Posted by: Nigel Praities Editor's Blog17 August 2016
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