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Gold, incentives and meh

GPs press GPC leader over potential industrial action

The possibility of industrial action if the Government imposed yet another contract on GPs dominated grassroots GPs’ questions to the chair of the GPC in Pulse’s live Q&A, held yesterday.

Dr Chaand Nagpaul was repeatedly quizzed over the GPC’s plans were the Government to impose a contract without agreement from the profession, alongside subjects such as increased workload, the future of the independent contractor status and the care.data programme.

Several GPs posed questions such as, ‘would you consider industrial action if [the secretary of state] takes a unilateral decision on contract change in 2015?’ and, ‘what are you going to do to stop further unilateral erosion of the GP ‘contract’?

Another said: ‘Why does it feel that the BMA always wants to be seen to engage with the Government (and save the NHS)? Is our powder bone dry now or mouldy from lack of use? When are we going to take proper industrial action, and is fee for service not on the table?’

Dr Nagpaul said he was unwilling to speculate on the prospect of industrial action while the GPC was still in negotiations with the Government, but said the decline in GP pay despite increased workloads was ‘grossly unfair’ and he hoped the Government sees that another contract imposition would be ‘a folly’ if it wants to keep GPs on board with the agenda to transform the NHS.

He said: ‘It is grossly unfair that GPs have received pay cuts rather than NHS pay freezes in the last three years, compounded by escalating unpaid workload which has not been recognised by Government.’

‘I hope the Government will see the folly of a contract imposition, given that its entire agenda to manage NHS costs, develop CCGs and move care into the community depends upon GPs. The government needs GPs to be on board to deliver a sustainable NHS,’ he added.

He added that the GPC is ‘presenting a robust case to the DDRB so that GPs are remunerated fairly, as well as recognising that they are working harder than ever before. Unless this is addressed, we run the risk of general practice not attracting and retaining GPs.’

Several GPs also asked about the GPC’s view on the future of independent contractor status, in the wake of outgoing RCGP chair Professor Clare Gerada’s comments that the model ‘is outdated’ and should be dropped.

Dr Michelle Drage, chair of Londonwide LMCs, which has launched a survey of members over the issue, asked: ‘In London, where Clare Gerada now has an NHS England role as chair of their clinical board for transformation of general practice, and where Ara Darzi has now been appointed by the mayor to review primary care, how does it help either partner GPs or salaried GPs looking for careers in partnerships (as most tell us they want) to throw balls into the air like salaried service and the end of ICS?’

Dr Nagpaul said the GPC would defend GPs’ independent status and that it was a ‘bargain’ for the NHS.

He added: ‘We need a concerted effort between the GPC and Londonwide LMCs to argue for the clear benefits of independent contractor status and we also need to positively engage GPs who wish to become partners. The partnership model underpins the success of UK general practice.’

‘I do not agree nor believe that GPs as a profession will become salaried. The independent contractor status is a bargain for the NHS, costing just over £100 per patient for a year’s unlimited care. However, we believe in contractual options for GPs and those that wish to be salaried should be able too under fair terms, conditions and pay.’

On the issue on the care.data programme, which gives GPs eight weeks to inform patients that data is to be extracted from their records, Dr Nagpaul said: ‘The issue about care data is that the majority of the public are oblivious that their data will be uploaded nationally. We are putting pressure on NHS England that there must be a widespread publicity awareness campaign that allows patients to object to their data being uploaded should they wish to.’

And Dr Nagpaul said the GPC was committed to fighting for longer consultation times and cutting back on ‘tick box’ exercises that takes GPs away from patient-centred care.

He said: ‘We are pressing the government to remove large areas of QOF that provide no benefit, or even damage care, and to give GPs the resources that they need to meet the core needs of their patients.’

Readers' comments (18)

  • Dr Nagpaul is a man that I have great respect for....he is in a completely separate class to Field and Gerada.

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  • With loss of qof area's will be loss of pay from the qof. we are not going to get the money for the points taken away which have been erroded year on year. are we just playing into the government hands?

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  • own goal: remove qof areas, remove associated funding, which ofcourse you can earn back by.....opening late/ weekends/becoming responsible for OOH etc etc. So clever!!

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  • even cleverer will be that QOF money will be withdrawn and will be offered back to the 'lowest bidder'. Ie virgin will be able to run all these 'additional' services. ie, if they are 'optional' services, they will be tendererd. We should all resign en masse and start charging £50 (minimum) per consultation until this is resolved...

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  • Again, why on earth would younger GPs become partners in small practices where they could easily be left on their own to be liable for redundancy payments?

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  • Vinci Ho

    Simple argument:
    When you are negotiating with 'somebody ' who does not respect you and keep insulting you with dirty politics, what would you do?

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  • There seem to be a lot of calls for all-out industrial action but my feeling is that this won't work well with either the public or politicians. A better option would be to start working up more co-payment options (which already exist in the form of prescription charges) and GP cover plans like the Denplan. This would align us more closely with equivalent western nations which often have at least as good outcomes as ours and send out a strong message that the government cannot keep chipping away at General Practice Resources and expect more without us looking for alternative sources of revenue.

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  • I don't think industrial action will happen as the profession will be split on this and 'society' will view it as GP's feathering their own nest.

    I agree with the above but would add we need to look at alternative models.

    I would hope some clever docs will start posting some ideas re: models which we could forward to the GPC and hopefully get a vote on.

    We really need informed debate on our future rather than political decisions by diktat.

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  • The best way to work up subscription models would be to ask some of the insurance firms to develop some model plans for GP access. Issues to be looked at would be number of visits allowed per year; concessionary rates for the unemployed, retired, children and vulnerable; how to give people equal access; how to target chronic disease management at no extra cost to the patient and how to cross subsidize priority needs.
    Any competent large consultancy firm would be able to model a variety of plans to suit all needs.

    The NHS should also abandon its ideological opposition to co-payments on the grounds of equality. Be honest with people and allow them to top up where NICE ration access without loosing basic NHS care, such as expensive cancer drugs and restricted surgical procedures. General practice needs to protect core services like trauma, cancer, heart disease, mental health and other long term conditions and pragmatically this should be at the expense of services which can be met by a consumerist model of care delivery. This is likely to lead to far more satisfaction in the long run.

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  • Look where ICS has got us. Perhaps salaried may be worse, but no other group has had such guts in pay or rise in workload. ICS, folks, much as everyone, including Dr Nagpaul, who is a wonderful human, supports, is, in reality, a millstone. It allows the Govt. to dictate ever increasing workload with drop in pay. We have no recourse in ICS. No safety in working conditions, hours worked, no leave, no defence Union, just more imposition.
    We have to leave this impossible contract.

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