    Had this not happened the following would have occurred
    • terms like " heart sink " and " worried well " would not exist
    • Preventive care ie screening would only happen to those that wanted it
    • the very poor would pay nothing as they would be subsidised by paying patients
    • GP's would naturally specialise to increase their income all sigmoidoscopies etc would be done in primary care
    • GP 's would get paid for activity not per capita and boy would we love our work
    • secondary care would only do a fraction of what it does now ( look at the massive improvement in procedures etc now done by Dentists who have left the NHS )
    • The best Doctors would flood to General Practice as they would DO !! something and not be medical " office boys "
    • We work at present under intolerable pressures all while our patients pay vast sums at B and Q etc WHY ? In the name of God
    • Get back your souls and pride be Doctors again you were once as SHO 's etc
    RESIGN !!!!

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  • BTW, in Guernsey the average fee is now £54. It makes the Guernsey option look a lot more attractive!

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  • YES
    YES
    YES
    YES
    YES
    CLEAR?
    If not GPs should leave the GPC and form their own representatives like resilient GP
    Etc

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  • Everyone knows the late Bob Crowe's name. Admittedly 10 million people use the tube but many more use the NHS.

    Like him and his methods or not, he was effective. How many of the public could name a single leader of our profession? Chaand who?

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  • General Practice is like an Autopsy report...getting sliced and diced by the older fat cats to foreign companies...authorised by the politicians!

    Vested interests....don't be silly! Generation Zero can smoke that as a Value-based outcome!!!

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