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At the heart of general practice since 1960

LMCs Conference is a chance for us to try and save general practice

Dr Kailash Chand

GPs from around the country are gathering on Thursday and Friday for the annual LMCs conference in London to discuss the urgent crisis facing GP practices.

GPs’ ever increasing workloads – not helped by the denigration of the profession by media and politicians – is bringing about a recruitment and retention time bomb. We now have a dangerous situation where there are hundreds of vacancies for GP trainees. Meanwhile, one in three GPs say they are considering retiring early and practices report they are struggling to meet demand for appointments.

An injection of realism is necessary to stop the destruction of general practice

The ongoing, demoralising influence of the regulator, the Care Quality Commission (CQC), only makes matters worse. This supposed guardian of patient safety has lurched from disaster to disaster over recent years – most notably having to withdraw a failed and laughable part of its inspection programme that judged GP practices before its inspectors had even arrived. It continues to require endless box ticking and paperwork from GPs – including records of the number of internal meetings held – which diverts valuable time away from treating patients. Adding insult to injury, the CQC plans to introduce an exorbitant increase in fees that will cost GPs £40m a year, threatening the future of small GP practices and potentially undermining patient care. I am not defending bad practice, but the CQC has never taken into account the circumstances in which practices operate. Variations in funding, the deprivation factor, poor premises, nurses shunning general practice, all of these factors are ignored.

The environment in which GPs are striving to provide services is increasingly challenging. GPs across the country tell us that they are firefighting to provide the services their patients want and the care they need. Without addressing these fundamental problems, we are in danger of undermining general practice to a point where medical students and junior doctors will not take it up and it could be in danger of terminal decline. The highhandedness of CQC is one factor, GPs are leaving the profession. If NHS England is serious in supporting general practice, it needs to abolish the CQC.

Rising indemnity costs are also having a serious impact on GPs as well as stifling innovation. The indemnity fees that GPs have to pay to practices have been rising for decades. When I started my career, the defence fee was £30. In recent years, however, the increasing costs of securing some types of cover have been threatening the viability of some of the services GPs provide. Neither recruitment of young doctors into general practice nor retention of senior colleagues will improve until all GPs working for the NHS are indemnified by the Crown.

At the conference, we’ll look at how the profession can begin to emerge from this gloom. Motions will explore the possibility of longer consultation times with patients, to cater for those individuals who have multiple health concerns that cannot be crammed into such a short session. And other proposals will include calls to explore how practices can work closer together in federations and networks to share resources. Many of the motions will also look at how we can achieve the personalised care patients want – something that is especially relevant given the formation of extended primary care teams, where GP practices include different healthcare professionals under one roof.

The funding crisis and increased demand for care means general practice as patients know it in England is under severe threat of extinction. We can no longer guarantee a future for general practice as our patients know it, rely on it, and love it. An injection of realism is necessary to stop the destruction of general practice. Forcing reform after reform, or chasing spurious projects, can only aggravate the low morale of its workforce. Politicians need resisting, promise after promise rolled out from the podiums, each more lavish than the last and ever more detached from reality. Politicians of all parties, need a reality check, to take a breath and stop playing games with our health services. I sincerely hope and wish NHS England take seriously the concerns expressed in this LMCs conference. The survival of general practice is the survival of the NHS.

Dr Kailash Chand OBE is the deputy chair of the BMA, and a retired GP

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Readers' comments (8)

  • Another chance? Not sure previous ones really did much?

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  • It will be the usual cardigans wringing their hands but doing absolutely nothing that has any effect. Every other LMC conference has been so. Just hot air.

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  • Indemnity as a factor destroying recruitment, retention or return to General Practice been ongoing since 2008. It's gotten worse. It's a fact well known to the BMA for several years. It's time the BMA act to stop the traditional MDOs monopolising this market and so deciding who can practice or not. It's really time to act.

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  • Can you hear the noise of the ladders being pulled up by those who have a good pension thanks very much.

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  • What are you trying to save? NHS general practice or general practice in the UK?

    The later might need a quicker exit from the NHS rather than a prolonged drawn out decline.

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  • Core funding must be increased and be recurrent. In addition it should be recognised that every practice requires a certain amount of funding whatever the deprivation of the area for it to run. This may mean that the days of the single or two handed GP Practices are over. In my opinion we should also define what the core services that we will deliver will be. As a result, anything outside these services should be additional resourced. Practices should not be worrying about whether they can afford to deliver core general practice. There are many who appear to be neglecting core practice because they are trying to tap into other pots of money just to keep their practice alive.

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  • quick exit

    split service -

    1. smaller state health service managed by those who want to work with the state - likely to be means tested, non-comprehensive, free at point of use service. will have a role in training juniors.

    2. small independent private practices run and staffed by primary care teams independent of state. income from direct payments, insurance, employers. comprehensive service. No QOF, disengagement from CQC and re-validation. Greater say in GMC and RCGP. Operate in networks to provide OOH cover (properly funded) and able to refer to state secondary care and private hospitals. payment by activity.

    3. mixed provision - provide some state services and top up with private care.

    such a model will ensure state healthcare exists and ensure survival of a properly funded general practice.

    affordability not an issue as there will still be state provision.

    obvious profession split so why try and unite? let each go their own way a win-win?

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  • Medical defence was £30, but overtime was 30 pence/hour and pay was £ 250.
    I am not sure if medicine will survive the law. I am staggered to read there are 26 billion pounds of outstanding claims against the NHS.
    It is not the MDOs. It is litigation gone mad.
    I would not be a doctor again, let alone a GP.
    One mistake, even perceived can end your career.
    Do another science like computers.

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