Could GPs really ‘do a dentist’?

Following 99% of BMA GP members rejecting the Government’s imposed contract, Pulse editor Sofia Lind questions whether ‘doing a dentist’ is a realistic negotiating tool for the profession

Last week 16 LMCs wrote to the GP Defence Fund (GPDF) to ask it to defund the BMA’s GP Committee.

The chair of the GPC in England didn’t take that well, as you may have guessed.

She took to social media to accuse the letter writers of looking to line their own pockets and destabilise the GPC at the worst possible time.

She also argued that the idea of ‘future proofing’ general practice by the potential route of following dentist colleagues (not something the letter said outright) was a fanciful idea.

However, some signatories of the letter said it was not about ‘doing a dentist’ but rather about creating leverage.

That’s something that the GPC leaders would also argue that they have done – with the recent referendum of BMA GP members resulting in 99% rejecting the Government’s imposed contract.

But many LMCs feel the GPC has been too much talk, and not enough action, with collective endeavours not resuming from 1 April as originally threatened.

The GPC in turn was accused by one signatory of the letter of ‘repeating the same behaviour year on year expecting a different outcome’. The idea of a ‘plan B’ is about painting a picture to which the Government would be forced to listen, they argued.

What this shows, is probably that the signatories of the letter do not all have the same idea of what future proofing general practice might mean.

But let’s consider for a moment the idea of GPs going down the route of dentists.

Immediately there are some serious obstacles: GP partners may be independent contractors, but general practice is far more tied into NHS structures than dentistry ever was.

Even partners who do own their own premises now have the funding to pay their staff tied up into complex NHS funding streams, not to mention that they are now covered by state indemnity.

Even in the instances where it may be possible, it is practices in the most leafy areas for which NHS practice has proved the most lucrative. Private GPs are reporting uncertain margins and high costs, alongside uneven demand, and they are not typically based in the areas where GP partners are struggling.

And then there is the question of what happens if it did take off. Because the likely outcome is not thousands of independent practices suddenly thriving outside the NHS. A smaller number may be able to make it work, but more likely there would eventually be corporate provision akin to the veterinary model.

That may create leverage of a kind, but not – I think – what the letter writers hope for.

Now, that doesn’t mean the frustration behind the wish to develop ‘plan B’ is entirely misguided. After all, it is very difficult to defend the position that the current approach is working.

But leverage only works if it is credible and at the moment, that of ‘doing a dentist’ is not really it.

Which leaves the profession back where it started, and I for one am holding my breath to find out what happens on 30 April: by which point Wes Streeting has been asked to delay mandated A&G, put in safeguards relating to same-day access demand, and have started negotiations in earnest about a wholesale new GMS contract.

Sofia Lind is editor of Pulse. Find her at [email protected] or on LinkedIn 

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