It is quite easy for me to sit here and call for full-on industrial action, or any other radical idea around how to give the Government and NHS England a bloody nose. If I make a misstep with one of my ideas for general practice, I can pretty much brush it off. It won’t lead to someone losing employment rights, or reducing a practice’s finances, leaving them having to make gut-wrenching decisions about their staff.
The English BMA GP Committee doesn’t have this luxury. Any decision they make has to take into account partners, salaried GPs, locums, GPs in huge practices in leafy suburbs, single handers in inner-cities, dispensing practices, GMS practices, PMS practices and so on. Many of which have interests in direct contradiction with one another. The only time there is a ‘mood’ of the profession is when it is a really bad one.
Then there are their negotiating partners. I hear a lot of people say that the Government/NHS England is becoming more anti-GP. And it is hard to argue with this. But there is also nuance. Because NHS England and the Government is nowhere near a single, unified body. NHS England has its own factions within it, all arguing for their own greater slice of a too-small funding cake. Within the Department of Health and Social Care there are different factions, and different health secretaries have their own agendas. Then they all have the Treasury to contend with.
So even if GPC and the NHS England primary care team are wholly in agreement, everything still has to go through at least three more levels: NHS England management, the health secretary and the Treasury. And, if they are very unlucky, a negative headline in the Daily Mail will get the Prime Minister involved. This is what the GPC has to contend with.
All of which is to say that I don’t envy Dr Richard Vautrey’s job as chair of GPC England. It seems to me to be a job that involves facing constantly closing walls, leaving hardly any space to manoeuvre. After fouryears, this week he announced his resignation. Reading between the lines of his statement, I don’t think this was totally his choice.
Taking into account the tiny space he has to manoeuvre, I think that Dr Vautrey has done a decent job. Up until this year, there was a growing acknowledgement from all policymakers (and I include the right-wing press in that) that there is a crisis in general practice. With this, came above-inflation uplifts in total funding. This might not sound much, but it wasn’t always a given. I’m old enough to remember in 2013 then-health secretary Jeremy Hunt – now bizarrely cast as a friend to GPs – deciding a 1.32% increase in funding was enough, despite the profession being in poor health even then. The fact that we have seen nothing like this since is, in part, due to lobbying from the GPC with Dr Vautrey at the helm.
Alongside this, he has built a relationship with NHS England where they can actually come to agreement, and convince the other layers of Government. Up until the past few months, we went through years where all the senior people at NHS England and ministers acknowledged that GPs are struggling. The past few months have shown that this isn’t a given.
The reason I am only giving lukewarm support is fairly obvious – because general practice is potentially at its lowest ever point, the relationship between the profession and the public is at rock bottom and GPs have lost the PR war despite having right on their side. There is a reason that Dr Vautrey is leaving now.
Because of all the factors above, I am not sure how much of the blame for this can be laid at Dr Vautrey’s door. That’s not to say I don’t think there have been missteps. I think, with the media tide turning over the past year, the BMA could have fought this earlier and harder, and should have been stronger with NHS England. The GPC should have held firmer with its boycotting of talks. And the claim that NHS England had made ‘concessions’ with their access plan – which had no basis in truth – was a terrible strategy, and undermined its case for industrial action (which is industrial action in name, only).
So what lessons should be learned from Dr Vautrey’s reign? I know the vast majority of the readership in England would be desperate for a more bullish chair, and I understand this. But then there is a lesson from the most bullish chair of recent times – Dr Laurence Buckman was very popular among the grassroots, but his final negotiations saw the only imposition of a contract that I have seen, and it was as bad as it sounds.
In terms of the next chair, I wouldn’t push forward a name. But there are two things I would point out. First, general practice is a predominantly female profession now, yet a woman has never been seen as the best leader of the profession. Either this is an incredible coincidence, or the GPC needs to review its structures.
Second, and more radically, having spoken to a few people, I am going to shamelessly steal a proposal I have heard from a couple. Is it potentially time for the GPC to be led by a professional negotiator? Negotiating on behalf of the profession is a full-time role, so even if the GPC chair still was able to do GP work, the amount of time they could devote that work would make their job so different from ordinary GPs as to provide no useful insight whatsoever. With a professional negotiator at the helm, it might even allow for a more calculated militant strategy.
So maybe they don’t need to be a GP at all. As long as it is not me.
Jaimie Kaffash is editor of Pulse. Follow him on Twitter @jkaffash or email him at firstname.lastname@example.org