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At the heart of general practice since 1960

Mass resignation will happen if the Government continues to ignore GPs

Dr Kailash Chand

I have no doubt that GPs will campaign for mass resignation if the Government continues to ignore their plight. Since last month’s LMCs conference, where the motion was passed to ballot the profession on its willingness to submit undated resignations, I have rarely met or talked to a GP without the topic of resignation being raised. The combined pressures of an ageing population with complex health needs, funding cuts, soaring medical defence costs, and lack of incentives for new trainee doctors has left GPs dangerously overstretched, paying huge amounts for locums and at breaking point.

No-one can withstand the pressures GPs are now under

Piecemeal, sticking plaster solutions are a waste of time and no good in reversing the impending recruitment and retention crisis. There are fewer GPs per head of population in the UK than in most other developed countries and we spend less than 10% of the NHS budget on primary care. The European Commission reported in 2014 that we had fewer GPs per head than Bulgaria and Estonia, and remember we still are the 5th richest economy in the world. Primary care is on the verge of collapse.

No-one can withstand the pressures GPs are now under and there is no prospect of any let up. GPs want to do their job but they do not have the tools to do it and it is not safe for patients. At present, many are working 11-hour days seeing up to 50 patients daily, with all the accompanying paperwork that entails. It is no wonder that so many GPs are taking early retirement. It is time people woke up and realised that they cannot expect a Rolls Royce or even a BMW service with the resources we have. What we have is a knackered Skoda. It appears the Government is deliberately pushing general practice off the cliff, so they can introduce a two-tier medical system similar to the dental system. If the present administration believes that it could starve the general practice into submission and bring in private providers to take over, it will be mistaken too. By which time it will be too late for primary care to be rescued and care will be much the poorer (and more expensive) for it.

The plans to recruit 5,000 new GPs is more of a wish list, the case for a seven-day GP services is based on flawed evidence and is neither workable nor needed. A promised £2.4bn rise in GP funding by 2020/21 is welcome news, but in my view a significant number of key questions for sustainabity of general practice remain unanswered. We still don’t know where this money is coming from. Practices are bleeding now and need jam today, not a promise for tomorrow. What is needed is to look at the terms and conditions of general practice, and an answer to the million-dollar question: why are so many GPs struggling to cope? We need stabilisation of general practice – a moratorium on PMS reviews, halting the MPIG withdrawal, reducing ever-growing bureaucracy, pointless CQC inspections and extension of crown indemnity to the general practice. Primary care needs much better planning, more GPs and a serious look at the way it is funded.

The profession has been brought to its knees both by a chronic slump in investment and the fact that there are now simply not enough family doctors to go around. General practice is at the heart of the NHS and if it is left to wither, as is the case now, it could sow the seeds of an unprecedented disintegration of the NHS at all levels. Mass resignation is on the cards, if the Government does not heed the strong messages coming from coal-face GPs.

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

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Readers' comments (10)

  • Mass resignation is happening NOW ,RELP is happening.No matter what the establishment does good , bad or indifferent(this includes the BMA)this permanent damage has been done to which there is no answer for we have a lost generation(and they will not return).We have lost youngsters new to the primary care,a generation of fifty something retiring 10 year to early and increased attrition all through our ranks.Something may be done but is it to late?

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  • Dear Kailash,

    You are not going to like this, but you personally and your colleagues at the BMA must take a very large part of the blame. The BMA has been a mixture of inept and blinkered.

    The BMA's inept negotiation of a GMS contract which had clauses allowing the government to change it at will is making us all suffer.

    The BMA is blinkered because you do not represent the doctors who pay your wages, you represent your political views, you believe the job of the BMA is to protect the state funded and state run NHS monopoly, so instead of planning a path for GPS to leave the NHS like dentists did you blankly refuse to do so and condemn GPs to be crucified inside the NHS.

    Kailash, you and your colleagues must take a very large part of the blame. The BMA is not going to solve this crisis as it is in large part a creator of it.

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  • T Roscoe

    To be fair on the BMA negotiators, the clause allowing unilateral change was said by the Government side to be necessary in case of national emergency such as a flu pandemic. The fact the Government were lying was not clear to everyone at the time.

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  • The sooner we resign and develop private primary care the better. If the government want to financially support this, then fine. The problem is that GPs are afraid of jumping into the unknown...

    Will patients pay directly per consultation?
    Could some form of private primary care insurance package tbe developed and shouldn't the BMA be doing this?
    Would there be enough finance coming into the practices to pay for the premises?
    Would NHSE suddenly give a huge increase per patient per year to a private provider under APMS?
    Would the local GP Federation take over?
    Would similar happen, but instead The local DGH?

    What is completely unforgivable is that the BMA is not looking to find some answers to some of these questions. The BMA's duty is to their members, not the NHS

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  • "Trefor Roscoe | GP Partner08 Jun 2016 12:14pm

    To be fair on the BMA negotiators, the clause allowing unilateral change was said by the Government side to be necessary in case of national emergency such as a flu pandemic. The fact the Government were lying was not clear to everyone at the time."

    Come on, you are dealing with here today gone tomorrow politicians. Do you honestly believe that Virgin or Boots or united Health would have fallen for that and agreed it if they are negotiating a contract? They would either reject it, or insist that the circumstances under which it can be used are put in writing in the contract.

    We just cannot escape the fact that the GPC repeatedly refused to bring in professional negotiators despite many pleas for them to do so, and as a result the gentlemen amateurs of the GPC got shafted by professionals on the other side of the table.

    I hold the GPC/BMA very much to blame for they actively refused to bring in professionals.

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  • OK, when do I expect to receive my ballot? It might be good to receive it before actual resignation.

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  • The BMA needs to draw up realistic plans for GP's to become private business, as the dentists did.
    The NHS England can buy services from them if it wants, but GP's themselves need to set realistic reimburment rates.
    The system at the moment is unfair to both doctors and the majority of patients.
    The current system is making it harder and harder to provide a safe standard of care, never mind an excellent one, despite the fact that many of us have the ability to be fantastic doctors. It is demoralising working in a system which penalises this .

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  • We HAVE TO, MUST look at a different model.
    So, we have to have a date from which such a model would start.
    All parties[DOH, Patients, Hospitals, GPs etc] need time to prepare for the new way.
    So a date is what we need. Next April?

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  • You cannot negotiate with a monopoly employer and no Kailash,there won't be a mass resignation.

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  • No it won't happen - we've been twatting on about it for years and the profession has gone from the gutter, to the sewer to the open sea. My VTS group of 30 (2011) - 0 partners, 5 salaried, 15 locums, 6 abroad, 4 returned to medicine or surgery training.

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