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One Voice think tank: What needs to be done to reunite the profession?

Leading figures from all sides of the debate give their views on how to promote unity – from establishing a separate political body within the GPC to a new-look, consultant-style GP contract.

By Gareth Iacobucci

Leading figures from all sides of the debate give their views on how to promote unity – from establishing a separate political body within the GPC to a new-look, consultant-style GP contract.

The political world of general practice has been shaken over the last few weeks by the news that many salaried GPs and locums have lost faith with the BMA and may join up with a rebel union. Pulse's new campaign - One Voice - is calling for action to tackle the growing divisions in the profession, including contractual changes to encourage creation of partnerships, a debate at the BMA about improving representation of sessional GPs and a special conference for general practice.

Dr Sam Everington, BMA council member, former BMA deputy chair and GP in East London

‘I think a split in committees at the BMA is inevitable. You just have to look at the same issue a few years ago over staff and associate specialists. They used to be part of the consultants committee. It doesn't matter whether there is actually a conflict of interest. If a lot of people perceive there is, it's very important. There's no reason why you can't have separate committees but then work incredibly close together, as happens with most BMA committees. The concern is that this will divide the profession but I don't see any evidence for that. You're all under the BMA umbrella - we can share resources and work together.'

'There's a whole raft of things that need doing on this issue. The first is training. We need people with training in business, management and personnel skills, rather than just medical training. The second is something around incentives. Quite a lot of GPs I know would be very tempted to move over to a consultant-style contract. It would address the sense among managers that if they invest more, all they do is put up GPs' incomes. We've got to address that. At the moment, I'm conflicted, because more resources could mean more income for me. I would love a consultant-style contract.'

Dr Clare Gerada, vice chair of RCGP, co-author of the BMA and RCGP's ‘Changing Partnerships' paper

‘We have to provide leadership opportunities for GPs of the future. If we partners aren't doing that, we are selling out our general practice heritage. At my group we're creating what we call local medical directors, which are leadership positions that are seen as a stepping stone to a practice partnership. Not all GPs want to be partners. We've got to be honest and say, some GPs want to raise a family, work part-time and so on. But for those that want leadership, we must create those opportunities. '

'The college is looking into this. We've set up a committee called First 5, to look at the gaps and career opportunities in their first five years post CT/ST. That will come up with some recommendations and direction of travel.'

‘It would be nice if the GPC could find a contractual route, but I'm also mindful of the fact that - unlike solicitors and accountants where you can set yourself up independently - you can't as a GP, so we've essentially closed the door to the next generation. We have to create leadership positions. Leadership could be within a practice, within a federation, within a PCT, or even in a Foundation Trust - that's one of the options.'

Dr Clarissa Fabre, president elect of the Medical Women's Federation, GPC member and GP partner in Uckfield, East Sussex

‘I feel very strongly there should not be a split in the profession. It's not in the salaried doctors interests anyway. The BMA giving them their own committee would be a mistake. That hasn't done the staff and associate specialists who broke off from the consultants any good at all.'

‘There needs to be an incentive for practices to take on partners. Practices are encouraged to keep costs down, the more partners you have, the less profit you make. It's human nature. Lots of people have said there is too much allocated to the QOF. It should have been more in the global sum. If they do make an incentive to take on a partner, the Government is not going to put new money in, it's going to be recycling of some of the money we've already got. I think that'd be great if some part of global sum could be tied to making sure you had a certain number of partners per head of the population. It wouldn't happen overnight, it would take a while and have to be negotiated. It wouldn't be a return to the Red Book, but something a bit more like it.'

‘There is a lot of talk about the salaried doctors' contract. I do feel it has to be modified. I believe in salaried doctors' rights but I think the Government should put more money in, and has to do more to pay their maternity pay and sickness leave, rather than leaving the burden on practices.'

