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At the heart of general practice since 1960

Widespread concern over GP-less service

The LMCs annual conference in June overwhelmingly passed a motion calling on its leaders to define core services. In July GPC chair Dr Hamish Meldrum announced that the GPC would not be issuing such guidance. Dr Nev Bradley, who proposed the motion, has sent Pulse this open letter.

What is the GPC playing at? Good unions lead from the front. Leadership involves providing clear guidance to worker and customer alike on what its workers do, what they don't do and what they might do as overtime if paid.

A better definition of what constitutes core, non-core and enhanced services is a good start towards a doctor's right – your right – to end exploitation. That is why the LMCs annual conference this year put a motion – overwhelmingly accepted – to its leaders to provide such guidance. Amazingly the answer was No.

As chair of Wirral LMC I am paid to represent GPs. Many GPs have valid concerns and doubts about their role under the nGMS contract. I say it is high time the GPC faced up to this. Moreover, I say a leadership which is incapable of clarifying the job role of those it represents is ineffectual.

So I accuse the GPC of rank complacency and of flying in the face of the rightful demands of the GPs it represents, and I challenge it to justify its failure to address the prioritised concern of its grassroots GPs. I also want you to think about this long and hard – and I ask you to write in to Pulse to make your feelings known.

The GPs I serve like their work and their patients. No profession on earth does more for people. GPs adapt. They provide the most cost-effective health service on the face of the planet. But they are heartily sick of change.

Much of this change sees the GP feeling increasingly obliged to become involved in the mere finance and convenience of the patient rather than his clinical well-being. GPs find it very difficult to say No to these demands and so patient expectations and the doctor's role definition steadily expand.

This is The Flypaper Syndrome – where a service provided once as a favour to a patient becomes, without agreement, a future expectation. Flypaper work is non-core work. It exploits GPs. It causes resentment. It is largely peripheral to their primary clinical role. It shouldn't be expected. GPs haven't been specifically trained to do it. With a little lateral thinking much of it is work that might just as easily be done by someone else.

I say that over the years GPC has been gutless. It just hasn't been assertive enough. It has allowed its GPs to become burdened down with an ever-expanding agenda of tasks at work. We now demand an end to this exploitation. We demand the right to say No to non-core work.

Because the GPC has refused to acknowledge 'non-core' services, I have compiled a list (see box) – by no means exhaustive and in some respects controversial – of the services many GPs have perceived as such and have reported to me as an LMC chair.

Are all of these genuinely core services? Or, if non-core, are they being paid for at an appropriate rate? Are there any other services you feel exploit you? Write them in and let's get an agenda sorted for discussion. Or is this issue unimportant? LMCs need to know – and fast!

The GPs I represent want the right to be able to complain about and withdraw from services they feel are exploitative. They want these services to be debated at national forums. They want the GPC to show leadership and by positively defining 'non-core' services thereby giving them the official right – should they wish to exercise it – to either withdraw from providing the service or negotiate to provide it as an enhanced service.

I say doctors and patients would be all the better for a clearer definition of the service we provide. What we provide. What we don't provide. What we can provide as overtime if paid. This clearer definition is required to foster more realistic expectations of our service. Without it, the exploitation of GPs is sure to continue.

And so to the GPC I say, stop mucking about, get on with the job you've been voted in to do and start defending our profession against the blatant exploitation to which we are increasingly exposed. Get off your backsides, address the concerns of grassroots GPs and get on with the tasks they set.

Dr Nev Bradley

Chair, Wirral LMC

My examples of non-core services

Med 3s for patients attending outpatient clinics

Sickness certification

Allocated patients

Ambulance bookings

Smoking cessation

Obesity management

Occupational health/disability/welfare/housing benefit forms

Prescribing initiative schemes – eg, withdrawals from longstanding hypnotic medication

Reduced referral initiatives

District nursing duties – eg, ear syringing

Public health initiatives

Dental emergencies

Copying letters for patients

Chase-ups for smear/mammography non-attenders

All travel advice and vaccinations

Chairing patient advisory forums

Pre-referral examinations

Minor injury management

Forensic reports for minor RTAs

Drug interaction forms

Private referrals for patients already referred for NHS care

Gym medicals (for reduced subscription fees for patients)

Multiple insurance company reports (for the same condition)

Section 12 medicals

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