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How the GP fightback began – and what happens next

LMC conference 2016

LMC conference 2016

LMC leaders have thrown down the gauntlet to the Government: unless the crisis in general practice is alleviated by August, the profession will set in motion the so-called ‘nuclear deterrent’. 

After an often-emotional debate at the Special LMC Conference in London on 30 January, GP leaders agreed to ‘canvass GPs on their willingness to submit undated resignations’ if the Government fails to deliver a ‘rescue package’ for general practice within six months.

They also gave the green light to a ballot of GPs regarding what work practices could stop doing in order to continue providing ‘safe and sustainable care for patients’.

While many GP leaders hail this as a move that will force ministers to listen to the profession’s concerns, others are worried it does not go far enough.

The vote comes as health secretary Jeremy Hunt prepares to announce a ‘package of measures’ he claims will help take the pressure off GP practices.

But details of the package are still scant and the conference vote will put additional pressure on the Department of Health to ensure the initiatives it unveils are substantial and rapidly effective.

GPC chair Dr Chaand Nagpaul described the motion as the ‘beginning of the great fightback of general practice’ and urged GPs to unite behind the proposal.

The motion in full

That conference instructs GPC that should negotiations with government for a rescue package for general practice not be concluded successfully within 6 months of the end of this conference:

(i) actions that GPs can undertake without breaching their contracts must be identified to the profession

(ii) a ballot of GPs should be considered regarding what work/services must cease to reduce the workload to ensure safe and sustainable care for patients

(iii) the GPC should canvass GPs on their willingness to to submit undated resignations

BMA Council member and former acting chair Dr Sam Everington said he had ‘not seen anything like it in his 30-year career’.

The vote comes as drawn-out negotiations over the new GP contract in England continue. Pulse last year revealed disquiet within the GPC over how negotiations were proceeding.

GPC insiders told Pulse the Government had ‘brought very little to the table that is going to make a big difference’.

It also comes after junior doctors forced some concessions from the DH after one day of industrial action last month. 

LMC leaders at the conference lined up to speak in support of the motion, saying it would give the GPC ‘the arsenal it needs for the battles ahead’.

In a particularly impassioned speech, member of Hertfordshire LMC Dr Katie Bramall-Stainer said: ‘This motion allows time to deploy our nuclear deterrent without actually letting it off. This is the headline to launch the campaign. Hold your noses and vote “yes”. Send a lightning bolt to NHS England.

‘It is not safe, and it is not fair and it is not just for juniors – because this is a state of emergency. So, conference, if not now, when?’

The time for talking is over

Dr Alex Freeman, a member of Hampshire and Isle of Wight LMC, told delegates they needed to take this chance: ‘Don’t just sit there and say “patients will suffer”. If you care about your profession, then damn well do something about it.’

The GPC has told Pulse the vote has given them a ‘mandate’ to go to the Government and ask for better support for GPs.

Dr Nagpaul said: ‘This motion has told the Government that the time for talking is over and the time for delivery has begun. It has very much put the ball in the Government’s court to put together a rescue plan – and they have a six-month ultimatum.

‘The profession has shown it needs a tangible commitment from the Government that it is going to revive general practice.’

The GPC chair added that the BMA would be looking closely at the technicalities of undated resignations and the precedents for such a move: ‘This has not been done for a long time, and we will need to look at what that means. There is a process and we need to see how that will take place.

‘Mass resignation is not a theory – the Government knows four out of 10 GPs would be willing to quit. 

‘The Government must now understand that failure to rescue general practice will have consequences, and that is what leverage this motion gives us.’

How the debate went

LMC conference 2016

LMC conference 2016

‘This will give the GPC the arsenal for the battles ahead’ Dr James Murphy (proposing the motion)

‘If not now, when?’ Dr Katie Bramall-Stainer (pictured)

’We have to act now, they are killing us anyway’ Dr Naomi Beer

‘The nicely, nicely campaign is not working’ Dr Fay Wilson

‘If you care about your profession, then damn well do something about it’ Dr Alex Freeman

‘We have got to stand up for our profession and our patients’ Dr Zoe Norris

‘It is our duty to put this right’ Dr Chris Hewitt

Although GPs in the devolved nations are also facing battles over GP funding, the threat of resignation is likely to be mostly directed at NHS England and the DH in Whitehall.

NHS England announced late last year that the budget for general practice will increase by 4.2% next year, to £7.65bn, and by at least 4-5% every year in order to hit £9.19bn in 2021. This adds up to a 25% increase on current spending.

It is the best hope I’ve had in 20 years

But some GPs say this is not enough, arguing the motion voted through at the Special LMC Conference should have been stronger in order to force a major change in conditions.

Family Doctor Association chair Dr Peter Swinyard said: ‘We need that option to say “no, we’ve had enough” and I think that the option they were given on mass resignation was rather on the weak side.’

And former BMA and RCGP Council member Dr Una Coales said the final result of the conference was ‘Jeremy Hunt 1 GPs 0’.

Dr Coales added: ‘Voting to canvass GPs on mass resignation in six months’ time is akin to taking a survey. It has no legal clout. It is a sad day for traditional general practice.’

But others welcomed the vote. Dr Eleanor Scott, a medical director at Londonwide LMCs, told Pulse she was heartened by the vote: ‘It is the best hope I’ve had in 20 years.’

Dr Kamal Sidhu, a GP in County Durham and a member of County Durham and Darlington LMC, said: ‘I think something very productive has come out of this meeting. Now I feel more confident that we can become safe in the longer term.’

The last time GPs were invited by the BMA to submit undated resignation letters was in January 1975, over cuts to wages. Some 60% of GPs submitted them and the letters were kept ‘as a precaution’ by the union, with the intention of using them if their negotiations for a better deal with then Labour health secretary Barbara Castle failed.

In 2001, there was a ballot on the need for a new contract and the GPC’s right to represent all PMS GPs. At the same time 86% of GP principals said they would consider resignation from the NHS. This was all a prelude to the new 2004 contract.

But GP leaders may be worried about a repeat of the pensions ‘day of action’ in 2012. The BMA’s ballot on industrial action was supported by the whole medical profession but on the day of action, only one in four practices took part and the union failed to secure any concessions from ministers.

GPC Wales chair Dr Charlotte Jones said it was important – now more than ever – for the profession to show unity.

She said: ‘I think we need to get the grassroots behind us now. This is an ideal opportunity for everyone to unite, and harness the strain and pressures of the profession to actually get something done about it once and for all.’

Dr Nagpaul concluded: ‘It is unfortunate, and shameful, that we need a motion to wake the Government up. At least now I can say “this is not just the GPC and BMA, it is the grassroots speaking”.’

In a message to the conference, health minister Alistair Burt said the DH was increasing GP funding over this Parliament and looking at measures to streamline bureaucracy, CQC inspections and the payment system. 

He said: ‘I know general practice is under pressure – I meet a lot of GPs up and down the country – but I’m also aware of what it is we are trying to do to help.’

What happens next?

The LMC vote gives the GPC six months to negotiate an ‘emergency package’ of support with ministers.

Perhaps in anticipation of this motion passing, health secretary Jeremy Hunt has already announced he will be delivering a ‘package of measures’ to support practices this month.

But after the disastrous ‘new deal’ offered by Mr Hunt last year – which had very little positive effect on practices – there is understandable cynicism about what it may contain.

If Mr Hunt fails to deliver substantial change, then he will face the prospect of the GPC being tasked with starting the process of requesting undated resignations from August. And this deadline could be brought forward if anger boils over at the annual LMC Conference in May.