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At the heart of general practice since 1960

This is the moment of truth for Team GP

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Watching Team GB in the Olympic velodrome is a real education. Strategy is just as important as strength; gold medals are won with the head and the legs. 

In a similar way, it is time for the GPC to show both potency and nous. 

GPC is not confident partners will lay their livelihoods on the line

We will hear this week about whether it will canvass support in the profession for industrial action. The three-month deadline set by the LMCs Conference in May is up and NHS England has not delivered enough to head off a rebellion from GPs.

NHS bosses may have announced a £30m indemnity reimbursement scheme, new measures to stop hospitals from dumping work onto practices and £16m for struggling practices, but even under a generous definition, this does not approach the measures called for by LMCs.

The GPC’s own Urgent Prescription for General Practice – backed by the LMCs Conference - calls for daily consultation caps, separate contractual arrangements for care homes and the removal of GPs’ responsibility for non-NHS work. There is little sign of these ideas coming to fruition by the end of August, so the BMA must declare a 'trade dispute'.

So are we heading for all GPs submitting undated resignations? My feeling is no.

The signs are that the GPC is not confident partners will lay their livelihoods on the line. The pensions ‘Day of (In)Action’ in 2012 still looms too large in Dr Chaand Nagpaul’s consciousness and the implications of following through with this threat is too grave. 

But there remains a real hunger for action. The GPC knows this, and will have to come up with something that the profession can unite around. So what are the alternatives?

Pulse gave some back-of-the-fag-packet suggestions in June. I have raised the idea of all practices closing their lists: easy, sends a message practices are too full to care safely for patients and gives NHS England a real headache. Tick tick tick.

Other alternatives include non-payment of CQC fees or non-cooperation with appraisal. Both have legs, but BMA lawyers will have had to look very closely at the legal implications.

Practices setting a limit on the number of consultations in a day, and referring all urgent work elsewhere if breached, is another option. Let’s face it some practices quietly do this already, but it would hit patients hard.

All of these options have positives and negatives, but - in lieu of resigning - could be capable of giving the profession back a sense of control and delivering a sharp poke in the eye to the NHS. More importantly, GPs are far more likely to follow through and they also allow a bit more wiggleroom for the GPC. 

As Jason Kenny can attest, you have to keep something in reserve to ensure that you can power over the finish line. The implementation of the GP Forward View is still up in the air – in particular how the £2.4bn by 2020 will reach the frontline – and the time is ripe to influence this and exact more concessions from NHS bosses desperate to keep their ‘transformation’ programme afloat.

But delivering all of this relies on the GPC not jumping the derny too early. And as we saw yesterday, even five-time Olympic champions struggle with that.

Nigel Praities is editor of Pulse

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Readers' comments (13)

  • No OOH for 1 month would do it . But it cannot happen because people cant be bothered to do an OOH ban . There is the weakness . It will be exploited . We will have to wait until the system decays naturally . Any ideas on how to accelerate this process would be welcome.

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  • ' could be capable of giving the profession back a sense of control and delivering a sharp poke in the eye to the NHS'

    Not sure we want to poke the NHS IN THE EYE. it's already injured enough.
    It's the politicians most GPs want to directly affect.

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  • GPs are so divided at all fronts,no action is practical,possible or deliverable. Sessional,locums, PMS,GMS and now ICOs,MCPs Manchester situation all have their vested interests. End for general practice is round the corner....

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  • GPs will never act as one body like the JDs did. Never.
    Therefore the best thing that can be done is accelerate the inevitable collapse, get it over and done with, and the GPC to urgently outline suggested models of private care for GPs to follow.

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  • Why do we always hear suggestions of OOH bans? Hardly anyone does it now! It's mostly salaried. Stopping doing OOH would make no difference (17/8 19)28

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  • "GPC to show both potency and nous"

    No, not so,the GPC cannot show either:
    There is a vacuum of purpose in the GPC
    There are those who wish to reduce GP workload to a safe sustainable level,either by increased NHS funding, or other means.
    Opposing are those who hold to the principle of free at point of use,regardless of consequences,the ideology taking precedence over the reality
    Without a unified view from one organisation it is unlikely progress can be made

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  • Team GP will never win anything because its not actually a team and those "competing" against you dont play by the same rules and certainly dont engage with you in good spirit;

    You also have the profession being directed by a group of people who are disconnected from the majority. Most of these people are self serving and their actions are responsible in part for the rot that has set in the vocation for at least a decade or so, its just become more evident and decayed faster due to the dreadful economic circumstances that have hit the countries coffers.

