This week the GPC turns 100 – and as the BMA celebrates, Pulse has put together a package which looks back at a century of GP representation through both the national GPC and local medical committees.
With thanks to Wessex LMCs, Essex LMCs and Dr John Canning, secretary of Cleveland LMC
1911: The BMA wins statutory recognition for local committees of ‘panel doctors’ in the 1911 Insurance Act, after doctors voiced concerns that the Government’s original plans for the new state health insurance scheme made no provision for GPs to participate in its administration. The Local Panel Committees become known as Local Medical Committees from 1913 onwards.
1912: After the Local Panel Committees are set up, the BMA establishes a national committee to represent their combined interests in negotiations with the Government. The national committee was initially known as the Insurance Acts Committee, before eventually becoming the General Medical Services Committee and later the General Practitioners Committee.
1912 to 1948: In the lead up to the formation of the NHS in 1948, the GPC and LMCs support the principle of state medical schemes, but staunchly resist attempts to bring GPs into a salaried service and fight to retain the independent contractor status of the profession.
According to Essex LMC’s The work of the Local Medical Committee in England and Wales report: ‘GPs feared that government would seek to direct them in their day-to-day treatment of patients… Had it not been for the tenacity of the national Insurance Acts Committee, GPs could have been drawn into a salaried service, as were their hospital colleagues in 1948.’
1948: The NHS is established in accordance with a number of principles that GPs demanded via LMCs and the GPC. These include:
– Independent contractor status upheld
– Freedom to practice without state interference
– Freedom of choice by patient and doctor whether to take part in the NHS
– Freedom of choice for the doctor of form and place of work
– Adequate medical representation on all administrative bodies in the NHS
1964 and 1965: General practice is in crisis, with morale low and increasing numbers of doctors snubbing the profession. As a result, 18,000 of the then 22,000 GPs sign undated resignation letters from the NHS. The crisis leads the GPC to drive the creation of the Family Doctors Charter, which receives backing from the profession. The charter secures a number of ‘wins’ for GPs, including improvements to premises and proper remuneration for out of hours work.
According to Dr John Canning: ‘In the late Seventies and Eighties, general practice was the career of choice. It was quite difficult to get training posts and jobs when you finished training. That was very clearly as a result of how general practice had been able to develop.’
1990: Conservative health secretary Ken Clarke imposes a new GP contract on the profession. According to Wessex LMC’s The History of Local Medical Committees the new contract ‘caused more problems than it solved’ but it introduced the basis for many recent concepts such as the purchaser/provider split, fundholding and practice-based commissioning.
According to Dr Canning: ‘The 1990 contract was a very fraught time for the GPC but I think looking back on it the chairman got as good a time as he was ever going to get.’
2004: Primary care undergoes major reform with the introduction of the new GMS contract. The Government promises a stronger role for primary care with more GPs and funding for general practice, while GPC pledges that no new work will be shifted to primary care without new pay. The new GMS negotiations introduced four alternative contracts for primary care- GMS, PMS, APMS and PCTMS – and brought greater roles for alternative providers.
Dr Canning said: ‘Leading up to 2004, [the situation] was very similar to 1965. General practice was no longer the career of choice, practices were finding workload increasing and resources were going down. It was a very difficult time to recruit. At the time my own PCT had something like 50% of the GPs aged 50 and over. It was looking very difficult.’
‘The nGMS contract was quite significantly messed about with in shifting core money into QOF, which meant there was underfunding of the core service. It was certainly a lot better in 2005 than it was in 2002 in the ability to do things. It was clear how you could get paid to do work beyond the core. Were there downsides? Undoubtedly. The real downside was the introduction of alternative providers.’
2008: A contractual row with the Government over evening and weekend opening leads to the GPC being forced to accept the ‘imposition’ of an extended hours deal. GPC negotiator Dr Peter Holden warns GP representatives face an uncertain future: ‘The Government can dictate its price – I can see nothing but blood, sweat and tears.’
2012: Candid email from a senior policy executive at GPC reveals belief that, as the Andrew Lansley’s unprecedented NHS reforms make their way through Parliament, ‘negotiators find themselves in a strong bargaining position’ for next year’s GP contract.
The email, printed in the South Staffordshire LMC newsletter, states: ‘The Govt / Departmentwere desperate to reach a negotiated agreement this year, and this was in no small part due to the fact that Andrew Lansley realises he cannot make his reforms a reality without the cooperation of general practice.