GP leaders have called on the BMA to ‘define core general practice’ and for any new GMS contracts to secure payments for additional work transferred from hospitals.
At their national conference last week, LMC representatives across the UK voted in favour of a motion which said it is ‘more important than ever to define what general practice should be expected to deliver for patients’, in light of the Government’s ambition to shift care from hospitals to communities.
The motion demanded that any ‘substantial’ new GMS contracts contain provision for payment to practices, on an item of service ‘or similar basis’, for all ‘identified work’ transferred from secondary care.
It also called for funding streams to be allocated to support ‘any current and future shifts’ in patient follow-up responsibilities, ensuring primary care is ‘not expected to absorb additional work without appropriate resourcing’.
The BMA will now create a working group to define core general practice obligations to inform contract negotiations.
Other motions tackling workload dump which LMC leaders passed included a motion calling on the BMA’s GP committees to adopt a ‘firm position statement to reject’ private share care arrangements.
And another demanded ‘recognised funding’ to support GPs with the ‘growing expectation’ to provide PSA testing and monitoring.
Cambridgeshire LMC’s Dr Ben Curtis, who proposed the motion on ‘core’ general practice activities, said that with the ‘flow of hospital-based care imminently coming’ towards GPs, they ‘only get this one chance to get it right’.
He told the conference: ‘We all generally have a sense of what is core but it is not written down with pinpoint precision, then the adequate and appropriate resourcing of our extra work cannot be expected, and our limits of capacity and provision may not be respected either.’
Dr Mike Lewis from West Sussex said that defining core general practice could be a ‘silver bullet for one of the scourges of general practice in the last two years’, saying the back and forth with secondary care is a ‘demoralizing and endless game of patient ping pong’.
The motion on PSA testing, proposed by Surrey LMC, raised concerns about the ‘increasing workload burden on general practice due to the resourced and un-evidenced expansion of PSA testing monitoring, driven by secondary care and local advocacy groups’.
Proposer Dr Larisa Han claimed that urology colleagues are asking GPs to repeat PSA tests every six or 12 months even when ‘no cancer diagnosis is made’.
She said: ‘I’ve raised this with our local urology team, and they told me “but surely it’s a good idea, just in case they get cancer later”. I kid you not.’
‘We are now running an unfunded, unofficial screening and surveillance programme on behalf of charities, urologists and public perception,’ Dr Han added.
But Dr Onyinye Okonkwo warned LMC leaders of the potential health inequalities risks, since ‘one in four Black men actually develop prostate cancer’.
She said: ‘Rather than pushing back against the national bodies and charities, we should join forces. We should be lobbying together for better, more inclusive research and improved identification of prostate cancer in at risk groups.
‘The urgency is real.The consequences of inaction are actually fatal. Health inequalities are not abstract. They are deeply personal, and they demand a unified response.’
The conference in Glasgow also saw LMC leaders calling on the BMA to launch a test case for defamation when a GP is subjected to ‘malicious, vexatious complaints’. This followed rousing speech from a GP who shared his own personal experience, published in full by Pulse.
In an exclusive interview with Pulse at the conference, the BMA’s registrars committee co-chairs revealed that GPs are working for free in order to stay on the performers list as a result of the unemployment crisis.
And local GP leaders urged the UK Government to permanently resolve the National Insurance contributions (NICs) issue instead of relying on contract negotiations to reimburse practices.
Motions in full
Defining core general practice – ALL PARTS PASSED
AGENDA COMMITTEE TO BE PROPOSED BY CAMBRIDGESHIRE: That conference recognises the ambitions of governments to shift medical provision from secondary into primary care and:
(i) believes that it is more important than ever to define what general practice should be expected to deliver for patients
(ii) calls for targeted training and education for secondary care clinicians to ensure a better understanding of primary care capacity and contractual boundaries, reducing inappropriate workload shift
(iii) asks the BMA to create a working group to define core general practice obligations in the UK, to aid GPCs in national contract negotiations and protect general practice from being forced to absorb unfunded work streams
(iv) demands that funding streams be allocated to support any current and future shifts in patient follow-up responsibilities, ensuring primary care is not expected to absorb additional work without appropriate resourcing
(v) demands that any substantial new GMS contracts contain provision for payment to practices, on an item of service or similar basis, for all identified work transferred from secondary care.
PSA testing and monitoring – ALL PARTS PASSED
SURREY: That conference is concerned by the increasing workload burden on general practice due to the unresourced and un-evidenced expansion of PSA testing and monitoring, driven by secondary care and local advocacy groups and:
(i) calls for recognised funding to support the growing expectation for GPs to provide PSA testing, counselling, and long-term monitoring, including post-treatment surveillance for discharged prostate cancer patients
(ii) opposes the transfer of routine PSA monitoring from urology services to general practice without clear evidence, agreed guidelines, and appropriate funding
(iii) calls for a national review of PSA screening and monitoring pathways, ensuring that primary care is not burdened with additional work without adequate resources
(iv) calls for national bodies, including NHS England, to push back against the pressure exerted by local prostate cancer charities to increase PSA testing without robust evidence or national policy support.
Private shared care – PASSED
AVON: That conference believes that any shared care prescribing arrangement with a private provider is unsafe, not enduring, and widens health inequalities, and demands that GPC UK adopts a firm position statement to reject this.
