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LMCs draw up explosive 'plan B' to take GP practices outside the NHS

Exclusive LMC leaders in England are looking at potentially taking GPs out of the NHS, which could even involve charging patients directly for some GP services, Pulse has learned.

Pulse has learnt that English LMCs are considering breaking off from the GPC due to disillusionment with the national negotiators and setting up a 'National Association of LMCs'.

They are following the lead of the Northern Irish GPC, which is currently developing a ‘Plan B’ in preparation for a mass resignation of GPs.

Pulse understands that the Northern Ireland document is looking at potentially charging patients, basing it on the Republic of Ireland model, where practices set their own fees for patients. 

The GPC in England called off plans in August to ballot members on potentially submitting undated resignations or industrial action after claiming that it has won concessions on workload from NHS England.

But the Northern Irish GPC is to press ahead with plans for a mass resignation, which is being supported by grassroots GPs with a meeting earlier this week in Belfast drawing 200 GP attendees, 97% of whom supported the plans.

Pulse has learned that Northern Irish GPC chair Dr Tom Black has already drawn up a 27-page 'plan B' modelled on general practice in the Republic of Ireland.

Dr Black told Pulse: ‘I think that I would rather have a contract directly with the population than with the Government.

'We already have a situation here in Northern Ireland that one mile as the crow flies from where I am sitting, patients pay to see their GP. We already have a model in the Republic of Ireland that works very well and gets morbidity and mortality statistics which are consistently better than in Northern Ireland.’

LMCs in England are currently considering drawing up 'Plan Bs', following the lead of Northern Ireland, Pulse has learnt.

Oxfordshire LMC chair Dr Prit Buttar is preparing a report for Berkshire, Buckinghamshire and Oxfordshire LMCs (BBOLMCs) on a range of radical alternative options for GP practices in the region after criticising ‘GPC representation and protection of general practice'.

He said that the LMC was considering ‘everything from one extreme to the other’.

Dr Buttar said the LMC was looking at ‘the economics, and the financial reality of what life outside the NHS would look like. How practical is it? How affordable is it? What are the likely consequences for practices and their patients?’

He added: ‘At one extreme, currently the situation is that you bill patients for HGV medicals and stuff like that, while the state pays for everything else.

‘The other extreme is you walk away from your GMS PMS contract and set up privately.’ He added that there were lots of 'shades of grey' between.

Dr Buttar added that they were not the only LMC in England looking at drawing up a plan B for their GPs.

He said: 'There is a general mood of, I suppose, a mixture of resignation and frustration that people need to start looking at alternatives. There is more than one area of the country looking at this, and what can and cannot be done.

The LMCs have also revealed that they are looking at the potential of paying GP levies towards a 'National Association of LMCs' rather than GPC in future.

Dr Paul Roblin, chief executive of BBOLMCs, told Pulse that 'at the moment we’re not particularly impressed with what the GPC is doing to make general practice a more desirable profession to enter'.

But he admitted that the idea of a plan B 'wasn’t universally received in Oxfordshire, because people felt their livelihoods were entwined with the NHS model' and that 'to extract themselves from that would be personal, financial lunacy'.

A BMA spokesperson said: 'The BMA GPs committee is totally committed to supporting and working with LMCs in representing all GPs across the UK. That is why we have completed a major review of the structure and function of GPC to enable closer working with, and optimal partnership with LMCs.

'We have been robust in our negotiations with government, and have been consistently outspoken in challenging flawed political policy such as routine seven day opening. We therefore do not recognise the unsubstantiated description of GPC’s approach as described in the comments of one representative at a recent Oxford meeting, and we do not believe this is reflective of the constructive working relationships GPC has with the overwhelming majority of LMCs.'


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Readers' comments (62)

  • 10.40 No. They paid tax to fund the previous generation and lived unsustainably. The boomers stole their childrens future and are now reaping the rewards.

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  • Great news for the 'bum' bailiffs who will make a fortune 'collecting' debts from patients and/or their surviving relatives.
    Now where did I put those fantasy novels by Cronin?

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  • I did an extended hours surgery this morning. Two patients didnt turn up and one came because he had a wart on his finger that is just at the point where he holds his cigarette and it rubs and hurts. Such bullsh@t is not sustainable. You dont hear of people dying on Eire streets because they have to pay a proper going rate for primary healthcare.

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  • can we scotch this myth about baby boomers stealing this generations future? We worked 100 hour weeks with overtime paid at 30% (NOT 130%),did compulsory 24-hour GP cover, waited 2 yrs even to be granted a mortgage, interest rates reached 15%, inflation reached 27%+, tax rate were higher we couldn't afford a washing machine or go abroad on holiday until we'd been together 3 yrs. We didn't have designer clothes, mobile phones; a night out was a couple of drinks at the local not megabucks. And yes we were evicted from our hole in the road. We have paid our dues, and any generation not wishing to support previous ones should think it through.

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  • Vinci Ho

    I can see where the arguments arise in this dilemma.
    In my opinion , the power of the anti-spinning strategy (as I always advocate in this war) lies on the words 'Plan B' not Plan A. And the right message needs to get out there to let people know how dystopic the government had made general practice and hence NHS , become. Even the loyal Toy Soldiers had to rebel.Yes , the other argument is this would be walking into a trap but politics is always about saying/doing the right thing at the right time at the right place in history , the 'supreme moment ', kairos. I would not even think one could push this Plan B 18 months ago but one day of politics is too long . The gravity of politics somehow reminds me Einstein's general relativity, the more intense the gravity ; the more extreme time-space is curved(warping). That was then, this is now.
    And I agree that this plan B needs a lot of background research to provide substances for colleagues to support and compare . Every region of the country will be different. But the most embarrassing thing to a government is a verdict of a complete failure to deliver health services ,for instance, in the capital and big cities .
    This battle goes on.....
    Good luck, comrades

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  • So instead of "billing" the NHS, the GP will invoice the patient - who will (probably) pass that invoice on to the NHS for payment; either that or GPs will invoice the NHS directly, who, in turn, will negotiate a group rate and any GPs charging more will not be approved - So, in other words, the same system as now but with LOTS more paperwork

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  • To all those who are saying that they pay their taxes and national insurance so why should they pay for their health, Friends I am very much aware of it. but what you don't realise is how expensive is health care? Do you even know the real cost of Gp appointment to NHS (approx 30 £) ,cost of attending A&E (£90) and cost of Hospital appointment 9150-400£ depending on speciality) and cost of hospital stay in ward 300£/day & ICU ( min 1500£/day). How many people pay for prescription charges (less than 10%). Thats the reality. This country spends much less on health care than any of the developed countries.
    GPs get paid aprox 140£ per patient/ year which is same as many of you pay for your dogs insurance.
    This NHS system works on insurance based system and as with any insurance when users use it more, premiums go up. So either government starts paying more to hospital/ GP or someone else pays for it.
    Average punter has taken more out of system than they have contributed to it. You all can work out yourself.

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  • Still on the plus side, there will be lots of money saved by DoH because they won't have to pay GP pensions or building/rental/staff costs directly. Also, national vaccination contracts will then open up to AQP - bring it on!

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  • Vinci Ho

    The other anti-spinning slogan is clearly the broken 'promise' of the money going into NHS after Brexit.

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  • Anonymous | Pharmacist28 Oct 2016 11:00am

    I'm sure you'll enjoy the competition from dispensing surgeries everywhere too!

    I think the biggest risk is to pharmacies - unfortunately some of the biggest pharma co. would be happy to cut out the pharmacy role totally

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