UK LMC conference to vote on plans for taking GPs outside NHS
GP leaders from around the UK will debate whether to call for a strategy for ‘exiting GMS contracts’ and options for ‘future working outside the NHS’.
At their conference in Belfast next month, LMC representatives from around the UK will vote on a motion to ballot the profession on ‘a plan B option for general practice’ that includes consideration of a ‘means-tested, subscription-based service’, such as those being offered currently by NHS dentists.
The conference agenda also includes motions asking the BMA to lobby for clear limits to GP workload and offer legal support to those who take steps to limit workload.
The motion on a ‘plan B’ for general practice said: ‘Conference recognises that current GP contracts are failing patients and practices alike, that more GPs are opting to work outside the NHS and believes that general practice within the NHS is no longer financially viable and a move towards a hybrid NHS and private GP service is the only option for the future.’
LMCs will also hear from Dr Maitiú O’Faoláin, from the Irish Medical Organisation (IMO), who will share his experience of the mixed public and private model of general practice in the Republic of Ireland.
On advice and guidance, LMCs will debate demanding ‘clear, nationally agreed standards’ defining the responsibilities of hospitals for patients on waiting lists, including timely communication, clinical oversight, and ownership of investigations and follow-up.
Representatives will also vote on a motion against ‘Amazon-style unlimited GP access’, which calls on all governments in the four nations to ‘pause and re-evaluate’ their policies around unrestricted GP access.
And another motion included in the conference agenda calls for a petition to Google to extend their policy of blocking reviews of schools to all UK general practices, due to reviews being ‘inappropriate, misleading and harmful to patient care and staff wellbeing’.
The conference is taking place on 13 – 15 May at ICC Belfast.
It comes after last year the BMA’s Northern Ireland GP committee was instructed by LMCs to set up a working group to ‘develop a plan B for general practice’, and to ‘immediately’ begin development of a strategy for exiting the 2004 GMS contract and ‘future working outside of the NHS’.
In 2024, UK LMCs had already 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.
Pulse has recently revealed that a large group of English LMCs has written to the GP Defence Fund (GPDF) to urge it to stop funding the BMA’s GP Committee.
The motions in full
Safe working
AGENDA COMMITTEE TO BE PROPOSED BY LEICESTER, LEICESTERSHIRE AND RUTLAND: That conference notes that
GP practices are expected to deliver care in environments that are increasingly unsafe due to excessive workload, inadequate staffing, and insufficient funding. Conference is concerned that despite safe working limits being a fundamental requirement for patient safety, they are not embedded in general practice across the UK. Conference calls on the BMA to:
(i) ensure workload limits reflect consultation complexity and supervision responsibilities
(ii) demand funding and contractual mechanisms that allow practices to meet minimum safe working standards, opposing contractual requirements that mandate increased access without corresponding resource
(iii) support practices who refuse unsafe working conditions that arise as a direct consequence of systemic underfunding
(iv) lobby UK governments and NHS bodies to ensure that when practices reach safe capacity, excess demand is met by appropriately commissioned alternative services, rather than being absorbed by general practice
(v) lobby UK governments to move away from access / volume metrics and move towards activity-based performance measures that value continuity, expertise, and population health outcomes.
Workload limits
AGENDA COMMITTEE TO BE PROPOSED BY MID MERSEY: That conference believes that current workload in general practice is unsafe for patients and GPs, and that the absence of clear limits enables ongoing exploitation of the profession. It therefore:
(i) calls on the GP committees of all four nations to agree and publish evidence-based guidance on a safe maximum number of patient facing consultations per whole time equivalent GP per day, and a safe maximum patient list size per WTE GP, explicitly adjusted for deprivation and case mix
(ii) insists that agreed safe limits are adopted by governments, commissioners and NHS bodies as the basis for all access, performance and contractual requirements, and that no scheme should assume activity beyond these thresholds without commensurate workforce and funding
(iii) demands that where practices are persistently operating above agreed safe limits, there is a defined mechanism for LMCs to support them to cap demand, restrict registration or reconfigure services on patient safety grounds, without contractual sanction
(iv) calls for clear medico legal and professional guidance for GPs who take steps to limit unsafe workload in line with these thresholds, including collective support where practices or individuals are challenged for prioritising patient safety.
