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Independents' Day

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)

  • I find the content of this article very very discomforting. The likes of people like Prit and Paul, both very knowledgable to come out with this, right in the middle of contract negotiations, maybe they know something and are trying to help GPC, the timing is rather curious considering the LMC meeting took place in September.

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  • i had a 10 year olds mother at the end of a consultation about another issue tell me 'oh by the way it occured to me that my son could have some loratidine for free on prescription. He doesnt use it often' I reply 'Why do you want me to prescribe something thats so cheap to buy?" She replies "because its free for him" I reply "this conversation we are having now costs money, the ink in my printer ther prescription paper, the charge from the pharmacy to the NHS and our presciption budget is not free. Loratidine can be purchased for a pound from a pound shop i know i have some in my pocket for my allergies. If you want your boy to still have free health care when he's your age dont ask for OTC meds from us. Obviously if its something very expensive or we directly recommend it we make an exception but this isnt one of those occasions' fortunately she took it without complaint. Ive tried tjat elsewhere and got abuse and entitlement in return... i want more funding to provide superior service shorter waiting lists and improved outcomes as well as reducing work load and stress. I dont want government funding just to feed a sense of entitlement. We have lost our way somewhere we need to reign it back in

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  • Anonymous | Other healthcare professional28 Oct 2016 5:41pm

    I think you don't understand the misuse of NHS by patients. I have had so many requests for OTC meds from patients for themselves and their kids. If there is a small misuse, then yeah, it can be sustainable. Now its not misuse anymore - its entitlement. one guy told me,"I f...g pay your wages" for refusing to prescribe paracetamol - 15p for a box in shops. I kept quite. I didn't want to lose my job/risk another complaint. I was so close to saying, '' No, U don't f....g pay my wages. But my taxes pay your benefits. I know because I did your sick notes and I know from the DWP letter you are on long term disability.

    Anonymous Health care professional - U have no clue whats going on and how serious this is. Just don't comment on this website please.

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  • Correction.

    I know from the DWP letter you are on long term disability without any illnesses.

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  • In the UK the NHS has attained godlike status, there is an almost religious belief in it being the only model of healthcare that is even conceivable, whilst it has massive benefits we should not forget it's weaknesses because of blind faith in it!
    GP does not work! It is underfunded, overused and collapsing nationwide, can our work be done in a different fashion? Perhaps, we need to collectively re-examine how we provide primary care services with the budget and resources allocated to us and then decide as a profession if we can consider alternative models of care, private GP? Perhaps! The way things are going in my patch presently means that there won't be any gps left anyway in a few years!

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  • Those who criticise this initiative need to realise that GPs now have only two choices - to broil gently in the pot of increasing workload and decreasing resource, burning themselves out until exhaustion or breakdown forces early retirement - or to look at other inititives such as the one reported here. There are no other ptions currently on the horizon.

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  • This is heresy.

    everyone knows that the NHS model is sacrosanct and we must never ever consider any other models. If we ever do then the universe will collapse in on it's self and we will cease to exist.

    no we must soldier on and find a way to deliver care within this system for as cheaply as we can but must not scrimp on staffing or quality if care. as pointed out the public (well most) pay taxes. Even if they paid 1p / year for GP care that's no excuse. We must be innovative and use new technology (which gets paid for by pixie dust), and have enough staff (who will obviously work for free) and provide every service that the public wants - even expensive cancer drugs, top of the range scanners etc etc. All of these items can be paid for by magic beans and pixie dust.

    the bottom line is - we are out of cash and our collective leaders have no solution. what the LMC have cheekily suggested is that all options are considered to see what possible solutions there are.

    look even if all GPs in the UK worked for Free we still won't have enough money to pay for care i.e. the other staff, equipment, drugs etc. you can hate GPs as much as you like but no money is no money.

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  • Note to Editor Nigel. Perhaps Pulse can help this debate by doing a big feature on national-scale private GP models like Ireland. How do they work? What's the day to day GP experience like? What's the patients view? What do secondary care think of it? What's the outcome data look like? What are the financials.

    The way things are going, we will need the info.

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  • Honestly don't think patients will mind that much if we start slowly introducing the notion our service is not free. Remove the restriction on charging your own patients for additional services - such as weekend or late night appointments. Many of us would happily see our own punters for, let's say £25 per 10 min appointment paid on booking. Some people happy to pay for convenience. That's how it should begin.

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  • I remember as a child well before I went to medical school or even contemplated medicine as a career when the prescription charge of 6d (decimal 2.5p) was introduced in I believe in 1966 (I maybe wrong as I was very young at the time) and I recall experts saying people wouldn't be able to afford scripts and the outrage at having to pay for medicines by some of the population.
    In fact the number of prescriptions filled went up I believe by 10% as they now had value.
    I work in Oz and have done so for decades. It seems to me, if the National religion of America is the right to bear arms then the right to free health care is the National religion of Great Britain.
    I charge a fee for most patients and the government issues a rebate that is paid back into their account usually that day or the next day. The internet is quite effective these days.
    I can choose to accept the governments very low rebate should I so choose to make the consult free. It is up to me to assess the patient's ability to pay and by and large the profession gets it right. Waiting times are non existent and specialist referrals I can mostly get seen within weeks if I twist my mates' arms.
    I understand that there are many patients who say they cannot pay in Britain. My reply is why do you drag the whole population down to the lowest common denominator and by the way how does that result in quality care.
    Last time I was in the UK I ran out of Pregabalin and was told by a GP it was"Black banned".I then asked for a private script and paid for it and sent the bill to my health fund to be rebated. No worries.
    My friends and colleagues,there are many examples of how to fund health care in the world. America is one extreme example as is the NHS. Both appall me. There are many other middle road examples and as is often the case with many problems the middle road is often the best course. The Republic of Ireland is another example with non free health care and better morbidity and mortality statistics. Look at the longevity statistics of Australia versus those of the UK.

    Is"free health care" killing your patients?

    I suspect GPs might have to charge some patients in the UK. Now I have committed sacrilege. Sorry.

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