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Dr Michael Ingram: ‘GPs are knackered and punch-drunk’

Dr Michael Ingram, chair of the 2013 LMCs conference, discusses the mood of the profession with Pulse editor Steve Nowottny and explains how he wants to represent the ‘hacked-off GP’ at next month’s meeting

Next month, around 400 GPs from across the UK will convene in central London at the LMCs conference. It’s the annual summit of the profession’s democratically elected representatives, an intense two-day bear pit where LMC delegates thrash out the key issues facing general practice and set GPC policy for the next year.

In doing so, they will give GP leaders, politicians, the media and the wider public their best opportunity to truly gauge the mood of general practice in 2013. And Dr Michael Ingram, the man charged this year with running it all, marshalling a record number of motions and somehow ensuring coherent decisions emerge as a result, is under no illusions about just how dark that mood currently is.

‘GPs are knackered,’ he says. ‘I think you have a feeling now that our workload is becoming intolerable, the demands on us are intolerable and the workforce is being squeezed at both ends.’

‘There is a combination of being punch-drunk from the Government, an air of resignation and a rabbit-in-the-headlights feel. Anger is beginning to come through too and fear for the future, fear for the viability of general practice.’

We meet in the grand surroundings of BMA House, the spectacular listed building designed by Sir Edwin Lutyens off Tavistock Square, a powerful symbol of the medical establishment. But Dr Ingram, a GP in Radlett, Hertfordshire, wears his prominent medico-political role lightly, describing himself as ‘very much a grassroots GP’, who first got involved in helping run the LMCs conference by standing for the Agenda Committee ‘in a fit of pique’.


A traditional model under threat

Among frontline GPs there is ‘real anxiety’ about whether general practice can survive in its current form, he says.

‘It’s everything from the viability of rural dispensing practices with changes to dispensing, to the disinvestment we’re seeing now which applies to the majority of practices, and other aspects such as privatisation, the potential for performance management and even any-qualified-provider status,’ he says. ‘Everywhere you look, the traditional model of general practice is threatened.’

Chief among the profession’s concerns, he says, is this year’s contract imposition, with the radical changes to the QOF in particular making GPs feel like ‘a hamster in a wheel’.

It’s a fair bet that GPC negotiators will come under fire at this year’s conference for not having done more to resist the changes, but Dr Ingram, who as conference chair also sits on the GPC, says such criticism does not allow for either the financial or ‘attitudinal’ environment GPs find themselves in.

‘There is a feeling among grassroots GPs that the GPC could have done more, but the GPC is caught between a rock and a hard place,’ he says. ‘It’s impotent and being blamed for its impotence.’


Year after year of ‘constant media attrition’ has stacked the deck against GPs, he says, adding that their public image has become defined by the 2004 contract. ‘The fact is the way we work now is harder, but it’s not perceived by the public to be harder, because you can’t get your own GP at 3am.’

Was the GPC hamstrung by the BMA’s decision to take industrial action on pensions – industrial action that ultimately only one GP in 10 joined? Dr Ingram picks his words carefully.

‘Personally – and this is a personal view – I think it was the wrong area to do battle on,’ he says. ‘There are so many other aspects of what’s going on…

‘We’re part of a collective, corporate body for the BMA, and it’s very important we support the whole profession in its message.’ He pauses. ‘I’m not sure it did general practice a lot of good.’

One of the more controversial votes at last year’s conference saw LMCs demand that ‘disengagement of GPs from clinical commissioning be included in any industrial action’. A narrow 48% to 37% vote made it LMC conference – and therefore GPC – policy. But it’s a policy that has never been enacted – and indeed the GPC has repeatedly ruled out any kind of commissioning boycott.

‘That is something the GPC clearly hasn’t taken on board,’ admits Dr Ingram. ‘It’s quite clear that it’s not as simple as it would appear. The fact is, if you do disengage with commissioning then that’s got obvious consequences. It’s regrettable that that hasn’t been done, and I think we might well see some of that taken further at this year’s conference.’


• GP in Radlett, Hertfordshire for 26 years

• Elected chair of LMCs conference in 2012

• Was member of the smallest CCG in the country before it was forced to merge

• Organises GP academic courses overseas with Conference Plus

• Keen marathon runner


Representing the profession

Do GPC negotiators generally do a good job of representing the views of their constituents?

‘As far as they can,’ says Dr Ingram. He insists the GPC ‘must listen to grassroots general practice’ and follow policy set at the LMCs conference – but he also adds a significant caveat.

Last year an unexpected and even closer vote – 48% to 47% – saw LMCs instruct the GPC to negotiate a hugely controversial change in the GMS contract that would allow patients to receive treatment not funded by the NHS from their own GP on a private basis. It was an instruction the GPC chose to ignore.

‘Though that was conference policy, I would be slightly more defensive of the GPC there,’ he says, pointing out that it was a motion wholly at odds with the BMA’s anti-privatisation agenda. ‘If it’s 47% to 48%, there’s far less expectation on GPC.’