Referrals
AGENDA COMMITTEE TO BE PROPOSED BY NOTTINGHAMSIRE: that conference believes that the GP’s clinical autonomy and right to refer are fundamental to safe and effective patient care, and calls on governments and health bodies to ensure that:
(i) any advice and / or guidance systems are optional, clinically appropriate, properly resourced, do not delay access to clinical care, and patients are able to resume their place in the waiting list if the practice disagrees with the advice
(ii) performance incentives must not be achieved through the discharge of patients without assessment so that all discharges include clear clinical ownership and transparent accountability
(iii) reductions in referral-to-treatment waiting lists reflect genuine clinical review or treatment rather than administrative removal
(iv) clear, nationally agreed standards are developed defining the responsibilities of hospitals for patients on waiting lists, including timely communication, clinical oversight, and ownership of investigations and followup.
Google reviews and social media
AGENDA COMMITTEE TO BE PROPOSED BY WEST SUSSEX: That conference believes that public rating systems and consumer style online review scores for GP practices, including Google reviews, are inappropriate, misleading and harmful to patient care and staff wellbeing, and calls on the four national GP committees to work collectively to:
(i) press for the removal of numerical ratings and league style comparisons of GP practices from public-facing platforms
(ii) seek formal recognition that confidentiality obligations prevent practices from correcting inaccurate, incomplete or unbalanced public commentary
(iii) press for the development of fair and proportionate mechanisms for responding to public criticism of general practice that protect patient confidentiality, professional standards and staff safety
(iv) petition Google to extend their policy of blocking reviews of schools to all UK general practices.
Digital access
AGENDA COMMITTEE TO BE PROPOSED BY BATH AND NORTH EAST SOMERSET, SWINDON AND WILTSHIRE: That conference believes and that the promotion of an “Amazon style”, unlimited GP access model is prioritising the wants of the worried well at the expense of the “needs” of the most clinically vulnerable and that the current four nations approach to digital-first policies, including mandatory access, is not fit for purpose and:
(i) believes this will drive over medicalisation, creating an environment for clinician burnout and unsafe practice
(ii) demands fully funded, nationally supported digital access tools for general practice across the four nations, including unrestricted clinical messaging and communication functions, rather than cost limited systems driven by wider NHS financial pressures
(iii) calls for GP practices to have free and autonomous choice of digital access platforms, enabling delivery models that reflect local population need, practice capacity, and patient demographics
(iv) calls on the GPC to lobby for digital access policies that prioritise clinical need, continuity of care, and health equity over arbitrary access targets and response times
(v) calls on all governments in the four nations to pause and re-evaluate their policies in partnership with the BMA.
Plan B
AGENDA COMMITTEE TO BE PROPOSED BY NORTHERN IRELAND EASTERN: That conference recognises that current GP contracts are failing patients and practices alike, that more GPs are opting to work outside the NHS and: (i) calls for contracts that permit GPs to provide private services to their NHS patients when those services are not contractually available to their NHS patients
(ii) believes that general practice within the NHS is no longer financially viable and a move towards a hybrid NHS and private GP service is the only option for the future
(iii) calls for a strategy for exiting GMS contracts and future working outside the NHS
(iv) directs GPC UK to work with all GPCs to ballot the profession on a plan B option for general practice provision that includes consideration of a means-tested, subscription-based service, such as those being offered currently by NHS dentists.
Source: UK LMCs conference agenda
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More hot air.
So many PR disasters by doctors leaders from alienating our colleagues who work with us to now like dentists giving the two fingers to our NHS- you know that institution which is the greatest public health organisation in the world( if you have had serious illness you know this..one day you will have something). GPs voting for this is another brexit moment and like lemmings we fall off the cliff…you know the public ( who it’s for) love the NHS and if we destroy it they will never forgive us and rightly so.
Do you think Gp are doing this happily ? Going out of NHS will cause uncertainty at least in initial phase but are we to blame for this ? Why aren’t politicians are being held accountable.
Going out of NHS is a last resort & if that happens politicians and public are to be held accountable for inaction and not GP
If we ‘ leave the NHS’ the NHS will leave us too..in 10 years there will be thousands of part time doctors scrabbling for private locums whilst the NHS adjusts to life with doctors and staff who want to work in NHS( they come from our ‘poorer’ areas usually in my experience ). My advice to Mr Streeting is if the NHS trains you and you leave the NHS then reclaim the full cost of that training. Guess what it costs an awful lot of money to train one doctor -much more than a nurse or other colleague who earns far less in their career pays same uni fees and works solely in the NHS. I would start with dentists and charge all qualifying the full training costs as they have effectively left the NHS. That would be fair to the taxpayer who funds it.
