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Dr Chaand Nagpaul explains the buzz he gets from medical politics

No GP working in the NHS is immune from the impact of medical politics. We all work in a system run by the government of the day, implemented nationally and locally, which determines the way we work, our terms and conditions, and our pay right through to influencing our clinical behaviour such as via NICE guidance, the national service frameworks or the nGMS quality framework.

Entering medical politics is usually a result of feeling compelled to say or do something about the system we work in or the wish to represent the interests of fellow GPs.

For myself, I was introduced to medical politics as a GP trainee in 1989, on the eve of the 1990 GP contract, when my trainer took me to a Pulse new contract roadshow with a packed audience of indignant GPs witnessing health minister David Mellor espousing the Government's vision for general practice.

This was a turbulent time, when the profession rejected this new contract, which was subsequently imposed upon us by the then Secretary of State, Kenneth Clarke. The 1990 contract undermined many of the patient-centred values that attracted me to be a GP, and made me want to become involved in medical politics.

Immediately upon joining a partnership the same year, an LMC vacancy arose, and I put my name forward and entered the world of local politics which largely involved trying to ensure adequate and equitable funding for GP surgeries in an environment of patronage and arbitrary decision making.

I was opposed to the Government's proposals introducing a market in health care, which also divided GPs via the fundholding scheme, and consequent two-tierism for patients. This propelled me to give a maiden speech at the annual LMC conference denouncing the internal market, which took me by surprise by receiving resounding applause and media coverage.

This resulted in a knock-on effect of further features and articles in the GP press, and letters published in national broadsheets. I helped develop GP commissioning, an alternative to the fundholding model, which also received much media publicity, and highlighted one of the oft-ignored successes of medical politics ­ that you can actually achieve change. So I became a medicopolitician really by accident rather than design, and formalised my involvement when I was elected on to the GPC in 1995.

The time commitment in medical politics can vary enormously. For example, being an LMC member may involve as little as one meeting every two months, yet my involvement in GPC and PCT work takes up two to three sessions per week.

A logistical challenge is that meetings are often erratically scheduled and it may be difficult to designate a particular half-day every week. GPs working in practices need to consider the effect of being absent on partners ­ if they need to cover for you they should be recompensed accordingly.

Alternatively, you can protect partners from additional workload by ensuring your work is adequately covered by locums. However, partners should acknowledge that a partner involved in medical politics can benefit the practice significantly by it being up to date in health policy awareness and better positioned to develop proactively.

Medical politics is rarely lucrative ­ although you should try to ensure you are at least fully compensated for your time away from the practice, or if you are a freelance non-principal that you receive your potential lost income. There may nevertheless be hidden unrecompensed work such as reading agenda papers or responding to e-mails.

Medial politics ­ like all politics ­ offers little security of tenure, usually requiring periodic re-election or re-appointment. Indeed each July for the past 10 years I have had to endure the annual anxiety of standing for re-election to the GPC.

Some mistakenly believe that medical politics is somehow divorced from clinical practice. On the contrary, my main drive to be involved in the LMC and GPC has been my experience of being frustrated and constrained by the system we work in ­ and wanting to do something about it.

And far from medicopolitics being all about talking shops, there have been key successes ­ both locally and nationally ­ such as the out-of-hours opt-out, which has transformed GPs' work/life balance.

And even where you don't succeed, at least you can have a clear conscience that you voiced your concerns, and moreover it can be an invaluable cathartic outlet when faced at times with maddening political policy!

In summary, if you have strong views about the NHS, or want to change local or national health policy, or if you want to protect the interest of your peers and the profession, then get involved ­ you have the makings of a medical politician.

Chaand Nagpaul is a member of the GPC, chair of its primary care development sub-committee, and

vice-chair of Harrow LMC

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