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GPs buried under trusts' workload dump

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)

  • yeah. What he said

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  • If the Government can stop adopting The Emperor's New Clothes approach actual tangible funding and accept there is a problem (that is so glaringly obvious to the majority) then perhaps we could all have a grown up conversation about increasing taxes to make up the shortfall?
    If there is a public appetite for a free at the point of access service method then we need to fund it.
    In many ways the NHS is a victim of its own sucess in innovating new methods of treatment...which save more but cost more too.

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  • I am very saddened by some of the comments about older people. I am very concerned that some doctors - I assume they are fairly young - have this attitude to my age group -or boomers- as we are so ungraciously called. Working with the wonderful doctors in this Practice I know that they show great respect and care for older patients, but they are mainly in an older age group themselves. It is a worry that my generation will be faced with the bitterness shown by some of the contributors here. I notice that no blame for the NHS deficit is apportioned to the huge number of people that have come to this country from the EU. Young people on low incomes have settled here and had children, and older people with long-term conditions and expensive medication, but they cannot, and probably never will, contribute anywhere near enough to pay for their care. I do not resent them having this care but I have worked since 1969 and feel I have always paid my way in taxes, NI etc. I don't deserve to be made to feel guilty for any treatment I may need.

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  • Don’t think you have entitlement just because you have paid taxes and NI. Successive governments have sold us a pup.

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  • Again entitled and deserving in a rationalised health care system it should play no part. You dont get a PCI because you earned it through your taxes you earn one by having a heart attack. Now if you can charge people for access to what they want (a second opinion, scan, early referral, home visit as a preference) to pay for the provision what they need everybody is a winner

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  • We taxpayers already pay for the NHS but the Treasury is not using our tax money because it is severely underfunding the NHS. This is not a reason for charging the patients because we already pay through our taxes.

    It is no use trying to hold up the tax fund by willpower like the proverbial stockings: it seriously needs a change of Government.

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  • This comment has been moderated.

  • this is not a difficult issue -

    either say what you want the NHS to do (eg face transplants for everyone) then cost it and provide the money.


    say we are going to give the NHS a fixed amount of money - what can we get for that?

    what is happening now is the state is giving the NHS a fixed amount of money but is expecting it to do everything - it can not be done. The system is falling apart simply because it can't mange to cope with demand on the resources it has.

    that means either fund it properly or expect cuts. not difficult eh?

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  • Bevan was a hard left Labour, son of a communist. It not surprising that the NHS model is 'communist' free to all, but where are they these days - gone. It doesn't have a place in the 21st century.
    The NI is irrelevant it is a robbery game, to pay todays pensioners from todays workers. So people have paid but not for their own health/pension!
    We have to move to a system where patients take some responsibility and pay for health along the way. And you are right, people aren't dropping dead on the streets of Eire due to a lack of health care.
    Come on other LMCs, look at these models. We need more to stand up, take some responsibility because the government isn't. I cant see any other way forward.

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  • LMC leaders in England are looking at potentially taking GPs out of the NHS ...........

    Thinking, looking, considering, possibly, potentially, talking, discussing ...... how many more adjectives - Time has run out already. Govt plan for insurance companies and private companies is taking hold. Ditch the country comrades !!!

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  • I am sorry but I already pay for the NHS in my taxes. If I am to be charged for seeing my GP, I shall be forced to go to A&E causing complaints there. I had to transfer to a large group practice after the CCG closed down my two-doctor practice in July and I have not yet had occasion to ask for an appointment so I am not a excessive service user. The large group practice offered electronic prescribing but failed to institute it after I had signed my consent. What is going on please? Her Majesty may complain that there is no longer good order in Her Kingdom, what with the chaos in commissioning, bidding and failed contracts which are an increasing feature of this NHS which we taxpayers pay for. That Taxpayers' Alliance may tell us to stop paying.

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  • Please remember that we pay for the NHS through our taxes. It is not us who should be charged for consulting our GPs but the Government which should be charged with Treason for causing such chaos in the NHS. How can Her Majesty claim that there is good order in her Kingdom when the NHS is in such chaos?

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  • So it sounds as though you would prefer to pay another penny in income tax to rectify the crisis?

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