Dr Richard Fieldhouse, National Association of Sessional GPs chief executive

‘The current situation, with some salaried GPs exploited because of loopholes in the way the BMA represent all GPs, is untenable. I know we should talk about professional unity, and some think that equals all being represented by the same organisation, but I think that is a big mistake.'

‘In pursuit of true professional unity, we need to leave no stone unturned. If it means looking at alternatives that emancipate exploited GPs, such as consultant-style contracts, we need to look at them. Some people may perceive this as a threat. But we've got GPs who are in positions of forced underperformance, unable to be proper GPs because of their contracts. We have a responsibility to support those colleagues.'

‘With regards to a BMA committee, we need to be involved in a discussion process that heads us towards proper professional unity, which isn't there at the moment. If it works with the BMA – fantastic. If it doesn't work, there has to be another solution. We can't just carry on ignoring it.'

'We're in no way dismissing any potential ideas or talks. Everything is open. At the moment, the position is simply working with the MPU to help raise awareness, to help sessional GPs realise there are alternatives to the BMA if they are looking for local representation in case of exploitation.'

‘If members of our profession are being exploited, that is not GP unity. We need to have a system whereby every doctor is treated the same.'

Dr Laurence Buckman, GPC chair

‘There was a call this year for sessional doctors to have their own craft within the BMA. But from where I stand, I think they are better off inside the body of GPs. What's key is whether they see themselves as GPs first, or whether the sessional issue is so big it transcends all others. The difficulty in being a separate craft is who will they negotiate with? They negotiate with individual practices, largely, so it's difficult to see how they could operate.'

‘I don't see this as a class war between employer and employee GPs. Sessional matters are at the forefront of any item at the GPC. We're very careful to ensure we have the right numbers of sessional doctors present. We've been talking about plans for a working group to look at improving sessional GP representation for about a year. We're looking at how we can get LMCs to make sure their sessional representation is fairer. The ideal is they should get there by being elected like anyone else, but where it doesn't happen sessional doctors' views should be made known to the committee.'

‘I believe this will help, but the NASGP may have a different view based on its perception of the difficulty between sessional doctors and their employers. Where employers are bad GPs, I don't stand up for them. The GPC is not some employer organisation that supports employing GPs even when they exploit other doctors.'

Dr Judith Harvey, NASGP member, freelance GP and former partner

‘In general, and I stress this is a generality, GPs haven't had a good record as employers of other GPs. A lot of employed GPs feel they are being exploited and used, and find it hard to get help, or don't know where to get help. The GPC's role has been as a representative of partners who have traditionally been the overwhelming majority. I think the way things are at the moment, incentives to take on partners should be given serious consideration as a strategic measure for the good of general practice. Giving sessional GPs their own committee would be institutionalising the division. That might be a good or bad thing. But I'd want assurance that it was in everybody's interest. We are increasingly fragmented, and communication becomes harder. It's about giving your employees what they need to their job.'

Dr Sam Everington, BMA Council member Dr Clare Gerada, RCGP vice-chair Dr Richard Fieldhouse, chief executive of the NASGP Dr Richard Fieldhouse, chief executive of the NASGP Dr Clarissa Fabre, president-elect of the Medical Women's Federation Dr Laurence Buckman, GPC chair Dr Laurence Buckman, GPC chair Dr Judith Harvey, NASGP member Dr Judith Harvey, NASGP member Sign the One Voice campaign petition

Pulse is running an email petition to call for all the main political parties to support moves to open up opportunities for partnerships.

The petition, which will also be submitted to all primary care organisations, will be a key element of Pulse's One Voice campaign to help bring the profession together.

It reads: ‘We the undersigned believe the declining opportunity for new GPs to become partners is at the root of the divisions within general practice, and is weakening the ability of GPs to act as strong advocates for patients and maintain continuity of care. We call on politicians to recognise the value of the independent-contractor model for providing innovation and long-term care for patients, and to explore contractual changes or local incentives to make it more financially attractive for practices to take on partners.'

To sign our petition, email your name and practice location to

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