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At the heart of general practice since 1960

Is it time for all GPs to resign from the NHS?

Dr John Cosgrove argues threats are the only language ministers understand while Dr Roger Henderson says widespread resignation would divide the profession

YES

The challenges facing general practice are well documented. Increasing levels of multimorbidity, an ageing population and health inequalities are cited in the NHS Five Year Forward View. This is not news, but the message about rising pressures still does not seem to be getting across. Jeremy Hunt’s much-trailed ‘new deal’ for general practice contained neither anything new nor any sort of a deal.

Experience tells us the only effective negotiating tool to bring about real change is a credible threat of mass GP resignation. Holding undated letters of resignation enabled the BMA to negotiate the 2004 GP contract, and the time has now come for a similar move.

This has the potential to persuade the Government to resource general practice adequately and to support us in defining our remit and that of the NHS. While there seems to be a growing belief in some quarters that GPs could be replaced, the NHS would most certainly grind to a halt if it lost us tomorrow.

After all, the health service cannot survive without GPs. Managers calling our bluff is not an option; GPs and their unique role are indispensable in any efficient healthcare system. If we were working outside the NHS, society – whether individuals, co-operatives, insurance companies or government – would have to find ways to reimburse our patients for the use of our services.

While it’s not easy to contemplate turning our backs on a job many of us care so much about, it’s the only way to recharge a profession that’s chronically underprioritised and misunderstood by the Government. As a proportion of GDP, the UK spends less on healthcare than the top 13 OECD countries and, despite the RCGP’s ‘Put Patients First’ campaign, our share of that spend continues to fall, even though 90% of all patient contacts take place in general practice.

While integration makes sense in many ways, there are pitfalls. Super-partnerships and federations are well suited to the current climate, but there is a threat they will accelerate the well-established shift of work from secondary to primary care while allowing social services to raid the cookie jar that is the ring-fenced, but inadequate, NHS budget.

Measures to improve general practice, such as ending media vilification, better targeted health campaigns and improved management of patient expectations will just be a wish list unless we do something radical. That’s why I say we should prepare to abandon ship – now.

Dr John Cosgrove is a GP in Birmingham and an RCGP Council member

NO

At first sight this may seem like a no-brainer – of course we should all resign. Morale is at an all-time low, we are working on less than 7% of the NHS budget and, rather than the promised 5,000 new GPs galloping over the horizon, we will probably have 5,000 fewer by the end of the decade as we retire in droves. Add the disappearance of MPIG and seniority payments, and the fact the number of NHS doctors working as GPs has plummeted to 25%, and things look even worse. Working days of 14 hours have become routine, which is why we’re all permanently exhausted.

Looking at this logically makes the prospect of resignation less rosy, though. Despite the frustrations, to make primary care work we have to be inside the NHS tent talking to ministers, not outside shouting into it.

If we fire our one and only negotiating bullet – the one marked ‘Stuff this’ – from our elephant gun then, yes, there will be a lot of noise, we will briefly feel better and it will shake up the media and politicians. But once the shock and awe has settled, the NHS will still be there, patients with no one to trust but their GP will still need to be seen, long-term care in the community will not have suddenly disappeared and, perhaps most importantly, we will have a divided profession since the one thing we can all probably agree on is that we’ll never get 100% of GPs signing resignation letters.

Within days, public support will plunge from the high level we maintain despite all the setbacks, and the words ‘greedy’ and ‘uncaring’ will plaster the front pages. And that’s without wondering what will happen to our pension, income, premises, staff and cost-rent schemes.

Achieving active change needs mass involvement, certainly, but not mass resignation. We must start with a strong trade union fighting to increase the global sum, to help to stop us drowning in pointless paperwork, and to cut back on futile CQC visits and the bureaucratic burden they impose on us. Working as larger practices may be a way forward, allowing for greater workforce resilience and economies of scale at one end of the spectrum, and better use of premises and resources and increased commissioning influence at the other.

We may all be sorely tempted by the idea of a mass throwing-in of the towel, but ultimately it would be a pyrrhic victory and lead to the break-up of the NHS as we know it.

Dr Roger Henderson is a GP in Shropshire

As debated at Pulse Live in Liverpool - find out more about Pulse Live by clicking here

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Readers' comments (12)

  • Yes it is!!

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  • Strike.....something that I have been advocating for years. You didn't and now look at what is happening!

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  • This would be a bad move.i think by doing so the government will dovide and rule because there will be few slave gps who will work for even a penny.

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  • There has never been a better time for gps to resign to show that we mean business and to show solidarity with junior doctors. Are you not all totally fed-up with all the crap the govt has dumped on us over the years? Do not let the rcgp cardies put you off and do not rely on the bma who could not negotiate their way out of a paper bag!! Is it only the junior doctors who have any balls? Shame on you if you do not stand up for yourselves!!!!

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  • The reason we are where we are is years and years of accepting crap for the devils opium MONEY !!!
    We have lost our street cred and self esteem and most important of all our one to one whole patient care role.
    No out of hours when our patients need us most
    The minute our patients get anything serious diabetes COPD etc then woosh it's off to a nurse run clinic you go
    Accepting the utter disgrace of 6 minutes per patient
    Accepting the degrading deals where we are paid/ bribed to do what any good doctor should be doing ( I'm talking Qof here )
    Resign give patients the time they need/ deserve take back the work we should be doing from nurses in out of hours and serious long term illness go back to our proper role of expert clinicians with only the quality of the medicine we practice as our banner
    Boy O boy would the public eye on our side
    TAKE BACK OUR SOULS leave the rest to God

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  • resign to renegotiate? bullsh*t, resign to go private

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  • GPs need their own Union. We could not trust the BMA to tell the time correctly, let alone negotiate our resignation on our behalf.

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  • Mass resignation won't happen. What other handles does the BMA have?
    - a mass petition signed by those attending general practice provokes a debate in Parliament. The opposition is asked to debate the cause vigorously.
    - sympathisers in the TUC and left of centre parties organise days of protest about the NHS
    - we form a nationwide c0-op, of NHS workers to bid for contracts. It becomes so big, it has genuine power to negotiate effectively with the commissioners.
    - and yes - we agree to provide n consultations/1000 patients per week. Seventy has been suggested by NHS Executive. Might this include telephone consultations, and nurse consultations? If so it can be done - but in deprived areas more may be needed, and extra time for lack of shared language in metropolitan areas.
    -

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  • 'We may all be sorely tempted by the idea of a mass throwing-in of the towel'

    Yep

    'but ultimately it would be a pyrrhic victory'

    Nope - because it would

    'lead to the break-up of the NHS as we know it.'

    Result!
    The NHS is perfectly designed to provide the cheapest service possible by squeezing the most work out of the staff.

    I think patients would be prepared to top up their government primary care allowance to access higher quality, more patient focussed, more accessible care. I would love to provide this, and every patient waiting to be seen, or struggling to get an appointment, would be an indicator of success or the need for me to put my fees up!

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  • I would like to clarify that whether general practice's share of the NHS budget has risen or fallen over the last year is open to debate by wiser minds than mine.

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