Can the LMC conference revive general practice across the UK?

Ahead of the UK LMC conference this week, Dr Burnt Out looks at the state of general practice in each of the four nations and considers the next steps needed to save the profession

‘I always arrive late at the office, but I make up for it by leaving early.’

If only Charles Lamb’s quote was true for GPs. Unfortunately, it’s more like: arrive at work early; leave late; and do all you possibly can to maintain some semblance of work-life balance while trying to avoid burnout at all costs. Unsurprisingly, it is widely agreed that fundamental changes are urgently needed in the way general practice is structured and delivered across the UK. 

So the UK LMC conference in Wales this week seems like a big moment for our profession. General practice in each of the four nations is on its knees in differing ways. But, in each country, there is a united feeling that something must change quickly, so the situation does not worsen. The conference is an ideal stage for LMC and BMA representatives to steer us through these troubled waters.

In the end of course, it is ultimately the Government who has the power to change the system and organisation of primary care. With an impending general election, general practice will be at the forefront of any election campaign – as the Labour Party have already stated.

But we should not underestimate the power of our own voices. The conference is a rare chance for GPs – leaders and grassroots – from across the British Isles to gather in one place, have vigorous debate, motion voting, exchange ideas and stories.

Despite general practice being wildly dysfunctional across the whole UK, it is wildly dysfunctional in a smorgasbord of different ways depending on which nation you work and/or reside in. I provide a brief summary of the state of play in each of them.

Wales 

In the conference’s host-country, general practice is in a hugely precarious situation. BMA Wales has called for more funding, and warned that without further investment general practice in the country will see its 100th practice closure in just over a decade. The RCGP has also expressed concern that there are only 374 practices left in Wales. Practice closures are predominantly affecting rural and deprived communities. In addition, Wales is also suffering from funding issues and a scarcity of GPs – both instrumental factors in pushing BMA Wales’ GP Committee to consider industrial action. The Senedd is aware of the problem and thousands have signed a petition for a rescue package. 

Scotland

Until recently, general practice in Scotland was arguably the most resilient and well-functioning in all the devolved nations. But the tide has turned, as the country battles a relentless decline in GP numbers. GP leaders in Scotland have also declared the current GP model ‘broken’, warning NHS Scotland against ‘solving’ the workforce crisis like England by expanding PA numbers.

Northern Ireland

The situation in Northern Ireland is difficult and delicate. In essence, there are – again – not enough GPs, not enough funding, record numbers of practice closures, and very long waiting lists for secondary care. It is thought that one in three practices has reached ‘crisis point.’ Not having a functioning devolved Government at Stormont until recently is unlikely to have helped matters. However, recent negotiations have been ‘encouraging’ and there have been some very recent funding changes regarding the scrapping of QOF.

England      

If there is a true epicentre of general practice omni-dysfunction then surely it must be England. Redundancies; thousands of trained GPs unable to get work, travelling the length and breadth of England for sporadic work; ARRS-led call centre same-day hubs being planned and panned. And, the BMA GP Committee England is now officially in ‘dispute’ with NHSE following 99% of GPs voting down the imposed GMS contract in a referendum. 

So where do we go from here? 

I believe that solutions to the multiple crises in our profession need to be solved on a largely UK–wide basis. It does not seem sensible to have wildly differing systems and models of primary care evolving separately across Wales, Scotland, NI and England.

Of course, there will be differences across systems appropriate to local needs. But funding, organisation, and form of general practice across all four nations surely must have a lot more in common with each other than otherwise.

Let us hope that the conference involving the BMA and LMCs across the land will help energise and re-invigorate our profession. It is about time we had some optimism in general practice.