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At the heart of general practice since 1960

So where to now, GPC?

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Politics is a funny old game. Our leaders seem increasingly impotent in the face of events, despite all the trappings of a modern democracy.

And this is reflected in medical politics. My overwhelming impression of this week’s statement from the GPC was that it sounded like a retreat.

Sure, I get that mass resignation was always going to be difficult (if not impossible). It was an imperfect solution foisted on the GPC at the end of a ‘special’ LMCs conference in January that was keen to be seen to ‘do something’.

Where is the new hope for a demoralised profession?

LMC representatives went home satisfied. Not many took pause to think about whether resigning was a workable solution or not. Mass resignation meant something in the 1960s when most GPs were partners and the NHS was very young. Now the risk is that Jeremy Hunt would simply say: ‘Go on then.’

But I worry that, rather than heed the will of grassroots GPs, the profession’s leaders have chosen to listen to the very ‘platitudes’ from NHS England that GPC chair Dr Chaand Nagpaul railed against in his speech in January.

May’s LMCs Conference was very clear that unless NHS bosses ‘accepted’ the GPC’s Urgent Prescription for General Practice, support would have to be canvassed for mass resignation and/or industrial action. NHS England mirrored this wording in its letter to the GPC, saying that it ‘accepts the BMA’s Urgent Prescription as a good basis for further discussion’ – but that has a very different meaning.

Dr Nagpaul tells Pulse that legal advice and feedback from GPs contributed to the decision to drop plans to ballot the profession on industrial action, but the fight for the future of general practice seems to have boiled down to a few vague statements, such as ‘ensuring that GPs work within safe limits’, ‘enabling GPs to have longer appointments’ and ‘empowering patients to better manage their own health’.

Where is the radical change that will dissuade hard-pressed GP partners from retiring or locuming? What happened to all the ‘if not now, when’ fighting talk from the LMCs Conference? Where is the new hope so badly needed by a demoralised profession?

The BMA will carry out yet another survey of GPs next month ‘to ensure that the profession’s priorities and views are properly taken on board when we continue our negotiations in the future’. But cold, hard cash is what will make a difference to practices in dire straits right now. Cold, hard commitments to relieve workload.

The GPC should be demanding the promised £2.4bn from the GP Forward View now, not accepting £30m to reimburse rises in indemnity fees next April. It should be demanding compensation for the failure of support services and refusing point-blank to accept any more patients until the QOF is suspended, CQC inspections are binned and the funding for the unplanned admissions DES is paid in full to practices whether they have done the work or not.

I despair, I really do. OK, I urged the GPC to not jump the derny last week on this issue, but chucking the bike away at the starting line is a bit much. Yes, I am a mere journalist shouting from the sidelines – I would make a terrible politician – and there has been ’considerable dialogue’ behind the scenes, but there are other options the GPC could take to protest (check here for a list).

The thing needed right now is brave leadership, but all I can see is the GPC eagerly opening a giant box of Daz to make its white flag look even whiter.

Nigel Praities is editor of Pulse

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Readers' comments (14)

  • Spot on,Nigel! White flag by GPC .
    What next???
    Pack up your bags.....end of general practice is not far off !!!

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  • Vinci Ho

    You see.
    You never say never. As I said I would have voted to support mass resignation if there was a ballot now ,though I was not sure about whether 'now' is the Kairos. A ballot , however , has its Telos. To trigger a confrontational debate as well as creating a 'passing moment' for other non-cooperation movements is the underlying aim.
    The story of the Labour Party Chosen One sitting on the floor of a Virgin Train with the political agenda of taking back train service under public ownership , looked a bit stupid and far fetching . But it certainly had turned a little storm in a teacup into national headline. Typically , his nemesis Agent Smith , the cardigan boy, took the side of Virgin as he appeared to be the 'non-lunatic' one.....
    The war was lost not by enemies breaking through the front gate of the castle but by those who opened the gate from inside.........
    Perhaps , mass resignation was referring to membership of the union instead.......
    Call me a naive dreamer......

