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Furious GPC negotiator predicts revalidation 'revolt' as GPs spend more than 40 hours preparing for appraisals

The GPC has warned GPs are now routinely spending more than 40 hours preparing for appraisals, with one negotiator launching an outspoken attack on revalidation ‘overkill’ and calling for the wider BMA to ‘get some balls’ in dealing with the controversial process.

Dr Peter Holden, a veteran GPC negotiator and GP in Matlock, Derbyshire, told Pulse he could ‘see a revolt coming’ over the ‘introspective’ process, in the strongest criticism from GP leaders since revalidation got underway a year ago.

The BMA has always supported the process in principle, while expressing concern about elements of the implementation before, such as NHS England’s threat to remove funding for remediation.

Dr Holden told Pulse the BMA’s support for revalidation may need to be reviewed following reports that some doctors are spending more than 40 hours on the annual appraisal process since revalidation was introduced – five times longer than the ‘one working day’ specified in the 2004 GP contract.

He said: ‘In the 2004 contract, where we agreed to annual appraisals, it was supposed to take one day and that’s eight hours. But they keep expanding the remit, and it’s become an industry. And some of us feel that we wouldn’t mind if [the Government was] honest - it doesn’t take eight hours, it takes a week.’

Dr Holden added that his own and his colleagues’ experience of the process was a negative one. He said: ‘A quick straw poll amongst my colleagues this afternoon… we all reckoned it had taken 40 hours.’

He said revalidation now amounted to GPs being guilty until proven innocent, and said GPs were ‘sick and tired of having to prove to the authorities that we’re OK’.

‘Everybody knows you have to collect evidence in all six areas; some people would say you do it as you go along. But actually there’s an awful lot of what we do that counts towards it, and you don’t necessarily collect it as you go along, they also want you to reflect on every one.’

Dr Holden added: ‘A lot of us are getting sick of justifying every breath we take and categorising every motion we pass. This is all introspective crap, at a time when we’re under immense pressure. A lot of us feel this is becoming overkill.’

‘The BMA needs to get some balls over this - we’ve been too willing to fall over,’ he said. ‘We’ve been too willing to be blackened by the spectre of [Harold] Shipman.’

‘A lot of us resent the fact that we pay for the GMC, when in fact it is nothing more than the Government’s poodle. And I can see a revolt coming.’

The GPC itself remains in support of the concept of revalidation. But Dr Dean Marshall, the GPC’s lead on revalidation issues, said that there were mounting concerns over its implementation.

He said: ‘As lead for the UK, we get fed in lots of reports from doctors who are very unhappy with the process. Reports over 40 hours, I’ve certainly heard that. And what was once a day to prepare is now significantly eating into people’s personal time.’

‘I was having a conversation with my partners, a locum and one my sessional GPs this morning, saying exactly the same thing. That the process has taken over completely with no real evidence of any benefit to patients or doctors.’

Dr Marshall also warned against revalidation being used as a tool to performance manage GPs: ‘Unfortunately not being revalidated is frequently used as a threat, that you have to do this, or you have to do that to be revalidated. And either that’s completely wrong or really it’s a misunderstanding – accidental or deliberate – of the process.’

Dr Nigel Sparrow, the medical director for revalidation at the RCGP, and both a practicing GP and appraiser said they aimed to make the process straightforward for all GPs ‘regardless of working circumstances’.

He told Pulse: ‘We have just published version 8 of the RCGP Guide to Revalidation which has many changes to reflect the different roles and working circumstances of GPs. We have given guidance for collecting supporting information which should not be onerous particularly if collected throughout the year.

 

 

Readers' comments (78)

  • The GMC needs to hammer the more "adventurous" ATs with their managerial demands dressed up as revalidation requirements

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  • Thank you Dr Holden, that was very well said.
    I for one entirely agree and you have my vote.
    We need someone to stand up for grassroot GPs -as the article suggests, there may not be many left for too much longer, if current demands and Dr bashing continue.
    BTW it's difficult for grassroot GPs to understand -- even in the current economic conditions, no new money etc -- given the dearth of doctors entering general practice, does that not give us a stronger hand in negotiations to try and obtain a sustainable contract that will take general practice forward?
    Surely, as striking is not an option, other options should be weighed up with regard to what the profession and GPC can do to protest meaningfully, if we keep being handed unacceptable contracts by the government?

