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LMCs blog: Coffee? hysteria? Leaders support ballot on collective list closure

Friday 19 May

16:20 Motion for GPC to negotiate limits on patient contacts and ‘clear legal parameters for where a GP’s duty of care ceases so that a GP is not responsible for the omissions of other parts of the NHS’ – carried. Another big decision here.

16:09 OK new motion urging the GPC to negotiate a ’maximum safe limit to the number of patient and other contacts a GP undertakes in a day’. Gill Beck at her last LMCs has just said that we need to enable practices to declare a ‘black alert’. Seriously, if this passes we will never hear the last of it from Nigel Praities (click here for an explanation). Please stop, LMCs.

16:01 Yup – definitely something in the coffee. Now a vote of ‘no confidence’ in the GP Forward View has just been passed. Either all the ‘steady Eddies’ have gone home or being holed up in this conference centre has resulted in collective hysteria here in Edinburgh. Whatever can happen next?

15:50 Gosh, something was slipped into the lunchtime coffee. Now we have a vote supporting a ballot of the profession to assess support for collective closure of practice lists. I had better mention this – otherwise I will get it in the neck from the Pulse editor – he did suggest it first

15:40 So we’ve actually had real things happening! First, some shocking figures from Dr Katie Bramall-Stainer on the costs of APMS contracts. You can read that here. 

Meanwhile, we have a story on the STP plans here. And now the big one…whether practices should close their lists.  

13:45 And we’re back, talking about how BMA funds are spent. It turns out that the levies on LMCs are increasing, and there’s a bit of anger in the room. 

13:15 As you may have guessed, it’s lunch. Reports of GPs storming next door shouting ‘strong and stable’ are unconfirmed. 

12:15 Lots of talk about sustainability and transformation plans. Everyone is in favour of them… only kidding, almost unanimous opposition to them, unsurprisingly. 

11:30 Standing ovation for Northern Ireland GPC chair Dr Tom Black. It’s been a massive year for Northern Ireland. Practices closing en masse, the Government collapsing and actual measures in place for mass resignation of GPs.

He tells conference that GPs do not want to leave the NHS, but at the moment there is no choice.

Read the full story here. 

11:00 BIG excitement! No, not at the Scottish GPC chair speech (though Dr Alan McDevitt is giving good detail on the new contract) but at a special visitor next door. 

We can’t divulge for security reasons, but we can talk about the building, which is both STRONG and STABLE, and MAY be full later. And the signage is clear – the EXIT MEANS EXIT.  

10:20 More debate on GP training. The motion calls on Health Education England to replace the £20,000 inducement payment for unattractive areas with paying off students’ debts for all GP registrars. 

This is lovely in theory. But we suspect it would be laughed off by HEE before negotiators opened their mouths. 

Update: LMCs agree. They voted against it. 

10:05 Now we’re actually talking about things that matter to GPs – GP training. We’re debating whether the BMA should support four-year training. We never thought we’d say that a discussion on four-year training is a breath of fresh air. 

10:00 We have spent 30 minutes debating motions on GPC representation. That, by our reckoning, is longer than any other debate over the past two days. We suspect grassroots will be delighted to hear that conference voted in favour of more GPC delegates being voted in through the BMA’s Annual Representatives Meeting. Or they voted against (we fell asleep during that debate).

9:40 We’re in a massive session of navel gazing. But there is a laugh when Dr Fay Wilson tells the audience that she has a poor eye, and someone in the audience shouts ‘111’.  She may or may not be in A&E as we speak. 

9:25 We’re now in the ‘quiz the GPC negotiators’ part of the conference. This, from Pulse blogger Dr Susie Bayley, sums it up better than we can:

9:00  Welcome to the second day of conference and we have a big debate coming on later today. GP leaders are voting on whether to ballot GPs on mass closing of lists in reaction to the GP Forward View ‘failing to deliver’. We expect the GPC to argue against this, But they don’t always win…


Thursday 18 May

18:00 And that’s a wrap for the day. It’s been… well, not exactly explosive. But that might be more reflective of the profession as a whole. With it in crisis, people tend to agree that it’s a mess. 

We’ll see if tomorrow brings more controversy. 

17:30  Well that teaches us to be snide. The conference votes against calls for the support services for general practice to be returned to being delivered by an NHS organisation. The reason? Well, they won’t do much better.

But they do vote for the following – ’That this conference:

demands that GPs are compensated appropriately for any financial losses and extra work done by primary care, due to its incompetency (iii) demands that NHSE take urgent action to resolve any outstanding payment issues relating to LMCs (iv) is dismayed by the inability of PCSE to produce an accurate performers list (v) believes the public needs to be fully informed about the financial damage to the tax payer and the risk to the medical profession, and demands that the Head of NHS England be held to account for the continued failure of the commissioned service.’

More on that here.

17:15 Wonder which way this is going?

17:10 Bit of a surprise here, and electronic voting was necessary, but the conference has voted down a suggestion for GPC to oppose the Government’s plans for GPs in A&E.

