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At the heart of general practice since 1960

A call to arms - time for a new trade union?

Dr Alan Woodall

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There can be little doubt that general practice will face its ‘Dunkirk moment’ in 2017. Our profession lies exhausted by repeated assaults from a triumphant government intent on stamping out any resistance. We have seen our allies topple one by one - the junior doctors, the consultants - and it is our turn to face the onslaught. Already we are being bombarded by exhortation to surrender to the inevitable. This is now a visceral battle for survival, with nothing but blood, sweat and tears ahead.

Just as in the dark days of June 1940, this is a time for fighting leaders. We do not need polite diplomats reminiscent of a more gentlemanly era who practise appeasement, and who think ‘peace in our time’ can be achieved around a table with politicians who bully, intimidate and lie their way to victory.

Since 2004, GPs have endured a string of defeats, with feeble defence from BMA leaders appointed to protect them. Pensions devalued. QOF goalposts changed. Revalidation hoop-jumping. Ridiculous CQC inspections. Vilification by press and politicians. Practices and people pushed to breaking point and, sadly, beyond.

It is not time for the BMA to be complacent

At each attack, the BMA strategy has been to negotiate to limit the damage. But rarely to counter-attack, and when finally it did over pensions, it was an ineffectual, half-hearted riposte destined to be a failure from the outset.

The grassroots are angry. They are clamouring on social media to overturn years of complacency from leaders who have focused far too often on process and too little on results. The BMA power kegs are not just kept dry, they are degrading from lack of use. It is not time for the BMA to be complacent. The consultants have fired a warning shot with recognition of the HSCA to negotiate on their behalf. This should send shock waves through the BMA establishment. GPs could be next to seek independent recognition.

For many, the final straw was the GPC executive overturning the 2016 Special LMC Conference motion to seek undated resignations from GP members. This desire for action was trampled into dust by leaders lacking the courage for a fight. One of the biggest factors stifling action whenever GPC has actually summoned courage to plan some action is the need to have this 'approved' by the overcautious bulk of the BMA and by the ever infighting BMA Council.

Many grassroots GPs think it is time for these passive leaders to step aside. We need a new leadership willing to fight, and without significant conflicts of interest. Revolution is in the air. It may be via an internal coup within the GPC itself to appoint activists not frightened to call for industrial action. It may be via formation of an independent National Association of LMCs – after all, why should the LMCs pay the levy if their instructions at conference are flagrantly ignored? It may be via one of the online associations gathering momentum, such as GP Survival, who while still embryonic with 6,000 members, are listening to grassroots GPs, not ignoring them from the comfortable armchairs of Tavistock House and Euston Square.

For too long, the BMA have put the survival of the NHS as their primary goal, willing to sacrifice their members on the altar of that sacred cow. Now it is time for them to produce a fully costed ‘Plan B’, demonstrating willingness to take general practice out of the NHS if necessary, should government resources fail to deliver what could be the most effective primary care service in the world.

Time is short. General practice is close to unconditional surrender. The BMA leadership must finally fight back, or step aside and let others willing do so. Thousands of grassroots GPs want action. As Churchill said as the tide turned in the last war: ‘This is not the end. This is not the beginning of the end. But it is, perhaps, the end of the beginning.’ Now is the time to call us to arms. 

Dr Alan Woodall is a GP partner in Wales and founder of GP Survival

This blog is part of our ‘Great GP Debate’ season. If you would like to write a blog on how you see the future of general practice, then please email the Editor at editor@pulsetoday.co.uk.

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Readers' comments (25)

  • This is the kind of person we need leading the countries GPs, NOT THE BMA

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  • What is clear is that the current leadership model for general practice doesn't work and hasn't been working for sometime. There appears to be a complacency inherent in the present monopoly of representation which feels like 'we know better than you' The current route of expression of grassroot GP feeling through LMC to GPC allows watering down and ignoring by those with different agendas who appear increasingly distant. Like the consultants we need an alternative voice; this would hopefully wake up the BMA out of its comfortable complacency and maybe we would start to see action and not words. No change here means no change anywhere and we definitely need change.

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  • Nhsfatcat

    Whilst I usually dislike comparing situations to war, I have to applaud the author because the severity of the situation is existential and although individually we cannot be compared to our armed forces, our service to the nation and our primary care 'regiment' is being destroyed and our leaders whilst delivering platitudes don their helmets for the occasional session on the front line and so can claim they stand by us.

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  • X.Ray

    As far back as the late 1990 Dr Jonathan Reggler a BMA/GPC member was making loud noises about the future effect of underfunding. He even set up the Independent GP Association to consider the Guernsey model of health care funding. But there was the usual damp squib response from GPs. Jonathan in his forward thinking and disillusionment at the whole lot of us emigrated to Canada.The BMA did its best to promote a riot over changes to our pension, but the grassroot GP response was once again pathetic and sent a clear message to all future governments that GPs are too meek to fight for anything.

    Dont blame the BMA. You can change the union but you still have the same group of GPs who dont want to get a bit muddy and bloody and are scared to leave or challenge the current NHS however uncomfortable it is getting.

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  • the end game being what? Mass resignation and dental contract which is exactly what they(DOH) wants. I'm not sure I know what I want. I"M not sure that many of us know what we want. Perhaps this is the first step - to try to find out how we wish to practice in future and start negotiation from there.

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  • A good thought. However as another poster pointed out, most GP s cannot be bothered to or are too scared to fight. Unless people are willing to act, this will be all just talk.

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  • The GPC have shown they either can't, or won't represent the profession and the grassroots GPs working within it. Either way, the collapse continues at an increasing pace. Are things bad enough, for enough colleagues, for them to do something about it? Who knows? Perhaps with effective leadership and more like this piece enough might be moved to act?

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  • It is an enigma to me that although we all acknowledge BMA's complacency, we are prepared to resign from the NHS but not from the BMA.
    Our union barons will carry on paying lip service and looking forward to their next gong for as long as we are prepared to foot the bill for their salaries, pensions and their Tavistock palatial offices.
    In Godfather Episode II, the following immortal words were uttered to an unco-operative producer: "What is going to be on the dotted line, your signature or your brains?" We can slightly paraphrase that to "Either you save general practice or we stop paying you."

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  • I am not sure how dividing the profession solve our crisis.
    Have we not learned from the Juniors debacle that they achieved nothing after all that fighting. It serves blogger's purpose to denigrate GPC, since it justifies and promotes his cause.
    There is nothing stopping the blogger to become GPC chair and bring in the war, which he assumes we are all up for it.
    Good Luck.

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  • We need another union,the BMA is ineffectual.

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