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  • Revalidation is going to leave a toxic legacy of mistrust between GPs and the GMC. It gobbles up precious resources in a time of scarcity and hurts patients whose GPs are no too busy form filling to look after them properly. There has been very little concern about the real world consequences of wasting doctors time, the patients who may not be attended to and the delay in completing more pressing tasks such as referrals for serious conditions however, I'm sure the evidence would not be hard to find. If such hare-brained schemes are the raison d'etre of the GMC one has to wonder if it's fit for purpose. It's now time for the profession to hold the architects of this disaster accountable for the time and money they are wasting.

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  • Well said Dr Holden that reflects my views entirely. Those of us in the older generation of GPs find the process demeaning and unprofessional. The BMA has been extremely weak on this and should be prepared to order all GPs not to engage with the process unless it is renegotiated satisfactorily.

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  • Don't do this work in your own time.

    We have allocated time off to prepare for appraisal and revalidation.

    It is the patients that miss out due to cancelled surgeries. A recent revalidation in our practice meant 50 appointments were lost for that doctor.

    A shame.

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  • Una Coales

    Good man Dr Peter Holden. I echo your views on the GMC and revalidation.

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  • Excellent set of comments - and pretty much what every grass roots GP is thinking.

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  • The truth is the process is more onerous than actually doing the studying. The reflection is inappropriate in alot of the process. We are so busy that you have to be part time on paper but spend a day a week doing appraisal. Alternatively GPs leave it untill nr appraisal and then spend a weeks holiday putting their plp on order.
    Ive been qualified over 39 years and its funny how i kept up to date prior to this rubbish

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  • I think it all depends on using the right tools in preparing for your appraisal. Ever since our PCO has moved to using GPTools.org, not only have they saved over £100K+ but the time we spend in recording evidence and reflecting upon it has been drastically cut. I can even send web articles I've read directly into my appraisal using the tool they provide. Actually makes revalidation ready appraisals easier than the old style ones we used to do.

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  • Revalidation was the principal reason why I retired from medical practice so I could tell the GMC that they were merely a branch of the Department of Health.

    Revalidation is not fit for purpose.

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  • I have been revalidated. I foundit immensley stressful amd lost sleep over it. It took me considerably longer than 40 hours to input the data and ten to reflect on absolutely everything. My appraiser was sympathetic and kind but had fully bought into the monstrous nonsense of a system which is not fit for purpose.
    I do nknow and acknowledge that some GPs particualrly salaried doctors find it helphul and in principle I am in accord with the need for it, but it needs serious redesign.

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  • I would say 40 hours is a low estimate.Attending courses ,travel,refection ,sat at a computer imputing it all etc I would estimate 150 hours per year.
    I have been revalidated and found it a mere tick-box exercise.

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  • Ironically the more involved you are in your work as a GP, the more evidence you have to collect and record, and the longer it takes, with no limits. If it the preparation is meant to take 8 hours only then this should be made clear and only a summary with limited examples and outlines of your work should be needed .

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  • Appraisal and revalidation seems to have been hyped up into a mini industry, with courses on how to do it etc, often run by the out-of-touch/unrealistic academic types who run the appraisals system. Some appraisers seem to expect an increasingly high totally inappropriate standard of documentation and ‘threaten’ that although borderline acceptable for appraisal, the work done would not be adequate for revalidation. Thus, due to that fear, the standard achieved tends to increase amongst the pool of GPs such that those doing the perfectly adequate minimum required, as originally intended, are regarded as having not done enough.
    The attitude of some appraisers makes me think about the Stanford Prison Experiment in the early 1970s and is a cause for concern.

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  • Appraisers? Didn't realize they still existed. They all seems to have all turned into inquisitioners where I work......

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  • Yes appraisal/revalidation has become an industry.. it will cost me £2,000..plus the time.. And new add-on are on their way, like free post envelopes for patients, multiple paying propositions for CDP..
    All that because a mad Dr (Dr Shipman) killed his patients? I have read about an pilot experimentation from the NHS (Daily Mail one month ago) that if a GP put on a special list the patients who are expected to died during the year, to avoid unnecessary not cost effective hospitalisations, they would get £50/per patient if that patient died effectively during the year!!! Is it true?? Who invent such inepties!!!
    Do you think Dr Shipman would have been revalidated???

