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Dr Michael Ingram: ‘GPs are knackered and punch-drunk’

Next month, around 400 GPs from across the UK will convene in central London at the LMCs conference. It’s the annual summit of the profession’s democratically elected representatives, an intense two-day bear pit where LMC delegates thrash out the key issues facing general practice and set GPC policy for the next year.

In doing so, they will give GP leaders, politicians, the media and the wider public their best opportunity to truly gauge the mood of general practice in 2013. And Dr Michael Ingram, the man charged this year with running it all, marshalling a record number of motions and somehow ensuring coherent decisions emerge as a result, is under no illusions about just how dark that mood currently is.

‘GPs are knackered,’ he says. ‘I think you have a feeling now that our workload is becoming intolerable, the demands on us are intolerable and the workforce is being squeezed at both ends.’

‘There is a combination of being punch-drunk from the Government, an air of resignation and a rabbit-in-the-headlights feel. Anger is beginning to come through too and fear for the future, fear for the viability of general practice.’

We meet in the grand surroundings of BMA House, the spectacular listed building designed by Sir Edwin Lutyens off Tavistock Square, a powerful symbol of the medical establishment. But Dr Ingram, a GP in Radlett, Hertfordshire, wears his prominent medico-political role lightly, describing himself as ‘very much a grassroots GP’, who first got involved in helping run the LMCs conference by standing for the Agenda Committee ‘in a fit of pique’.


A traditional model under threat

Among frontline GPs there is ‘real anxiety’ about whether general practice can survive in its current form, he says.

‘It’s everything from the viability of rural dispensing practices with changes to dispensing, to the disinvestment we’re seeing now which applies to the majority of practices, and other aspects such as privatisation, the potential for performance management and even any-qualified-provider status,’ he says. ‘Everywhere you look, the traditional model of general practice is threatened.’

Chief among the profession’s concerns, he says, is this year’s contract imposition, with the radical changes to the QOF in particular making GPs feel like ‘a hamster in a wheel’.

It’s a fair bet that GPC negotiators will come under fire at this year’s conference for not having done more to resist the changes, but Dr Ingram, who as conference chair also sits on the GPC, says such criticism does not allow for either the financial or ‘attitudinal’ environment GPs find themselves in.

‘There is a feeling among grassroots GPs that the GPC could have done more, but the GPC is caught between a rock and a hard place,’ he says. ‘It’s impotent and being blamed for its impotence.’


Year after year of ‘constant media attrition’ has stacked the deck against GPs, he says, adding that their public image has become defined by the 2004 contract. ‘The fact is the way we work now is harder, but it’s not perceived by the public to be harder, because you can’t get your own GP at 3am.’

Was the GPC hamstrung by the BMA’s decision to take industrial action on pensions – industrial action that ultimately only one GP in 10 joined? Dr Ingram picks his words carefully.

‘Personally – and this is a personal view – I think it was the wrong area to do battle on,’ he says. ‘There are so many other aspects of what’s going on…

‘We’re part of a collective, corporate body for the BMA, and it’s very important we support the whole profession in its message.’ He pauses. ‘I’m not sure it did general practice a lot of good.’

One of the more controversial votes at last year’s conference saw LMCs demand that ‘disengagement of GPs from clinical commissioning be included in any industrial action’. A narrow 48% to 37% vote made it LMC conference – and therefore GPC – policy. But it’s a policy that has never been enacted – and indeed the GPC has repeatedly ruled out any kind of commissioning boycott.

‘That is something the GPC clearly hasn’t taken on board,’ admits Dr Ingram. ‘It’s quite clear that it’s not as simple as it would appear. The fact is, if you do disengage with commissioning then that’s got obvious consequences. It’s regrettable that that hasn’t been done, and I think we might well see some of that taken further at this year’s conference.’


• GP in Radlett, Hertfordshire for 26 years

• Elected chair of LMCs conference in 2012

• Was member of the smallest CCG in the country before it was forced to merge

• Organises GP academic courses overseas with Conference Plus

• Keen marathon runner


Representing the profession

Do GPC negotiators generally do a good job of representing the views of their constituents?

‘As far as they can,’ says Dr Ingram. He insists the GPC ‘must listen to grassroots general practice’ and follow policy set at the LMCs conference – but he also adds a significant caveat.

Last year an unexpected and even closer vote – 48% to 47% – saw LMCs instruct the GPC to negotiate a hugely controversial change in the GMS contract that would allow patients to receive treatment not funded by the NHS from their own GP on a private basis. It was an instruction the GPC chose to ignore.

‘Though that was conference policy, I would be slightly more defensive of the GPC there,’ he says, pointing out that it was a motion wholly at odds with the BMA’s anti-privatisation agenda. ‘If it’s 47% to 48%, there’s far less expectation on GPC.’

And what of the LMCs conference itself? How well does it represent a diverse and fast-changing profession? Dr Ingram says one of his key goals as chair is to ensure that every kind of GP is fairly represented, and conference feedback forms have been amended to collect key demographics as a first step. 

‘Sessional GPs are underrepresented, and certainly younger GPs – and women,’ he adds apologetically.

He is also acutely aware of the need to represent the whole UK, and was pleased to see the 2012 conference move outside the capital, to Liverpool, for the first time in years. Asked about 2014, he smiles: ‘There will be an announcement soon.’

In the meantime, he’ll be focusing on ensuring that the voice of the profession comes over loud and clear this month.

‘I want to encourage the grassroots GP, sitting brassed off in their surgery thinking “Right, something’s got to be done”, to be able to go to the LMC, and to see the LMC convey their personal message up to conference, up to GPC policy. I want to see a connect between that hacked-off GP and the policies the GPC tries to attain for the profession.’


Watch the full interview