I too hope that the conference will not vote for GPs to work out how they can move to NHS to private work, but the reality is that it is barely financially viable and practices are closing every week. According to the BMA, Since 2015, 1,451 independent community GP practices have closed or merged (as of February 2026). That is 2 or 3 every week. As Pradeep says, the politicians have to ask themselves what they are going to do to stop this. In the end the NHS is in their hands. Why have they allowed to primary care slice of the NHS budget to fall to 8%?
Ahermm..anyone voted for conservatives in last 40years?..you reap what you sow.
Keeping politics out of the conversation Shaun, the NHS is failing, the socialised funding model looks irreparable.
Surely we/the country should consider funding models that work far better for patients in Europe and Australia for example?
I say bring it on. Private model like dentists. Dental plan pay basic £25 per month for one dental rv and 1 dental hygienist per year. That is £300 per year, over double what GPs get per patient for unlimited GP contacts and appointments. General practice is being run on doctors goodwill alone. A private GP model with subscription will fund a much better service that would take pressure off the rest of the NHS, as we know well that if GP services were being run optimally we could do much to support the failures through the rest of the NHS. Admission prevention for starters, overload on A&E-which is where patients end up when they can’t access general practice. It is doctors like you Shaun, who like to self flagellate in the name of supporting the system for the good of the public, that are ignoring how by accepting the status quo we are letting down everyone, because the NHS is letting down their patients. Enough of this government and the last lot. Negotiate a way out. I should imaging that private health companies would snap up the prospect of providing cover plans like dental plans to support guaranteed income. Good access to GP is the single thing most people want out of their healthcare. Use that to negotiate a return to having private and NHS patients within a surgery provision as per pre 2019 and then the private income can help support NHS provision as it has done before. Then we would be in a position to negotiate better terms for NHS patient provision, ie better funding. Then we could provide a primary care service that actually worked for people. That’s how we serve the public Shaun, not by bowing and submitting to the operators running this country. Streeting is very happy to pay private companies for NHS work as long as it is multinationals not the hardworking individuals that are providing most of the consultations for a minimum of the funding. We need to outmanoeuvre the government and this is how we do it. Can’t strike. Need to outmanoeuvre them.
I say bring it on. Private model like dentists. Dental plan pay basic £25 per month for one dental rv and 1 dental hygienist per year. That is £300 per year, over double what GPs get per patient for unlimited GP contacts and appointments. General practice is being run on doctors goodwill alone. A private GP model with subscription will fund a much better service that would take pressure off the rest of the NHS, as we know well that if GP services were being run optimally we could do much to support the failures through the rest of the NHS. Admission prevention for starters, overload on A&E-which is where patients end up when they can’t access general practice. It is doctors like you Shaun, who like to self flagellate in the name of supporting the system for the good of the public, that are ignoring how by accepting the status quo we are letting down everyone, because the NHS is letting down their patients. Enough of this government and the last lot. Negotiate a way out. I should imaging that private health companies would snap up the prospect of providing cover plans like dental plans to support guaranteed income. Good access to GP is the single thing most people want out of their healthcare. Use that to negotiate a return to having private and NHS patients within a surgery provision as per pre 2019 and then the private income can help support NHS provision as it has done before. Then we would be in a position to negotiate better terms for NHS patient provision, ie better funding. Then we could provide a primary care service that actually worked for people. That’s how we serve the public Shaun, not by bowing and submitting to the operators running this country. Streeting is very happy to pay private companies for NHS work as long as it is multinationals not the hardworking individuals that are providing most of the consultations for a minimum of the funding. We need to outmanoeuvre the government and this is how we do it. Can’t strike. Need to outmanoeuvre them.
Well said Finola. Private system in Jersey works very well. No gnashing of teeth or wearing of hair shirts in sight. GPs who have time to see their patients and patients who can get to see their GP.
The NHS trained all the doctors above but what if NHS charges all who never work in the NHS their years of access to its patients and facilities in future? It will cost millions to become a doctor then and the public will not be pleased with those who do nor have appropriate unbiased care ( like dental care now). They will choose doctors who want to work in the NHS instead. I suspect our dental colleagues are about to find they will be paying for their access to NHS in their training soon as they rush toward money rather than good NHS dental care for our public.
Btw keeping politics out of NHS…really? The NHS is amazing because it does not charge for access. When you have illness that is a matter of life and death. That hinges on a vote every 5 years.