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  • BMA / GPC to ask all GPs if they are in agreement for the BMA to fund a lobbying company to spread the word across social media, main media and lobby MPs that from date.... The following will take place:

    Only 12 consultations per session.
    All secondary care work refused - no follow up bloods, no monitoring and prescribing of methotrexate, sulphasalazine, mycophenolate, no monitoring of mental health, no methadone prescribing
    Monitor every letter coming back from hospital and refer back PRN
    No bloods done in primary care, apart from QoF, if this still applies - refer to hospital
    Refer to out-patients or A+E for everything that requires investigations
    Prescribe branded rather than generic drugs
    No home visits if patients can travel in a vehicle / taxi

    If there is no formal limit to the increasing work load in primary care.

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  • Can someone please tell me why Nigel is the only one speaking any sense? And he is not even a GP!

    I f*cking despair, I really do.

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  • I sometimes wonder whether key leaders in the BMA, CQC etc have been 'bought' by the Government....pretend to care, but do nothing.

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  • Dear All,
    Read this very carefully and maybe read it again in the morning before you decide.

    I am on GPC and was part of the vote to defer the action. The reason Nigel is apparently the "only one speaking any sense?" is because he was not there at the moment and did not have access to all the information.

    This decision is not a capitulation, it is a pragmatic evidence based experience grounded political decision.

    The special LMC conference laid down a gauntlet. After drips and drabs and at the 11th hour NHSE sent a letter that appears to accede to all the remaining Urgent Prescription demands. As a seasoned GPC subcommittee chair I repeat "appears". My scepticism is undiminished but happy to be negated by delivering on promises.

    In the circumstances who could possibly expect that all the devilish detail surrounding the complex Urgent Prescription demands could be delivered within the timetable demanded by the LMC conference resolution?

    So what has been agreed is a deferral not an abandonment.

    You cannot negotiate except on the basis of good faith; if NHSE comes up with the goods then all will be well.

    What has actually happened is that GPC has decided to withhold its sanction to give NHSE time to flesh out their proposals (for problems that we agree and have argued may take up to ten years to resolve). So be patient.

    If NHSE does not come up with the goods you will have your opportunity to express your anger and dissatisfaction.


    Regards
    Paul Cundy
    GP Wimbledon

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  • Paul Cundy @0.30

    The big problem is that General Practice needs the necessary changes 'now', not in ten years time. By then British General Practice will be long gone. That is why we are all so angry.

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  • We've already lost a practice down the road.

    It's too late, something needs to be done very fast. It's within the government's power to fix this but they have clearly chosen an alternate path and the cuts continue.


    The concessions announced by the BMA don't amount to much. There is no immediate funding boost and no protection from the extraordinary level of risk we face daily. Doctors are losing their livelihoods and patients are losing their care.

    This is why we need IA.

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  • @Paul Cundy - thanks for your honesty.

    The trouble is there is no goodwill left.

    People are rightly angry and panicking about the future. To tell them that you need more time to work with a department that we all know has no interest in saving GP, and that these changes may take 10 years, is only going to inflame the situation more.

    Eventually you will need to realise that you are our representatives, and if you do not represent our views then you should consider your position as a negotiator on our behalf.

    We have told you what we think - now you should do as we have bid you.

    Frankly, to tell the angry mob to "be patient" is insulting and infuriating. People are losing their practices, their patient goodwill, their livelihoods, their families and their lives over the state of GP at the moment and this has been coming for a long time and the patience has ALL GONE. You do not seem to realise the urgency here.

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  • Sad to say I despair. Very hard to remain working when I totally disagree with many long term proposals for Primary Care. Most of us are intelligent, self- motivated individuals. The micro- management, and lack of ability to work in a way that we see fit, only serves to demoralise us. I am taking some time- out. I may locum - or I may give up on the NHS entirely. This feels so sad after years of training and hard work.

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