    The "do as I say" dictates can only be met with unity and and non cooperation, otherwise all the "emergency gpc meetings" are empty threats.

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  • Why have we still not learnt from the juniors? Why aren't we moulding the message, sharing the ideals, mobilising online and speaking out more?

    Why aren't we building to crescendo through carefully correographed acts of defiance which will unite and motivate? Why isn't Nigel invited to GPC to moderate their stupidity and raise them from their slumber?

    Why do we think we can turn the supertanker quickly or without getting it moving first? Why are we so afraid of mistakes that we don't act?

    You've got the words to change a nation
    But you're biting your tongue
    You've spent a lifetime stuck in silence
    Afraid that you'll say something wrong
    If no one ever hears it
    How we gonna learn your song
    So come on ,come on
    Come on, come on

    You've got a heart as loud as lions
    So why let your voice be tamed?
    Maybe, we're a little different
    There's no need to be ashamed
    You've got the light to fight the shadows
    So stop hiding it away
    Come on, Come on

    Yes, I wanna sing, I wanna shout
    I wanna scream till the words dry out
    So put it in all of the papers,
    I'm not afraid
    They can read all about it
    Read all about it oh
    Oh-oh-oh

    At night we're waking up the neighbors
    While we sing away the blues
    Making sure that we're remembered, yeah
    'Cause we all matter too
    If the truth has been forbidden
    Then we're breaking all the rules
    So come on, come on
    Come on, come on,
    Lets get the TV and the radio
    To play our tune again
    Its about time we had some airplay
    Of our version of events
    There's no need to be afraid
    I will sing with you my friends
    So come on, come on

    I wanna sing, I wanna shout
    I wanna scream till the words dry out
    So put it in all of the papers,
    I'm not afraid
    They can read all about it
    Read all about it oh
    Oh-oh-oh

    Yes, we're all wonderful, wonderful people
    So when did we all get so fearful?
    And now we're finally finding our voices
    So take a chance, come help me sing this
    Yes, we're all wonderful, wonderful people
    So when did we all get so fearful?
    And now we're finally finding our voices
    So take a chance, come help me sing this

    Emily Sande, Read All About It

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  • Peter Swinyard

    The LMCs Conference handed Chaand and his team a major headache when voting to canvass for undated resignations. When the world was a different place, in 1966, general practice had a monopoly of primary care and was a sole practitioner model with a few partnerships or group practices (not the same thing). The NHS was only 18 years old and many doctors had made a perfectly decent living outside the NHS and could see that as an alternative.
    Now the NH~S and "free at the point of access" has become a religion and a political mantra. With about half of GPs now on a salaried model - partners handing back their contracts are taking a massive financial risk as they will be left with a buildings and wages overhead which was just not there in 1966. I think that to hold this vote would hand the perfect weapon to the government who would see that we lack the will for the sort of all-out fight which we admire in our juniors.
    There is no easy going back from an NHS.
    Yes, we could still make a perfectly decent living outside the NHS -as long as patients could still have the NHS prescriptions to which they are entitled, the main barrier to private practice financially for many.
    When the NHS collapses, we will have a choice - private practice and holistic patient care or corporate-run penny pinched minimalistic poor-law service. What a future to behold. Can it be different?

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  • I want the NHS to survive more than I want general practice to survive. I'm proud of my skills as a GP but I think that if one was designing an NHS from scratch one wouldn't necessarily have to have GPs at all so we mustn't commit professional suicide. I want wide-ranging and serious debate about what it is about the NHS that is worth saving. It certainly isnt any possible treatment for any possible problem 'free' and paid out of tax. I think it is something to do with an impartial honest opinion on a patient's health problem. This empowers the patient -even if they then have to work out how to pay for a particular treatment.The key being being that the health professional giving the opinion on a treatment doesn't then have personal gain from the provision of that treatment. We have a bit of that in the NHS, particularly in general practice, so let's hear our leaders getting that message across

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