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‘GPs can’t continue as we are. It is unsafe’

Dr chaand nagpaul 3x2

Dr chaand nagpaul 3×2

Pulse: Are contract negotiations still ongoing?

Dr Chaand Nagpul: Contract negotiations are continuing, they are likely to be concluded – they have to be before next year. But I want to be clear that our aim is to negotiate a bigger package of reform that general practice needs.

So that potentially is what the LMCs special conference can bring, then?

We need now to completely re-look at how general practice can be properly resourced and can operate in the current environment. We’ve reached a point where continuing as we are endangers the care of patients. It’s unsafe. Your own data shows that 200,000 patients are being displaced, so these are not theoretical scaremongering tactics. This is a reality that’s unfolding in front of our eyes.

Some areas are at risk of not having a GP service at all

We’re on the verge of seeing swathes of practices likely to find themselves unsustainable under the current arrangements due to funding cuts, not being able to recruit, and workload pressures. It’s not just about the practices that have closed: it is about a much bigger iceberg of collapse. We’re now also seeing some geographical areas at risk of not having a GP service at all.

There needs to be immediate action taken, but there also needs to be a longer-term strategy that enables sustainability. This conference is about demanding that some action is taken now to stabilise the current parlous state of general practice.

I know that the GPC and the RCGP, NHS England are all signed up to the 10-point plan on GP workforce. But is this enough?

The 10-point plan was, in my mind, never a solution. We need much more. Proper sustained resources to expand the workforce. We need to follow the lead in Northern Ireland where every single practice will be supported by a pharmacist, as opposed to what we have in England, which are time-limited, on-off funding projects. At a time when we don’t have enough GPs we also need as much support as we can get to relieve the intolerable workload burdens on practices. It’s not a case of skill mix replacing GPs, it’s about skill mix making the job bearable and manageable so that we can expand the GP workforce. You’re not going to expand the GP workforce whilst the job is unsustainable and intolerable in its pressure.

The most important, immediate thing is that we need to reduce workload to safe and manageable levels. You will never retain GPs or attract young doctors to enter a job where they feel that they’re not able to practice safely and where they feel they are doing inhuman hours, and where they feel the job has no value or reward. So we need to do something about that immediately,

How would this work?

GPs are being, on a daily basis, asked to do things that is wholly inappropriate. We know that up to 27% – that’s NHS England’s own statistics – of GP appointments are due to inappropriate demands on our time, That is a staggering statistic and reflects the scale of un-resourced and inappropriate workload moving in the direction of general practice. That needs to be stopped and it is possible for the Government to put a stop on much of this.


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GPs are funded on a capitation basis and we’re being exploited in having workload thrown our way. Because the system doesn’t then pay for it. That needs to stop, because it’s got to the point where this is affecting safety and quality.

We need a new commissioning system. I think it’s inexcusable and unacceptable that we’re seeing 70m more patients in general practice compared with six years ago, and we haven’t commensurate increase in resources. We need a payment system that recognises where work is delivered, and in that regard general practice needs to be given its fair resource.

But we also need to make sure that general practice isn’t being asked to do things it shouldn’t be doing. CCG board members having duty also to stem inappropriate and unfunded work coming the way of general practice. I’ve written to every CCG about this before, and I think that has to be a core function of CCGs.

LMCs Conference 2015

LMCs Conference 2015

Pulse will be reporting live from the Special LMCs Conference this Saturday. Follow all the developments at

We need to see a very public commitment that the pressures in general practice need to also be reduced, and that our time needs to be used appropriately. There needs to be some short-term immediate funding to stabilise practices, where it’s inexcusable that practices who are at the mercy of the funding formula that may not reflect their needs are finding themselves now on the verge of unsustainability. The Government needs to put in place short-term measures so that practices that are suffering the effects of funding cuts are stabilised.

Do you feel the £10m fund that has been allocated for that is adequate?

It isn’t about £10 million for practices that are identified as struggling, it’s about having the money for the entire infrastructure of general practice and for the whole profession that is under strain and is at risk of collapse. This isn’t about just providing support for some identified practices. £10m is far too low, it’s only going to be targeted at a small number of worst-affected practices whilst ignoring the iceberg underneath that tip, which is of a large number of practices that are reaching their tipping point. What we really need is proper resourcing of that larger iceberg if we’re not to continue to see more and more practices then revealing themselves as being unsustainable.

And I presume that comes down to funding CCGs to have local autonomy to step in…

We’ve advised NHS England that there should be funding now for resilience teams of GPs, practice managers and nurses to support practices when they are going through difficulties or practices that are in a proactive sense. We shouldn’t be waiting for a crisis to occur and then solve the crisis. We should be trying to prevent the crisis occurring, and that needs much more than a £10m pocket of money, just to deal with a few. Secondly, the £10m has a bureaucracy associated with the application process so we need much more than that.

There is a motion in the LMC’s conference regarding the submission of unpaid dated resignations. Should that motion pass what would the next steps be?

The special conference is to highlight to the public and to politicians that general practice is not sustainable, and is not safe. It is a springboard for action. It will empower GPC and the profession to stake their claim that general practice needs to be rescued from its current plight.

We need to see real tangible changes with immediate effect

More than that it needs to have a sustainable future. This isn’t about just rescuing us for a few months, then going back to square one. What the conference is asking for is for us to implement a rescue for general practice, but I believe it needs to be more than rescuing, it needs to be sustainability in the long term, and that motion is asking for us to do that. What it is saying is that if it isn’t delivered in six months, then of course, if that motion is passed, that’s what we’ll look at.

But the immediate requirement for us is to deliver a change in general practice, and that’s what that motion is asking for us to do. the other thing to say is that I don’t think this is about some theoretical issue about mass resignation; we’re seeing mass resignations occurring in front of our eyes and the Government’s own commissioned work-life survey shows that there will be a mass resignation of nearly four in 10 GPs in the next five years.

That is going to happen, so this is something that isn’t a threat – it’s going to be a reality, and the Government needs to take notice of that reality. I can’t pre-judge how the conference will vote – that’s not my job. I will do what the conference asks me to do and what it’s asking GPC to do is to negotiate a rescue package with the Government. I don’t want to wait six months to negotiate that – I don’t think that general practice should be waiting six months. This is something that needs to happen now, immediately after the special conference, we need to capitalise on the conference to make sure that we start to see incremental, real tangible changes and commitment by the Government with immediate effect.