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GPs buried under trusts' workload dump

GP reluctance around resignations was factor in GPC decision, says Nagpaul

The GPC chair has told Pulse that legal advice and feedback from GPs contributed towards it dropping plans to ballot the profession on industrial action.

Dr Chaand Nagpaul said that the BMA took legal advice on its options for taking industrial action, or submitting undated resignations, following a vote at the LMCs Conference in May.

However, he said that the legal advice had thrown up a number of complexities in submitting undated resignations, while other forms of action – such as non-engagement with the CQC – were illegal.

Dr Nagpaul added that the GPC had ‘considerable’ dialogue with NHS England around implementing the GP Forward View and the GPC’s recommendations in its Urgent Prescription for General Practice.

A motion at the LMCs Conference in May said that the GPC should ballot the profession unless NHS England accepted the Urgent Prescription recommendations within three months to address the increasing workload of GPs.

But the GPC announced yesterday that it will not be going ahead with a ballot, after NHS England agreed to negotiate on the recommendations in the Urgent Prescription, including longer appointment times, stopping all unfunded work and ending inappropriate workload demands on GPs that could be done by other parts of the NHS.

Speaking to Pulse today, Dr Nagpaul said: ‘The letter in a way it summarised NHS England’s position, but we have had considerable dialogue with NHS both in terms of implementing the GP Forward View and the Urgent Prescription for General Practice, which is our priority.’

This was the main reason the GPC took the decision, but there other reasons for not balloting on industrial action, Dr Nagpaul said.

He added: ‘There’s some very practical and financial reasons for why many GPs would not sign up to undated resignation. We’ve had considerable feedback from LMC meetings etc.

‘There are complexities around salaried GPs, complexities around the large numbers of locum doctors, complexities around partnership agreements and what would be allowed in terms of resignations.

‘We’ve actually looked into all of that – we’ve had legal advice – and therefore if that question ever is asked in the future it would have to be understood properly. It’s not quite as simple a question as what one had originally imagined.’

But Dr Jackie Applebee, chair of Tower Hamlets LMC, who proposed the motion in May, said: ‘I am concerned about the decision not to ballot. There was an overwhelming vote in favour of this at LMC conference. General practice is in extremis and this is widely acknowledged throughout the profession and the grassroots have by this vote showed the strength of feeling.

‘I understand that if NHS England has said that they accept all of the demands of the Urgent Prescription for General Practice that some might perceive this to be a breakthrough, however it will take more than words.’

Readers' comments (31)

  • The LMC meeting was hijacked by this not thought through motion. I usually support the most radical and militant views but this motion to hand in mass resignations was never going to be supported by the grassroots because of the risks involved. Well done to the GPC to prevent another poorly thought out referendum like Brexit where the protest and frustrations overshadow common sense. This is not a proposal we should be balloted on without proper legal advice and risk assessments however strong the frustration and resentment is. Common sense is what drives General Practice and for once it has prevailed. We need to think of smarter actions than this gut reaction.

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  • Like what, anon @9.15?

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  • I think there should be an orchestrated mass list closure. This will concentrate the minds of the government as incomers to an area cannot register with a practice. It would not take long.

    Another action could be a refusal of local GPs to do shifts in OOH.

    It has to be orchestrated and we have to stand together. The income we will lose is small compared to the disruption to national life.

    If we wait for RLE to bring about change we will have sacrificed swathes of doctors who are very unlikely to return once they have experienced freedom.

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  • "We need to think of smarter actions than this gut reaction."
    "Like what, anon @9.15?"

    I would suggest changes that cost money but do not affect patients (badly) or the core contract (they might take some work - but there is some hardship in industrial action):
    1 - All prescriptions to be branded rather than generic
    2 - Non-cooperation with admission avoidance systems
    3 - Non-cooperation with schemes to reduce prescribing costs
    4 - Everyone (GMS) abandoning the minor injuries enhanced service and following it through with directing all injuries (including falls where there has been an injury) to A+E
    5 - Work bounced to GPs can be automatically be bounced to A+E. e.g. for a follow up U+E.
    6 - Declaring managing a clinical area unsuitable/ unsafe in primary care (because of the workload) and automatically referring ALL patients with that illness (say asthma or diabetes) to secondary care.
    7 - Limiting appointments to 12/ session (maybe a different number) and then routinely diverting every extra to A+E.

    Am sure we can all think about more inventive ways, but all the above are technically within our contract (I think), do not risk too much GP practice income and will cost the government significant amounts of money.

    That is quite a good combination for industrial action.

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  • Anon 9.47. See Anon 10.01 , concerted list closures , disobedience with NHSE referral and prescribing pressures. I'm sure if we brainstorm deliverable measures and the agree and action them it will bring stronger support within the profession and a bigger pressure for our case. The nuclear option of mass resignation could have indeed turned into bankruptcy of many partnerships and GPs and a completely counterproductive step. For once I support the GPC and Chand Nagpaul who I believe to be the best GPC leader that I have experienced in the last 20 years. We need a leader with a cool head now, our profession is at threat of obliteration but the NHS cannot survive without us and I think the endgame for our future is near bug let's not forget that they need us more then we need them (NHSE). We need to be smart and not suicidal. Resignation was forever going to be absolute lunacy. It might have worked half a century ago but the NHS and General Practice has changed since and if we don't recognise that we devalue our own position.

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  • Anon GP Partner 10.04 pm

    I think, if your suggestions are wrapped up in a form of industrial action by GPC, it may work.

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  • Anon10.04. That's exactly what I meant with smarter action. I very much think that we are undervalued and to drive this point home in the ' market ' we are now operating in is via removing the financial benefits to the 'market'(NHSE) we deliver. They need to feel the financial pressures, let's stop all the 'efficiency gains BS' let's just be GPs again to our patients. Let's refer them if we feel it is appropriate, let's prescribe effective but not be bullied by our CCGs. This is something our patients ask us to do and they will fight for us a fight that can be won within the profession and the public. CCGs going bust? So what? I know we feel bad as they are led by our colleagues and friends but we GZps should have never taken on that 'comissioning' ( speak cost cutting ) role.
    The weak underbelly of the system is the finance and this is where we need to aim at not at putting our own practices, livelihoods and thSg of our employees at risk.

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  • It seems like we're debating more of a 'work to rule' attitude and push a lot more back into the hospitals. This is something the GPC should look into. There was real anxiety on this thread that mass resignation would lead to partners losing their homes? Would the government really allow practices to shut, at all? Wouldn't they cave first out of sheer terror of the pandemonium this would cause the NHS. They've called out bluff. Again.

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  • A work to rule is the way forward this has to be organised by OUR union.

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  • Anon 11.23. Mass resignation would have been a bluff that we would have inevitably lost as undeliverable in these days. Work to rule is a strong hand we can play. What's the better way forward? We would have looked like a bunch of fools if we had balloted.

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