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Medicopolitics is the art of the risible

Medicopolitics is the art of the risible

Look, I’ll level with you. I’m good at sore throats, but I’m no good at medicopolitics. I don’t understand it and I’m not that interested in it. The annual LMC conference, for example, is as mysterious and arcane to me as a Masonic meeting, so I really have no right to shout ill-informed opinion from the sidelines.

But that won’t stop me.

After all, if I’ve got this right – and you might need eyelid-propping matchsticks for this next bit – the successful LMC motions mould GPC policy which in turn, I’m guessing, must inform contract negotiations. So I’ll summarise the successful motions from the recent LMC conference here. See if you can spot a problem:

No new PCN work or DES extension, all PCN funding to be moved into core, PCN withdrawal without withdrawal symptoms, a new fee-for-service contract, alternative contract models for a post NHS apocalypse, income protection until April 2022, suspension of direct NHS111 bookings, a ban on mandated Advice and Guidance, and an end to contractual online consulting.

I know: no mention of solving the migrant crisis, curtailing global warming or achieving world peace.

OK, it’s not that I disagree with any of the LMC demands, it’s just that, taken as a whole, it reads like a catharsis rather than a serious negotiating position. I mean, if we GPs took to the streets right now, inspired by this, what would we be chanting? ‘What do we want? Everything to be less shit.’ It doesn’t even scan.

Not that there seems much likelihood of militancy. While there were signs of anti-PCN sentiment in the pre-ballot ballot responders, that response rate was a dismal 35%.

So the risk is that the Government will see the demands as a joke list from an apathetic profession. And that the negotiators will be in a state of increasing desperation and futility, shouting themselves into hoarseness and sore throats. At which point, of course, I can help.

Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at



Please note, only GPs are permitted to add comments to articles

Patrufini Duffy 29 November, 2021 10:38 pm

I want every practice in the UK to get one free parking permit. Out of pure understanding. And CPD culled to 20 hours. But that ain’t never going to happen. Home visiting, what a 21st century gimmick and Victorian age charard. And certificates, how childish.

Darren Tymens 30 November, 2021 11:55 am

I usually enjoy your articles for their clear-headed cynicism, but this one seems misguided.
I think it is fair to say that many of the motions state the obvious (though some people still voted against many of them), but what alternative motions would you have liked to have seen presented before conference and passed?
LMC Conference motions become GPC negotiating positions.
Negotiating positions have to start from clear statements, before actual negotiations erode them into something both sides are usually unhappy with.
I don’t think asking GPC to argue for a new contract where workload and funding are directly linked is either fanciful, illogical or controversial.
I don’t think asking GPC to argue for an end to PCNs and a shift of funding into core funding is fanciful or illogical either (though some GPs have heavily invested time and energy in PCNs, and that was reflected in the vote against this).
I think the motions that were passed this year give a clear mandate to Farrah (as new GPC Chair), and send clear and helpful signals to government.
I think in that regard it was one of the most successful and useful LMC Conferences in years.
What happens next depends on the government’s attitude, their appetite for a fight, and the skills of our GPC negotiating team.
(COI: I am an LMC Medical Director, so attend Conference but don’t get to speak or vote).

