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GPs should be ‘prepared to walk away from the NHS’, say LMC leaders

GPs should be ‘prepared to walk away from the NHS’, say LMC leaders

UK LMCs have authorised the BMA’s GP committees ‘to use the threat of mass resignation to improve the NHS offer to practices’, adding that GPs ‘walking away’ from the NHS will be more powerful than collective action.

The debate, at the UK LMCs Conference today, saw a passionate speech from GPC England chair Dr Katie Bramall-Stainer, who argued that any funding uplift for GPs will not be enough to save general practice and that the threat of leaving the NHS is more likely to bring positive change.

A motion, which was passed, mandated GP committees across the UK to collect undated resignations, and develop viable alternatives to the GMS contract.

A motion passed at today’s LMC Conference demanded that ‘GMS contract amendment can only be imposed on general practice at time of national emergency and not when negotiations prove difficult’.

LMCs also believe that ‘UK governments have failed to provide the necessary investment to ensure the survival of GMS’, and demanded any amendments to contracts should never be imposed on GPs.

Dr Bramall-Stainer gave the final substantive speech in the debate, which was given a standing ovation.

She said ‘nothing’s going to change’, regardless of what party is in power. She said: ‘The cavalry is not coming. You are the cavalry. Your destiny is a choice. Do not leave it to chance.’

Even if the pay review body does uplift funding by 4% in England, it would still leave only a 6% funding uplift for 2024/25, she added.

‘So what is 6%? It is £660m less than in 2018-19. If you want to be on a level to where you were five years ago, you need 12%. Who’s going to deliver that for you?

Nobody is, no matter what party they are. They’re not going to do it until they have to and they’re not going to agree to anything once they’re in government. Now is the window of opportunity, and this is why we have to get every political party to agree to terms for a new contract in England because otherwise we’re on a hiding to nothing.’

‘Before we even start to consider undated resignations, we have to take action now. We have to vote in the ballot. Now our voting and our plans and our action must be sequenced. They must be strategic. We have got to protect our practices to protect our patients. we have got to take action to save general practice. The time is now.’

Dr Michael Lewis (pictured), from West Sussex LMC, proposed the motion, saying that if the governments continue devaluing general practice, ‘you walk away’.

He added: ‘Whether or not you believe this is palatable, or even viable, the threat of GPs [following the dentist model] will significantly empower our negotiators. We’ve had enough. We must take substantive action. We must show whichever government is in power that we will not continue to tolerate the continued undermining of the partnership model.

‘It is up to government to fix the NHS. It is not up to GPs to sacrifice themselves to save it.’

Dr Ian Harris from Bro Taf LMC said that similar motions were passed at the Welsh LMC conference, which helped in getting the cabinet secretary for health and social care too acknowledge funding problems in general practice. He added: ‘But she also clearly stated, and I’m going to paraphrase her a bit here, “we fund secondary care because that’s where the backlog and the problems are”. So as long as GPs continued to soldier on and leave, practice by practice, this perception with politicians isn’t going to change.’

This year the GP contract was imposed in England for the third year running, with GPC England now in a formal dispute with the Government. Meanwhile, in Wales, a contract was unilaterally introduced after parties ended negotiations without an agreement.

The potential threat of submitting undated mass resignations was last raised by the GPC in 2016 and 2001, although never came to fruition on either occasion.

It was also used by the BMA in 1989 but was ultimately unsuccessful when health secretary Kenneth Clarke imposed a reformative GP contract on the profession that introduced fundholding.

But 1966 appears to still live on in the collective GP memory, when then-GPC chair James Cameron was given leverage to negotiate the ‘GP Charter’ after 17,000 out of a total 19,000 GPs submitted undated resignations to the BMA.

Motion in full

That conference wishes for our governments to offer GMS contracts that have been agreed by negotiation and:
(i) demands that a GMS contract amendment can only be imposed on general practice at time of national emergency and not when negotiations prove difficult CARRIED
(ii) believes that UK governments have failed to provide the necessary investment to ensure the survival of GMS CARRIED
(iii) believes that being prepared to walk away may be more effective than industrial action CARRIED
(iv) mandates the GPCs to develop viable alternatives to GMS, including actively supporting GP practices to work outside the NHS CARRIED
(v) empowers the GPCs to use the threat of mass resignation to improve the NHS offer to practices. CARRIED



Please note, only GPs are permitted to add comments to articles

G Raj 24 May, 2024 3:48 pm

It’s just not viable. I am a partner and can’t resign. The liabilities are too high. The redundancy costs etc etc.