This comes as all trusts have been told they must have a GP ‘streaming’ service in place in all hospitals by Christmas.

GP leaders have already vocally criticising the plans, which they say will only encourage inappropriate A&E attendances.

And, presenting the motion, Dr Tim Morton from Norfolk and Waveney LMC argued that the plan would only serve to divert GPs from where they should be – in their practices.

Speaking against, Dr L-J Evans Hampshire from Isle of Wight LMC said she believed it could ‘really benefit patients’.

But perhaps what lost the motion was the wording, as some speakers argued that the GPC could not oppose the placing of any GPs in A&E – indeed, many already work in A&E.

Oh the intricate workings of the LMCs conference…

16:55 Now we’re actually getting somewhere. The conference has voted for a motion that insists that as independent contractors, GPs should be permitted to provide and directly charge their registered patients for treatment not available on the NHS.

But Dr Richard Vautrey, deputy chair of the GPC, slightly dampens the excitement. This is the sixth time the conference has voted for such a motion, he says. Spoilsport. 

And, he adds… NHS England have shut the door completely on any talk on this. Read more here.

14:40 We’ll be honest – there’s not much happening right now. A change in the format of the conference means that now, there’s a little more conversation, a little less action. Delegates are speaking in little seminar groups, about – well, we’re not sure. 

But we are hoping for some actual decisions after these seminars are over. Hopefully. 

13:15 Story now up on the indemnity debate, with GPs demanding the Government reimburses indemnity fees in full going forward.

Read all about it here

12:30 A bit of a lull in proceedings, but we have had one interesting vote. GP leaders passed a motion that commits GPC to develop an action plan for ending the the anonymous cyber bullying and trolling that occurs on NHS Choices.

Lincolnshire LMC’s  Dr Carl Deaney says GPs feel powerless in the face of anonymous complaints, which are often based on a single patient with a grudge or can even be entirely fabricated.

He asks conference: ‘Why is anonymous feedback allowed? How come cyber-bullying is inappropriate for my children, but not for us?

‘Why can we be trolled online? Where is our protection?

‘Why is perception allowed to drive reality, what happened to facts?’

11:40 ‘The GP crisis is my fault. I am to blame,’ says Dr Zoe Norris. ’Yes, I am one of those lazy hormonal female doctors. And it gets worse – I am also a money-grabbing locum.’ 

That gets a laugh from conference – and is the start of a barnstorming speech. More about that in a moment.

11:20 An unbelievable (read: very believable) anecdote from Dr Mary McCarthy here:

11:15 We’re still discussing indemnity. Dr Preeti Shukla says that unless indemnity is sorted, ‘We should let the system collapse’. She unsurprisingly gets a big cheer. 

10:55 Ooh, a motion that might actually change something. GPC are being urged to negotiate with medical defence organisations so they will have to give reasons for refusing to renew indemnity, calls for an appeals process for those GPs and for the Government to ’provide an overreaching indemnity cover in the form of a ‘national indemnity scheme’.

Dr Phil Melluish of Devon LMC points out that Scottish GPs pay a third of their English counterparts for their indemnity. ’Are they better GPs?’ he asks. A big cry of ‘Yes!’ We’re in Edinburgh – you have to know your audience. 

10:50 Now we are discussing occupational health services, with conference unanimously condemning the woeful provision of occupational health services for GPs, demanding a comprehensive funded occupational health service for all GPs on a performers list and all GP practice staff. Not a surprise. 

10:40 Now he’s doing Ed Sheeran! We suspect most of the audience don’t recognise the song. But we do have video. In fairness, it was very impressive lyric writing. Not entirely sure about the voice

10:25 The first motion says that the current funding formula is not fit for purpose, being proposed by Dr Jim Kelly from Kent LMC. He is the one who sung Elvis’s ’A little less conversation’ two years ago. 

Everyone agrees, it seems. A lot of Suspicious Minds around the Government’s intentions in the audience. This debate around the Carr-Hill formula has been happening for almost a decade now, so It’s Now or Never. The funding issue is certainly Always on (their) Mind, anyhow. 

10:20 As is now standard, Chaand gets a standing ovation, lasting around 25 seconds, for those interested.  

10:10 Dr Nagpaul attacks the use of GPs in A&E, which gets a loud cheer. Wonder if Theresa May is watching? (Almost certainly not, if we’re honest).

9:55 And he’s off. To be honest, there is nothing particularly new in the speech, but he is summing up all the problems in general practice with a lot of passion. He makes a good point – that the GPC has done a good job in making sure everyone knows about the crisis. This is true. It’s not clear what good that has done, mind. Read the full speech here.

9:45 Welcome to this year’s LMCs Conference, which will determine the policy of the BMA’s GP Committee for the coming year. Last year’s was explosive, with local GP leaders calling for a ballot of GPs to resign en masse. Which was, er, later quietly dropped by the GPC.

That will be discussed at some point in the meeting (to be potentially quietly ignored later in the year).

But first, we’re all waiting for GPC chair Dr Chaand Nagpaul to give his flagship speech. He does give a good speech, does Chaand. You can find a sneak preview here.