Jamal Hussain 30 November, 2021 11:56 am

I can see how your lack of education in medico-politics can sometimes cause confusion.
The don’t believe the problem here isn’t the GPC negotiation or the negotiators. The problem respectfully is people like you. People who are happy to leave it to someone else who is more clued up to do it but also content to fling shit from the sidelines. At every opportunity they undermine the negotiating position of the the negotiating team rather like brexit.
The negotiating team equip themselves with a mandate and a list of demands from the grassroots. Then the haggling starts. If you go in just wanting one thing you’ll come out at best with half of that one thing you wanted.
The biggest problem is that the grassroots are apathetic and aren’t prepared to be whipped into more of a work to rule position to facilitate a better negotiated outcome. It ends up like herding cats and it all goes to shit as everyone and his dog pipes up with dissenting voices from the sidelines having no clue as to the minutiae of the negotiating positions but feeling they have the right to chip in with their clueless opinions. Just like you said in your introduction.
If you look at another industry say the London tube drivers whose union has the average pay for FT work at 56k. That’s right 56k for a bleeding tube driver. That doesn’t include overtime which is handsomely rewarded. Consider for just a moment how much training and debt is accrued in training a doctor and how much training and no debt goes into becoming a tube driver. And then you ask the question how did this come to pass? Can can a tube driver be earning more than a GP. One thing should become plainly obvious. That some people have enough intelligence to know when to shut the F up and not undermine what’s in their own best interests by undermining the position of their union leadership. Also it helps to be prepared to piss people off to get what you consider you are due. Having an undervalued self worth is the enemy of success. Disagreeableness to a point is a positive personality trait for those who want to be better rewarded for their work. ( see Jordan Peterson on YouTube). If the grassroots are weak and have no resolve and are more concerned about what their patients think then why bother with GPC at all. Most patients think doctors earn more than them and that is too much and they don’t work hard enough for it. The Whitehall propaganda machine works. We have too many people who are apathetic and too many people who are gobshites in our profession. We need to learn to shut the F up and tow the line for our mutual benefit.

Darren Tymens 30 November, 2021 12:00 pm

A clarification and a correction:
To be clear, concerning PCNs it should have read ‘in the size of the vote against this’.
I mis-spelled Farah’s name – a simple typo, sorry!

Shaba Nabi 30 November, 2021 1:28 pm

Thank you so much Darren 😍

Paul Evans 30 November, 2021 3:20 pm

1) There WAS a motion on the environment. Migrants also got mentioned by Tower Hamlets LMC. Fact-check next time.
2) It’s easy to sit on the sidelines and snipe anonymously, putting the boot into those daring to raise their heads above the parapet, rather than getting in the game and at least trying to improve matters. Probably more fun too. And you get paid for doing so. Win win win – actually, I can see why you do this now!
3) The alternative to giving GPC a negotiating list is not giving them one, and letting HMG have a free pass, unopposed. Yes, the system we have is imperfect, and negotiating with a bunch of greedy, corrupt sociopaths is likely to have limited success, but your implied alternative (do nowt) is worse.

DOI: LMC Chair and member of this year’s agenda committee.

Michael Mullineux 30 November, 2021 6:42 pm

Not sure TC’s thoughts constitute sniping… the profession is apathetic, it signed up to the PCN DES’s en masse despite LMC warnings many never having even bothered to read the contract, it continues to accept almost any new NHSE initiative that comes our way and PCN leads have vested interests in continuing with the project.

Finola ONeill 1 December, 2021 12:30 pm

Jamal thank you, you say everything I am thinking. Michael I also agree. The PCN DES is a poison chalice. If a majority of GPs want to accept an open ended contract term that ca dump any amount on work on us, then we will end up where we deserve. As independent contractors, and PCN DES being a DES, we are in a very powerful position. Ie; we just ditch it. We can tether it down to a term of of the core contract, or delineate it as the fixed DES now (no further expansion, no open ended terms) ie to include funding for additional roles, no strings attached, and leave it like that. Or just ditch it entirely. But we need to ditch any further expansion of its remit and limit it now, no further expansion, end of. For me, although GPs/doctors are bright people they don’t know where their remit ends. We are good at clinical work. We are not good at interpreting or negotiating contract law. That should be left to the experts; contract law solicitors and contract negotiators. Now is the chance to protect our profession and our patients. We will see how pathetic or how clued up GPs will prove to be. If pathetic wins out there will be a mass exodus, including more transfer to locums, or career changes. We shall see. Many of us don’t relish the role of martyr.

Sujoy Biswas 5 December, 2021 5:35 pm

LMC bods out there…. many LMC advised strongly to sign up to the PCN DES. A few resisted but our local one were adamant and based on this we joined. Sorry but he’s right doing nowt would have been better!

Reply moderated
Kevlar Cardie 17 December, 2021 3:16 pm

If politics is showbusiness for ugly people then medical politics is…

fill in the blank.