What we need is work to rule, we need to see the number of patients we da. Safely see and the rest can go to AE. Primary care breaking doesn’t bother them. Need to break the system then they may listen.

Undated resignations, is a distraction

Andrew Marshall 24 May, 2024 4:14 pm

Mass undated resignations is the ONLY way to preserve GP and flourish in the ever increasing world of increasing demand. This is not resign and make your staff redundant, this is resign and have even more staff and more GPs to do the job that only we can do and provide a proper service. Believe in your absolute worth. Your future will only come if you value yourselves.

Dave Haddock 24 May, 2024 4:19 pm

What GPs need is a coherent plan how to leave the NHS whilst still earning a living and caring for patients. Something analogous to Denplan or the Guernsey option.
The failure of the BMA to explore this option tells the Government that they can do what they like – GPs are going nowhere and will just accept what they get.
“Industrial action” is an empty threat; how is that junior doctor’s strike going?

Rob M 24 May, 2024 4:20 pm

At last finally they have finally come out and said it it. Well done KB-S – and shame on her (mainly male) predecessors who who never managed to grow a pair big enough to stop acquiescing to NHSE and pandering to the RCGP spineless

Yes Man 24 May, 2024 5:11 pm

Bla Bla Bla

Just My Opinion 24 May, 2024 5:54 pm

It is never, ever going to happen.
Why? Lots of reasons. But the main one is that there is nothing stopping practices right now, today, from handing back their contracts and going private. But they aren’t. Go figure.

J Smith 24 May, 2024 11:29 pm

In any mass action, there would not be 100% participation. See the first comment who are too afraid to be crumpled and crushed to save their skin. Even in consultant and Junior Doctors strike, there were some who were singing a different song. Even if 40-50% do mass resignation, it would be enough.

Gerald Clancy 25 May, 2024 7:29 am

It becomes more feasible when contractors have an alternative model, whether that is a subscription-based or other with legal advice, IT solutions, staff transfer – which is what the motion has called negotiations now and years into the future.

Some Bloke 25 May, 2024 7:55 am

mass resignations= mass bancruptsies of GP Partners. this is exactly what NHSE and the gov are hoping for, and planning to replace us with expansion of 111/UCC style healthcare staffed by noctors. few millions will die in the process, causes of mortality will be declared to be complex and nothing to do with changes in the healthcare. Just like AE waiting times crisis apparently does not affect mortality in the eyes of our institutions.
if I am to walk away from my biggest contractor, what am I walking away to? show me an alternative. I will look at it.

Darren Tymens 25 May, 2024 1:31 pm

A great speech by Dr Lewis, and an excellent response by KBS.
I think both really caught the mood of the room, and also the overwhelming majority of the profession.
The relationship with NHSE is an abusive one. We have tried negotiating, we have tried working harder in the hope they will appreciate us, and we have tried being nice.
We have to stop wanting to be liked. We have to be prepared to walk away. We have to be prepared to work-to-rule. If we aren’t prepared to do that, traditional General Practice will be gone in 5 years and it will be replaced by something far inferior (and ultimately far more expensive to the taxpayer).

So the bird flew away 25 May, 2024 3:36 pm

I agree DT. Stirring speeches but words can’t replace action to save traditional general practice and decision making under uncertainty (lots of maths game theory about this exceptional skill that GPs possess). Need to strike while the iron is hot. I’m fed up being made to feel like Chas and Dave. Rabbit, rabbit, rabbit….

So the bird flew away 25 May, 2024 3:47 pm

Scratch *game*, meant *probability*..

Dave Shave 26 May, 2024 9:04 am

Junior doctors to some extent can be covered by seniors and nursing colleagues.

ED can’t cover 300 million attendances per year

Dr No 26 May, 2024 2:29 pm

Agree with above comment. Resignation is meaningless without a clear option to move to. That needs at be fully worked-up and ready to roll. Appreciate the new-found assertiveness, but government are wolves and we are sheep. These sheep need to arm themselves with a plan.

Marilyn Monroe 28 May, 2024 7:06 pm

Anyone genuinely interested in preserving the concept of a generalist UK Dr practicing medicine in the community must come to the conclusion that we need to leave the NHS. The politicisation of family medicine has virtually destroyed it. The disappearance of generalists is the fundamental flaw of modern medicine. We are virtually the only ones left. We owe it to our children and the future population of the country to preserve the integrity of this profession so central to everybody’s well being. When I get old I want to be able to see a Dr GP! What I’m witnessing is their destruction. If the NHS is the cause (which IMHO it absolutely is) then we NEED TO LEAVE before it’s gone. If you run a practice and you aren’t fighting this corner you are the one wheeling the scythe.