For a man who was remarkable for his subdued presence in 2011, Dr Laurence Buckman is entering the new year in combative mood – and is quick to single out the profession’s number-one concern.
‘GPs are furious about pensions,’ he says pointedly. ‘They, like me, are going to see a nosedive in their take-home pay. They are already spending a fortune on expenses and their income has fallen anyway because of inflation.’
But how far does he feel a profession that has faced wave after wave of tabloid attacks over their pay will go to protect their pensions? Dr Buckman rules out a strike but admits that less direct industrial action is ‘possible’: ‘What we need to do is find things that will hurt the Government, that will demonstrate our anger but not hurt patients. There are ways of doing that.’
He’s speaking ahead of last week’s BMA Council meeting, and it will be BMA Council that leads on pensions action. But in the meantime, Dr Buckman and his negotiating team are turning their attention to protecting against future bear traps for general practice.
Dr Buckman is adamant that revalidation cannot get underway in December without a deal being struck on funding for remediation, despite the GMC’s claims to the contrary: ‘If remediation is not sorted by the time revalidation starts, revalidation cannot go ahead.
‘It’s a make or break issue, and the GMC can say what it likes. The GMC is in charge of revalidation, but the BMA cannot support a system of revalidation that does not have supportive mechanisms beneath it for people who require them.’
Dr Buckman won’t be drawn on whether ministers are pushing for doctors to foot the bill for remediation – talks are ‘amicable and positive’, he says diplomatically – but the GPC is adamant that the NHS should pick up the tab, not GPs: ‘After the pensions business there is going to be so little money left that paying for remediation as well is just not going to happen.’
On the health bill, Dr Buckman adopts a sceptical stance: ‘I think the idea of GP commissioning, or clinically led commissioning, is something I think many GPs find quite attractive – I do. Unfortunately, it’s looking more and more like clinical commissioning groups are getting pushed into bigger and bigger groups.’
It’s a warning at odds with the GPC’s insistence before Christmas that CCGs should merge in order to cover at least a million patients, but Dr Buckman clearly feels GPs risk being cut out of the loop entirely.
‘We wanted [CCGs] in larger groups for economic reasons, but not as large as they now seem to be. These larger groups appear to be remarkably like PCT clusters, the PCT clusters are going to be privatised, the services they offer to the caring bit of the NHS are going to be subbed out. So we will end up with NHS managers employed by the private sector selling their services back to the NHS, to deliver what? Pretty much what we’re offering now.’
If the Government’s approach to talks over pensions and the health bill is anything to go by, the GPC will struggle to make ministers listen. However, Dr Buckman can claim a victory of sorts in last year’s GP contract negotiations by limiting Government plans to abolish practice boundaries. A limited set of practice boundaries pilots will go ahead, but the scheme is a far cry from the tub-thumping rhetoric about abolishing them entirely.
Dr Buckman says ‘it will be interesting’ to see how the pilots fare. He suspects that the take-up will be far less than ministers believe, and the costs of home-visit services and temporary residents will prove too much.
‘Success means, from the Treasury point of view, that it doesn’t cost anything. I suspect they’ll be disappointed.’
But what about this year’s negotiations? With many GPs facing their sixth effective pay squeeze in the last seven years, does Dr Buckman believe a pay rise for general practice is now inconceivable?
‘There is a prospect because the Government has said there will be a 1% average pay rise across the NHS. But we have no basis to be sure that expectation will be justified,’ he says gloomily. ‘It depends on how George Osborne interprets his statement of an average 1% rise. It might mean GPs are on the wrong end of that calculation.’
Dr Buckman warns GPs are contending with the ‘general strangling of the NHS because of underfunding’ and offers a deliberately routine example – his own PCT has ‘actively discouraged’ prescribing of emollient creams to eczema sufferers: ‘That drive to do it cheaper and cheaper and cheaper doesn’t enhance the doctor’s or the patients’ experience, and every GP around the country is telling me they are fed up with it.’
But far from having had enough of the health service, Dr Buckman will move back to full-time practice when his stint as GPC chair ends next year – news that may come as a surprise to some observers who felt he would be a strong candidate to replace BMA chair Dr Hamish Meldrum when he steps down this summer. Was Dr Buckman tempted to stand for the role?
‘No. I work in my practice presently two full days and many evenings and weekends – and I will be happy to return to full-time practice.’
The pensions reforms
‘I will end up, after tax and expenses, with about 20% of my gross income. That’s disturbing.’
‘This is right at the top of the frontburner for both us and the Government.’
‘It seems strange to place so much energy doing something most people don’t want and that will destabilise some practices.’
Hospitals dumping work
‘It’s up to GPs to say no. You don’t refuse the patient, you refuse the person who has dumped this on you and you say no.’
Devolved health services
‘The Celtic nations, they look on with a smile on their face saying: “It’s wonderful in Scotland, Wales and [Northern] Ireland.” And I can understand why.’