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  • Sorry we are already almost through the first year of revalidation
    Shouldn't the GPC been saying these things about appraisal/revalidation some time ago?

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  • Appraisal is a daft game . It does not determine whether someone can do the job of a gp . Using the same principle of appraisal I could see Ian Broomfield the Leeds Utd scout say I've watched loads of football , reflected on it ad nauseam (according to the wife ) and could you please put me upfront this Saturday . I promise I'll score goals . Being a traditional soul Mr Broomfield would like to see me kick a ball about before making a commitment . This should be applied to appraisal. Get another gp to watch us doing a surgery . All done in 4 hours .

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  • I agree with Peter Holden and Jobbing Doctor. Do members of the GMC undergo revalidation by anyone?
    Disillusionment is setting in.

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  • i'veseen Ian Broomfield play up front and he was crap.He played a few games for Bristol City in the early 70's

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  • My wife has been a GP for 26 years. She recently got a letter from her accountant stating that next April her pension pot will exceed George Osbourne's new, lowered, lifetime limit. She has also been informed that her revalidation will take place in Nov 2015. I dont think so....

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  • Revalidation is here to stay in some form or another.Like QoF it has become more onerous with time and may be trimmed down in the future but the concept of periodocally re-evaluating doctors will remain.The only component of any intrinsic value is the CPD/educational learning part.The rest is just trying to prove that you're good at following government dictats.

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  • I have spent 4 days of some desperately needed time off, as well as previous evenings etc, to do this damn thing. I am fed up of being portrayed by all media as a money-grabbing, mass-murdering, lazy, incompetent, wholly-responsible-for-the-terrible-state-of-the-NHS GP. Revalidation will not change this and makes little difference my competence, it simply winds me up more so I wish I was in a position to retire much earlier than I can. I agree with previous comments: grass roots GPs need to be listened to and more vocally supported by the GPC to deliver a much more appropriate revalidation process

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  • Absolutely agree but more worrying is the fact that managers are trying to get hold of revalidation and actually appraise GP's ....this is crazy and must be fought at all costs. To say it takes 40 hours to prepare for revalidation is also wrong.....it takes a MINIMUM of 40 hourse to prepare and its more like 60 to 80 hours in reality......plus the fact that it will not prevent another shipman......!!!!..........a revolt is needed and long overdue so that we can get back to spending more time with our Patients...!.......the bma was castrated a while back now,....!!

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  • No amount of revalidation would prevent a crook or a murderer like Shipman (this fact GMC admits), particularly when the GMC-processes that allowed him to murder over 20 years & the 'corrupt council of reputable crooks like Rubin' remain largely unchanged. Revalidation has always been 'a lot of anti-patient & anti-environmental paper-pushing', with no tangible benefit for the patients --- or the doctors.

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  • I am sorry to hear that GP's are going through the bureaucratic mill. Nurses have been experiencing similar treatment.

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  • In Wales, we have a central database to which we have to up load our supporting material for appraisal. Its just taken me 8 hours to do this alone.

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  • At last some common sense being spoken - The revalidation process has become and introspective timewasting mess - and will be one of the many reasons I retire early - It is like pulling nails - and does the exact opposite of what I worked hard to achieve all my life - to be a professional - along side the QOF rubbish - I feel that I have almost completely lost that feeling altogether

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  • It's an utter waist of time money and effort!

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  • Sorry waste!

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  • I will begin by confessing that I'm no longer a Proper Doctor. I left General Practice 14 years ago and have worked part time in Occupational health since. I now derive a modest income by working from home examining motorsport competitors and doing DVLA drivers medicals. I have just been informed by the GMC that I will need a licence to practice to continue. Revalidation for me will be in July 2014. I do not have a Responsible Officer and it will be impossible for me to comply with the requirements of revalidation. I am facing unemployment with the possibility of having to sell my house. The concept of a limited licence to allow me to continue does not seem to have occurred to the GMC. It seems a little bit unfair that I will not be able to continue with examinations which I have carried out thoroughly and conscientiously for many years.

