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I don’t envy the GPC chair


Short-term boost


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 editor@pulsetoday.co.uk

READERS' COMMENTS [8]

Turn out The Lights 4 November, 2021 6:43 am

Would anyone want to be put in charge of a sinking ship when the captain has abandoned it .

Turn out The Lights 4 November, 2021 6:49 am

But then again a lot of us have already abandoned ship and left the BMA when the GPC steered it toward the iceberg when the let down the juniors and rolled over with each year contract pension reforms,and funding freezes.The seeds have now been set.The outcome which ever way it goes is unlikely to solve anything.In Dr a au try’s place I woul do the same.

Thomas Robinson 4 November, 2021 5:38 pm

Absolutely, the negotiator and his team, need to be proper professionals in this field with legal, relevant background, training, and proven track record.

Now what about a bit of further radical thinking

Dr vautrey, and his predecessors never represented me, nor did they care about my views, nor did they ever seek a mandate from me. I spent my entire career totally disenfranchised by an arcane, incompetent, BMA system. Worse when I tried to cease supporting the local LMC I was told the LMC levy was compulsory.

What about the ordinary grassroots GP’s who actually see patients and try to get things done, directly electing the GPC. What about a mechanism to hold the GPC to account for their failings.

Monica Aquilina 5 November, 2021 5:10 pm

The BMA is made up of its members representing every branch of the profession .
I have been a member since 1981 and I have found the BMA to be an organisation that encourages its members to participate and get involved whatever their views.
As a grassroots doctor or medical student one can get involved with one’s local branch and submit motions to the BMA annual conference where policy is agreed. What could be more democratic than that? Sure it is not perfect but it is up to the individuals that belong to the profession to engage with its elected officers-or stand for election if one feels one’s views are not being represented.
Dr Vautrey has been at the helm for 4 years. I wish to thank him for all his efforts and it is reasonable for him to decide when it is the right time to pass on the baton.

Thomas Robinson 5 November, 2021 8:18 pm

There you go

That’s exactly what happened every time, put forward an idea and someone from the BMA, told me I was wrong, every time.Eventually became tired of being told I was wrong, and paying for the privilege

Absolutely no consideration of the idea, just a blunt rejection.

Absolutely no way Monica would consider balloting the profession as to whether it would like to directly elect the GPC. No, no need, because we know best and we know you are wrong.

You just have to look at how brilliantly we are representing GP’s, and how happy they are.

Monica Aquilina 6 November, 2021 10:33 am

I am sorry-I am a doctor who is a simple BMA member, not ‘someone from the BMA’
My point is not to say anyone is ‘wrong’ but to point out that doctors can engage from within the BMA and debate how grassroots doctors are represented. It is a fair point to have professional negotiators as part of the GPC team-and led by one at the helm.
We can argue for this from within the organisation-the more people do this, the more it is likely to happen.
We are all on the same side-wanting the wellbeing of doctors and the delivery of good health care to the public.

Turn out The Lights 6 November, 2021 9:37 pm

Over the years the BMA seems to be consultant centred with GPS and Juniors being an after thought.Preservation of the status quo in the NHS being the pattern of the last decade.The last straw for me after successive funding restraint GP contract was when they let the juniors down more work for less pay.Stopped my throwing money at them then.Sorry but there is now nothing that can be done to convince me to throw my money away.I suspect the current noise will be just that all noise and no action.The decline of th the NHS and the disintegration of the GP workforce will now continue their is no going back.Too little to late BMA.

Simon Sherwood 14 November, 2021 3:47 pm

Well the BMA have presided over the biggest deterioration in terms and conditions for a shortage profession .
You need an RMT style militant
I offer my services