And what of the LMCs conference itself? How well does it represent a diverse and fast-changing profession? Dr Ingram says one of his key goals as chair is to ensure that every kind of GP is fairly represented, and conference feedback forms have been amended to collect key demographics as a first step. 

‘Sessional GPs are underrepresented, and certainly younger GPs – and women,’ he adds apologetically.

He is also acutely aware of the need to represent the whole UK, and was pleased to see the 2012 conference move outside the capital, to Liverpool, for the first time in years. Asked about 2014, he smiles: ‘There will be an announcement soon.’

In the meantime, he’ll be focusing on ensuring that the voice of the profession comes over loud and clear this month.

‘I want to encourage the grassroots GP, sitting brassed off in their surgery thinking “Right, something’s got to be done”, to be able to go to the LMC, and to see the LMC convey their personal message up to conference, up to GPC policy. I want to see a connect between that hacked-off GP and the policies the GPC tries to attain for the profession.’


Watch the full interview

Readers' comments (10)

  • Mark Struthers

    I heard a GP on the BBC radio 'Today' program this morning say that parents claimed GPs had a financial conflict in promoting the MMR because of an 'item of service' fee that each vaccine attracts. He didn't mention the target system that is the true conflict. If General Practice persists in such dishonesty then it is truly finished.

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  • Why are doctors knackered and punch drunk ? Have they not the basic human right of rest and work balance? Are they devolved from the rest of the UK workforce? Who speaks for them ? Where is their Union ? Should they not set their house in order ? The fault is not in our stars, Brutus, but in ourselves.

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  • The comment above (posted anonymously of course) is from a moron. Yes- you halfwit- doctors have a union- it's called the BMA and is the subject of the article you have just posted on.
    And if Mark Struthers would prefer GPs didn't have targets then there are lots of GPs who would agree with him. This is the first time - as a GP- I've commented on a post on this website and it'll be the last. I prefer to use sites were fellow commenters have an idea of how general practice actually works

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  • Mike Morris,

    Don't shoot the messenger. Anonymous 0:45 speaks for many of us who do not feel our union is very effective. We feel this because we are working under intolerable conditions, yet our union is letting the government get away with its targeted propaganda, convincing the public that we are overpaid and underworked. The union should be using media more effectively to counteract the lies that are printed about us. If something is said often enough it becomes truth in the mind of the public.

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  • Mark Struthers

    The media messenger who should be shot the GP who spoke at 8 AM yesterday (25.4.13 at 2:01:56 ) on the 'Today' program relating to the outbreak of measles in Wales and the new campaign to flog MMR to all and sundry.

    The Liverpool GP implied that parents were resentful of the income GPs generated from immunisations despite the "paltry" item of service fee for each MMR. Of course, the GP was very economical with the truth i.e was being dishonest ... in failing to mention the very significant bonus that the GP receives for achieving immunisation targets. These bonuses are highly motivating. But the bonus culture means that the GP is no longer an impartial advocate for patients. And vaccines are certainly not safe for every child at any time the GP is paid to give them ... but GPs don't care as long as they're getting their bonus.

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  • Mark Struthers

    And while there is talk of the bonus culture that has taken hold of GPs, I recall the words of the union boss who said,

    “The ‘quality framework’ that earns us a lot of money, I negotiated that. There happen to be fewer dead people as a result of that contract. About 8,500 people are not dead, where you would have expected them to die.”

    And what do you think should happen to that media messenger?

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  • It is true that we are "knackered" and there is a rabbit in the headlights feel to the new changes brought by the NHS bill. However, I agree that we have participated in the making of this bed with the introduction of a fee for service culture, all be it without realising at the outset where we were heading. I detest the idea of big-business moving into healthcare with profits coming from the public purse, however it is true that our profits also come from the public purse, the difference is in the scale of the individual businesses, the scale of the profits and the fact that the profits go to those who do not physically deliver the healthcare.
    Should healthcare be part of the not-for-profit sector?

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  • Mark Struthers

    Here's one knackered, punch-drunk GP who's giving up the struggle.

    "I am proud to have been an NHS GP. I believe the way a society delivers its healthcare defines the values and nature of that society. In the US, healthcare is not primarily about looking after the nation's health but a huge multi-company, money-making machine which makes some people extremely rich but neglects millions of its citizens. We are being dragged into that machine and I want no part in it."

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  • GPs are not just knackered and punch drunk, they are on the ropes. In my opinion General Practice as I was taught (in the 1980s), is completely finished.
    Whatever iteration is now evolving, it is a profession so far from those standards, it is hard to reconcile what has gone wrong.
    Successive governments treat General Practice as a political plaything and, now, Hunt blames GPs for all that has gone wrong!
    I retired last year at 55 and am thankful for it. I suspect there will be a rush of others soon.

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  • I think anonymous 1144 was being facetious [ a word with all the vowels in order]. I think he/ she is trying to say that all doctors should be defining safety levels themselves to protect against burnout and punch drunkenness [ like pilots do]. Junior doctors have this already, but it took the EU. Why not the BMA ?

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