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  • Abdul QADRI

    Dr Holden is 100% spot on about the feelings of the gross root GPs up and down the country.
    Last year I had to work weekends to prepare the documents for the Appraisal. I suddenly was exhausted and unable to have good nights sleep. I ended up seeing psychiatrist who suggested escitalopram but needed first cardiac check up, ended up having angiogram that showed 30% narrowing of the LAD artery without any symptoms.All the Appraisal data is the in tool kit & I decided to call it a day on 31.03.2013. Having worked as a successful GP since April 1982 , it felt humiliated to prove myself after all this experience. You are absolutely right , so called Shipman factor has consumed BMA and they never realise that those incidents happen once every 50 years or so. Besides if Shipman wasn't a Doctor , his personality disorder would have made him to do the same by using different strategy. Appraisal or revaluation has become commercialised and people promote their business by targeting Doctors. If you want to up-to date yourself in any field of General Practice, there is price tag attached. So called learning CPD in BMJ or Pulse Magazines have started putting a price tag too on their hourly topics. GP are already struggling with the time restrains in the surgeries as they have to enter all the unnecessary rubbish in the computer for the sake of achieving targets. Take the example of finding new patients of dementia or depression or angina in the preceding 12 months. If you don't have any, you score Zero points. What is poor GP supposed to do , make people demented to get points. In my last 2 years of the practice, my patients who have been with me for decades, always commented that Doctor - you have changed as you are always glued to the computer screen and don't have time anymore to talk to us like before. The whole system has been ruined by outsiders who don't have a clue about the Golden Concept of Family Doctors as it used to be called. Now it is like a Doctor -client relationship.180 or 360 degree tool revaluation test doesn't have any benefit whatsoever to Doctors or patients. Recently they are now focussing on lifestyle changes incentive programme and nurses have to go for training to be able to organise it for the Doctor. What a waste of nurses time as if she doesn't know how to address the issue of lifestyle changes. Come on , this is basic thing we have been doing as soon patients registers or if he or she is on chronic disease register template. There is a big section waiting : Smoking history , exercise history , BMI history etc & one has deal with this according to the answer given by the patient. What is so dramatic now to waste every bodies time on so called special training which will be repetition of what we already know. GP should have been approached in a most time friendly practicable manner for yearly Appraisals. Majority of us are good Doctors. Yes if somebody had been reported with significant genuine complaints, then that individual should have been informed according and offered necessary help by involving fellow practitioners. This way that under performing Doctor wouldn't have felt threatened.
    One can go on writing but in summery , I feel that whole procedure of Appraisal & revaluation is in a mess and BMA as a representative body needs to take a closer look again and listen to the comments of the gross root GPs , otherwise there is a danger that GP jobs may not be the top option for fresh medical Doctors in the future.

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  • Well said Abdul

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  • Thanks Dr Holden for standing up to real GPs. We full timers are often being told by doctors that only do 1 to 2 sessions what to do as they know best. There should be a rule that anyone less than 6 clinical sessions should not be making any rules as it does not affect them significantly. The primary job of a doctor is to treat patients not wasting time producing lots of paper work for managers to keep their jobs. Doctors has lost trust in the GMC that is deprofessionalising us. Lets change things or move abroad.

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  • Recently got revalidated after being informed few months ago that I was on the line for revalidation. That after putting hours of scanning and attaching ,not to mention reading guidance which changed according to any authors fancy every 2 months.. Of course I had a lot of time for that as full time partner and of course patient care and safety has improved (what a joke) as the policy makers would like the public to believe. After this looking to move on from UK as this is no longer worth it.

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  • Why do GPs not simply request a straightforward knowledge test for re-accreditation? Taking maybe three hours (cf the MRCGP AKT), this will correlate pretty well with actual competence, and precipitate a few failing individuals into proper assessments. Most GPs I know would prefer this, and it would surely re-assure patients far more than appraisals.

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  • A GP WITH SOME BALLS!!!! FIRST ONE I HAVE HEARD...!! WELL DONE DR HOLDEN
    GMC NOT FIT FOR PURPOSE ANYMORE.

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  • I so agree..and as for 360 colleague feedback..when I said I didn't have 20 colleagues I was told I could use my friends! Of course they aren't biased..what a waste of time for everyone..never mind the cost of administering such nonsense

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  • Come the revolution appraisers will be first against the wall. Traitors to their own profession .

