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Let’s call ministers’ bluff and resign from CCGs en masse 

‘We should all stand up, stop moaning and call for a boycott of commissioning if negotiations are not reopened’ says Dr Anthony O’Brien

Why is the GPC not suggesting co-ordinated action in response to the contract imposition? We have a powerful negotiating weapon that we seem to be ignoring. A co-ordinated resignation of practices from CCGs would have no effect on patients or doctors but would cause apoplexy in Government and Whitehall. 

It is surprising that GPs who have been coerced into commissioning are not now questioning whether we wish to continue our involvement. Why should we help the Government with its NHS rationing difficulties? The Government cannot allow its commissioning ‘project’ to fail. But CCGs are membership organisations. The statutory duty to belong to a CCG may be part of the new contract – but it is not in the old one.

If we resign from our CCGs, political chaos will follow. The Government will be forced back to the negotiating table. The public will not be affected and will have no understanding of what is happening. We will not be seen to be complaining about money – just reconsidering the flawed health bill proposals. Commissioning enthusiasts might have to twiddle their thumbs for a bit, but we have survived without fully functioning PCTs for many months. A few more will not sink the NHS.

If practices want to leave CCGs, they do not have to justify themselves. If the Government wishes to use the courts to impose the contract and commissioning, we should challenge them to do so. It is important to emphasise this is not a debate about money or pros and cons of commissioning. It is a point of principle. We have negotiated in good faith and do not wish to be treated in this way. 

Shame on the GPC for being so despondent. We should all stand up, stop moaning and call for a boycott of commissioning if negotiations are not reopened.

From Dr Anthony O’Brien, Silverton, Devon

Readers' comments (3)

  • andrew Field

    I wouldn't say that GP's have been coerced. In our area at least there's a willing cohort which doesn't seem terribly bothered by adverse political climates and contract impositions.
    Furthermore it would seem a little paradoxical for the GPC to reject the control and power involved in the new commissioning arrangements, even if that power seems eroded and underfunded.
    This was debated at last year's conference of LMC's and firmly knocked into touch by the GPC big wigs.
    I totally agree that boycotting commissioning would be a fantastic bargaining tool but I see neither enough radicalism among leaders and colleagues nor sufficient unity in the profession to make it happen (sadly).
    I feel that our leaders are far too timid and anxious about eroding public support if we're seen to do anything remotely radical in protest. The politicians and DoH know this and will continue to walk all over us until we make a stand

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  • I say 'hear hear' to Dr O Brien.
    It mystifies me why the grass roots , already overworked GPs have not found the courage to decline this poisoned chalice with a resounding NO.
    We trained to be clinicians and were taught to be the patients advocate, not health care planners and commissioners, and certainly not as rationers of a shrinking health care budget.
    What a perfect storm we are helping to brew.
    It seems we will be forced to accept mind boggling debt at the outset (despite promises of no inherited PCT debt from government and warnings of how such debts strangled almost all innovative action by pilot commissioning groups).
    Then we must all turn a blind eye to the obvious conflict of interest that this places between GPs and their patients on the one hand and GP's verses their commissioning budgets on the other. ( How encouraging anything other than not for profit organisations to provide health care services in this scenario also mystifies me).
    If a reduction in the overblown management structures and an increase in clinician representation was needed, as many of us had been saying for years ,the answer was surely not to sack one whole tier of health care management and hand their work, unbidden and quite without mandate from either the profession or the populace, to an unprepared and, in commissioning experience at least, largely untrained workforce ( who are already fully committed to their own day job and most so ill prepared for the task that they re hire many of the sacked pct commissioning staff anyway).
    But then, how easy it will be for government ministers to blame those greedy overpaid GP's who have not used the NHS budget wisely enough to provide a 5 star service for all comers despite the ' Nicholson challenge'..( he may yet suceed in avoiding taking the ultimate responsibility for the failings of the services he presided over and led ,but you can bet your last dollar that GPs will not be so fortunate).
    No wonder 50 something GPs are in mass exodus to locum work or retirement, and young GPs are steering clear of partnership in favour of the now , after a 7 year pay freeze for partnerships, frequently more lucrative locum work or a portfolio career.
    Hospital Consultant posts and hospital budgets / PFI finance projects have increased exponentially in recent years whilst GP numbers have stalled or fallen and research shows we are better value than ever. However with unattainable QOF and thev withdrawal of MPIG many will struggle to keep all the plates spinning in the air at once for much longer.
    Add the pension debacle to the whole sorry mix and it is hard to see how general practice can survive the storm. Of course the Government has supported the DARZI concept of large shift led multidisciplinary team primary care centres and the local and national talk is of the growth of federated practices and the likely unviability of small practices.
    I ,for one, know which one is generally more trusted by the public and suspect which is probably more likely to reliably offer high quality family medicine with continuity of care and compassion..and yes, with accountability..and will mourn their loss.
    Conspiracy theorists will say that is exactly what the government intend..the collapse of general practice as an independent entity so that they can finally seize control or sell it all on to the highest private sector bidder.
    Those who still feel General Practice ,as we know it at it's best, is still worth fighting for have only a few short weeks to act to protect it (and ourselves..we are not superhuman and one demanding and responsible job is enough without adding another! ).
    We lost our protected list status with the change of contract, we have lost our intellectual property with the transfer of our patients records to distant software servers and the national spine ,and have proved ourselves unable to strike in any meaningful way over the pensions disgrace for fear of harming patient care. To boycott commissioning in the 11 th hour could be our last stand and most potent weapon.We should not be afraid to bypass our supine representatives and resign from commissioning groups en masse but I fear we have become a cowed and exhausted profession who will continue their increasingly thankless plate spinning and juggling.

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  • Ever tried to herd cats?
    There are too many over-inflated egos out there to get any unified action.

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