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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)

  • The problems is that the Great British Public has been part of the problem. Not enough is paid for Primary Care. It's Government's job to fix this, not ours.

    There is nothing to say that individual GPs should be forced to work in an unsatisfactory, dangerous (at times) system. This is not our problem to fix.

    Personally I would welcome privatisation of this market. As a patient, it wouldn't be good for me. As a provider, I know that I would work less and earn more.

    Unfortunately it's time to stop this lie - you cannot have excellent primary care for approx £130 per year - it just doesn't add up.

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  • Dear Pharmacist at 11.00 am .You are very much ill informed about GPs pension and staff costs. Please go and check facts. GP partners pay for their pensions themselves (both employees and employers contributions). Staf cost are paid from GPS gross income.
    With regards to payment of rent, yes that is paid by NHSE ,they can stop paying rent and increase our gross payments .Its one and same.

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  • Took Early Retirement

    I think there was a misprint: the BMA statement should read, "The BMA GPs committee is totally committed to supporting and working with Jeremy Hunt in mis-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 Jeremy Hunt".

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  • Took Early Retirement

    Also, the idea that patients have somehow "already paid" is a myth. If they did (and the same for education and social care) we would npt be running up billions in debt every month. The problem is that the British Public want a Rolls-Royce Sevice, but want to only pay for a Hyundai.

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  • But I am sure that the pharmacist knows that the 140/pt includes staff wages and running costs. etc. Profit in NI used to be 80 pounds per patient year, for about 4 consults and 20 other contacts [ prescriptions, lab, letters, phone calls, treatment room etc].
    I think it is good value but obviously the Govt does not think so because they have cut the share of GP land from 11 to 5.5%, so that profit is about 56 for 6 consults and 32 other contacts per year.
    Ultimately, market forces will either find enough GPs at that rate or they will be gone and may find a better rate. Only time will tell.
    In any case, I think different causes will change doctor land. The GMC, litigation costs and trauma, CQC and the dangers associated therein will decrease the folks wanting to do Medicine.
    I know that I would not embark on this perilous journey today.
    I would have become a computer nut or looked out at the stars. Medicine is just frightening and I do not recommend it to anyone.

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  • £140 yr for pet insurance, wow that is cheap who are you insured with.

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  • Dear GP Partner, its bulk discount 1 dog and 2 cats (approx £140/ animal)
    Moral of the story is people whinge at GP getting that much amount to look after them, so basically government equates people life same as animals life. Thats great for animal lovers but not for us human beings.
    Public has to realise that If you want Rolls Royce service be prepared to pay for that. ,Don't expect that service when only pay for Fiat.

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  • 10:55am The boomers have done a lot of damage, not you personally. We know most doctors did 100h weeks in the past but things have changed and you weren't hunted to extinction by venal lawyers and a corrupt government. As for mortgages - where have you been living? - The housing crisis is at least as bad as the NHS one! A short period of hyperinflation ate away at your debts unlike the present medical graduates who owe £100,000 and are threatened with being imprisoned in the NHS to pay back their "training". Mobile phones are not really a luxury item any more and at least you still had a local rather than a rip-off wine bar! Good good, how out of touch can you be with the struggle of the millennials? No wonder they are unhappy. The boomers have a huge debt to pay to society and the creditors are knocking on your door...

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  • I wonder where have all those anonymous contributors who have been saying that because people pay national insurance contributions they should get free health care for rest of the life have gone?

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  • Having had a couple of days off I woke at 3:30 this morning (2hrs before my alarm) worrying about what I would come into this morning, and how I would squeeze the quart of demand into my pint pot of a day. Working in NHS general practice is like being waterboarded for 40hrs a week. And I'm not even clinical.

    If you think you have a better alternative I'm all ears.

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