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  • In fact I can't add up it has been 70 hours I forgot the audit time!
    It has become an industry. Whilst I am in favour of appraisal it was NEVER envisaged to be like this. Once i get my new license in January I will spill some more beans but as I have a mortgage to pay I have got to get relicensed first!

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  • So now what? Action should be on schedule!! Wake up Doctors and do the Revolution!! Start by refusing confidence to the elected professional body's members responsible of that bureaucratic mess, think of next political elections, presenting candidates able to expose to the public the truth!! Make posters for the patient's waiting room, explain to them what is best for them, also for the General Elections.. and may be things could change..

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  • Una Coales

    In other words Peter, you are being held to ransom to deprive NHS pts of 70 hours of GP appointments for meaningless appraisal/revalidation that is not fit for purpose. What would happen if all GPs acted on their conscience and refused to be appraised/revalidated? What if the BMA took a stand and said this was not what was envisaged or promised!

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  • Una Coales

    If the line is never drawn, the Department of Health may keep piling on more meaningless paperwork, audits, checks, excessive hurdles to remain on the NHS performer's list, 24/7 patient care burden, full and sole criminal culpability for any and every NHS pt mishap on your list whether in hospital or out, cut pay, force practices to sell out or join federations, relinquish their independent GP partner status and work as cheap salaried GPs for federations manned by a handful of GP managing directors. Where do you draw your line?

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  • there are 3 powers: independent intellectuals, money, and politic.
    The Bureaucratic people wants all the powers. That's why they are against us: we have the 3 powers! We are intellectual scientists, we can influence the votes, we are not poor.
    You know now why all this junk..

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  • What revolt ? A 50% cut in pay in 10 years. Discriminatory pension changes that do not apply to the legal profession for example. Imposed contracts. Balls !! what a lot of balls. We are pussycats. we roll over and die.
    If we ever stood up and said we would leave like dentists - now that's balls.

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  • 50% per consultation is the pay cut. Take home pay per consult has exactly halved in 10 years with increased consultation rates and real cut in pay.

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  • Abdul QADRI

    Reading these comments in the last 12 hours is very painful to absorb & I couldn't stop adding more. There is so much discontent among my Colleagues. As I decided to retire recently, I am liberated & not scarred to reveal my identity. Majority of the frustration is evident from those of us who have decided to remain Annonymous obvious reasons. I sympathise with them & feel for my colleagues as it shows , how much scarred we are to face these beauraucrats like GMC and our so called friends BMA.
    What comes to mind is this : If any Doctor has successfully passed his yearly Appraisal & Revaludation. Is he or she immune from patient complaint or will patient complaint be dealt in any different way. Reasonable answer is NO. Then why not to empower patients & let them decide about the choice of their GP. If they are not happy , have free choice to change from that practice or even complain against the Doctor or any other staff member in the practice. I am sure this complain will be dealt in the same way if Appraisal or Revalidation didn't exist. It is an ideology only to please voters and a knee jerk reaction following Shipman sargar. Patients are themselves intelligent enough to choose between good & bad Doctors. Thank Goodness , majority of Doctors are good consciences professionals and care for their patients. As I said this rediculous Appraisal or Revalidation is meaningless and is insult to Doctors especially to those like myself who have spend more than half their age looking after patients. I can openly say that my Appraisal or Revalidation is in the hands of patients. I have worked in an inner city of East London and my working life for 30 years is an open testimony to my ability. By being stubborn and arrogant about the madness of Revalidation , they are loosing vital work force of gross root Gps who could have supported new breed of GPs by providing their services on part time basis. Look at the frustration our locum's or part time salary GPs who have to collect all the rubbish for the Appraisal tool so that they can work. I am not surprised why there is shortage of locum's up and down the country.

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  • Quof and revalidation is why I took VER. The more I read the more I have decided it was the right decision. Where is the proud profession that I knew and loved?

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  • Appraisal and revalidation are parts of the contract. GPs in the main are self employed contractors. It is illegal to suggest or induce people who are self employed to breach a contract. You lot need to through the LMC Confrence/BMA ARM mandate us to renegotiate the DETAILS of what is needed. I don't think you can re argue the principle

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