Dr Laurence Buckman: ‘Ultimately, the Government holds all the cards’

‘We had reached an agreement with a part of the Government, which another part of the Government didn’t want, and matters came to a sudden stop,’ says Dr Laurence Buckman.

In his distinctive way of speaking – short, clipped sentences, matter of fact and to the point – the north London GP and GPC chair is attempting to explain why this year’s contract talks broke down in such catastrophic fashion.

In October, apparently out of the blue, the Department of Health announced five months of negotiations had collapsed and said it intended instead to unilaterally impose a raft of contractual changes – changes that will have a significant impact on the workload and pay of every GP from April.

It’s not the first time Dr Buckman has faced an imposition. In his first year as GPC chair, back in 2008, Gordon Brown’s Labour government railroaded through extended hours. So he speaks from bitter experience when he warns practices they should prepare for the worst.

‘You can’t block what governments decide to do,’ he says simply. ‘There are many things governments decide to do that I don’t agree with, or indeed that the vast majority of the population doesn’t agree with. But that doesn’t mean they don’t happen.’

If he sounds somewhat defensive, it’s with good reason. A Pulse snapshot survey over Christmas suggested many GPs believe the GPC is at least partially to blame, with half claiming negotiators did a ‘poor’ or ‘very poor’ job of representing the profession.

Dr Buckman doesn’t believe the survey is large enough to be representative, but accepts some degree of criticism is ‘inevitable’.

‘I don’t think we did a bad job, but we did our job and if they’re disappointed, well, I agree with them,’ he says. ‘But actually, ultimately the Government holds all the cards. If the Government decides that anything will be the case, then that’s how it will be.’

The GPC will survey the profession and hold a series of roadshows around the country this month – ‘the whole point is being seen, you don’t hide behind an email’, he says. But with formal consultation on the proposed changes now well under way, Dr Buckman’s focus is very much on minimising the fallout from what fellow negotiator Dr Chaand Nagpaul has called ‘the most significant quantum reduction in the GP contract that we’ve ever seen’.

‘Now what we have to do is make sure that GPs are as equipped as they can be to cope with what is coming, that we can do our best to diminish the damage that the deal, as imposed, will put on doctors,’ he says.

The uncomfortable truth is the contract imposition was announced – perhaps not entirely coincidentally – when the BMA was still reeling from the failure of its industrial action on pensions.

Dr Buckman brushes aside any suggestion that just one GP in 10 supporting the ‘Day of Action’ last June weakened his hand in contract talks – ‘I don’t think it made the slightest difference, it was about an unrelated matter’ – but he is clear there will be no repeat.

‘There is no point in calling for industrial action when nobody takes it,’ he says.

He also rules out a boycott of commissioning, despite support from a number of senior figures within the BMA and a slim majority of GPs polled by Pulse.

‘Some of us suspect that the Government may not actually mind terribly much if GPs did not take part in commissioning, so we may be playing into their hand by saying: “Well then, we’ll stomp off the pitch.” Who would take over? It sure won’t be GPs.’

Instead, the focus is on damage limitation – and he is clear that the damage will be substantial.

‘A lot of English GPs will see significant adverse cash movements, and I don’t have an answer to that except to say it is the same for me and it is not something I am pleased with,’ he says.

The GPC estimates the removal of 150 QOF points will cost the average practice £31,000 a year – ‘a member of staff, if you choose to do that’ – and Dr Buckman believes GPs will struggle to tackle the four new DESs into which funding has been shifted.

‘I am not sure actually you could take on all four DESs. The workload of all four is very steep.’

‘Most’ GPs will see a significant cut in their personal pay packet, he believes – as he expects to personally – and cuts to patient services are ‘inevitable’. BMA economists are currently modelling the full impact of the changes, and the GPC will provide detailed guidance to practices.

‘I think our main job will be to help people understand what this will do to their practice incomes, practice organisation, their staffing levels, their take-home pay. It is a lot to take in. These are major, disturbing changes that are going to upset people a lot.’

It’s a difficult, thankless task, and so it’s perhaps unsurprising Dr Buckman is not entirely sorry to be stepping down as GPC chair in the summer, after six years in the hot seat and 15 as a negotiator.

‘Would I have liked to stay on and get us out of this? Not really. I’ll be quite happy to let somebody else do it. This is too big a job for any individual to try and solve.

‘I think some GPs have the naive idea that if I go and thump the table hard enough somebody will wake up and listen but it’s not like that at all.’

And his legacy? He smiles mischievously.

‘A world at peace is how I’d like to go out. At least an NHS at peace, but that won’t happen. So I’ll go out making a noise, like I always do.’