‘GPs get a deliberately bad press’
BMA Council chair Dr Mark Porter talks to Caroline Price about defending general practice, his plans for the election and the implications of co-commissioning
Late and apologetic, Dr Mark Porter weaves between his press officer, lighting rig, photographer and tripod to greet me.
The anaesthetist has seen it all before in his two and a half years as chair of the BMA and is more than comfortable with meeting the media.
But Pulse meets him as he prepares to launch his biggest-ever media campaign, challenging politicians to ‘stop playing games’ with the NHS in the run-up to the general election.
Dr Porter is well aware that he has a hard sell, particularly with GPs who, he acknowledges, are likely to be sceptical, having been at the sharp end of politicking over the NHS in recent years.
But he is combative over what he sees as politically motivated attacks on the ‘failed’ GP contract.
‘It’s not a failed contract,’ he states. ‘It’s a contract negotiated in good faith by the profession and the Government at the time to address certain problems.
‘One of the reasons is the Government wants something different now, and its way of getting something different is to engage in constant criticism.’
And that criticism is jeopardising the future of the profession, says Dr Porter.
‘GPs get a bad press – at times you might say deliberately bad,’ he says. ‘When young doctors are making decisions they look at the criticism GPs get – not only in the press but also, for example, the effects of CQC inspections and the way they bear in particular on GP practices.’
And his view that many trainees view general practice unfavourably is backed by the latest figures. Pulse revealed online last month that GP trainee applications have fallen 6% this year to the lowest number for six years.
‘We’ve seen a number of plans from various bodies – whether that is Health Education England, the Labour party, or whoever, to increase the number of GPs. You think – great, somebody’s recognising there is a problem.
‘But I see a variety of problems with that,’ he explains. ‘The main one is persuading people to sign up for general practice. The training schemes are underfilled in many places. People are not choosing general practice in the same numbers we would like to see.
‘You can announce an increase in training places but the question is: will people come?’
But Dr Porter is prepared to back his words with action. Just weeks after we meet, he kicks off the BMA’s ‘No More Games’ campaign with a giant sculpture in the shape of a Jenga block at BMA house and posters all over the country.
Dr Porter is keen to emphasise the BMA’s role in addressing recruitment problems. For example, he points out, the GPC was involved in developing the 10-point plan for GP recruitment from NHS England, and the GPC ran its own ‘Your GP Cares’ campaign to engage patient support for doctors on the front line.
‘We want to see health and the health service being a really important part of the debate in the general election,’ Dr Porter says. ‘It takes up one-sixth of public expenditure so it’s a matter of concern to the entire population as well as, of course, to our members.’
He says that Labour’s policies fit most closely with the BMA’s objectives, but criticises the party’s past experiments with private providers: ‘We should remember it was the previous Labour Government that brought in the extension of the market following experiments with independent sector treatment centres.’
He expects the Conservatives to do ‘more of the same’ if elected and concedes that the Lib Dems’ plans do, in some respects, ‘cohere with what BMA members want’. But he says, with a smile, that he is ‘intrigued’ by UKIP’s proposals (the party has announced it wants to scrap the CQC and revalidation) although with the caveat that its position ‘isn’t as consistent’ as other parties’, referring to the recent difference in views over the role of private health insurance in the NHS.
He is taking nothing for granted in the current uncertain political climate: ‘I’m intrigued by what’s going to happen when we try to engage with UKIP about their policies for after the general election.’
This low turnout curtailed the union’s power and while other NHS unions have been out on the picket lines to protest against Government policy over pay, the BMA has stayed largely silent. Many GPs are disillusioned with a union that at times seems powerless to protect them.
In a further threat to the BMA’s role, the GP contract is being quietly unpicked by CCGs, 65 of which have been given the green light by NHS England to take full delegated commissioning responsibility for GP services from April. Pulse revealed 12 already have plans to introduce an alternative to the QOF.
At last year’s LMC conference, GP leaders voted to oppose giving primary care budgets to CCGs, but Dr Porter has more of a nuanced view.
‘Co-commissioning is fairly new, and it’s something individual GPs and practices are taking different views on,’ he says. ‘We don’t have a settled view yet because of those two factors.’
But won’t it inevitably have an impact on who controls the GP contract? ‘Absolutely,’ he says. ‘It will and it is meant to.
‘That said, many GPs and CCGs face a rather stark choice – either try to take the best they can from whatever’s on offer, or try to ignore it on principle and hope things will get better.’ Dr Porter will hope that many choose the latter option.
Is there a greater role for GPs in A&E departments?
Yes, but this has to be an individual choice for GPs. GPs’ job isn’t to sort out who attends hospitals – it is to actually provide general practice services for the population.
How do you make general practice a better place to work now?
Answers to that have to revolve around people deciding they want to stop having a go at the NHS.
Is the BMA going to launch some sort of marketing campaign aimed at general practice, like the RCGP?
We don’t have any specific plans to do anything similar in parallel to what the RCGP is doing.
Will the initiative to pay GPs not to retire early be successful?
It wouldn’t, if it had been the only thing announced, but being part of a package makes it more viable.
Do you think the Government deliberately stoked patient demand in order to make the case for an alternative health system?
No, I don’t believe the people running the NHS, or indeed Government ministers, set out to deliberately cause the NHS to fail and fall over.