Dr Chaand Nagpaul, GPC chair
The BMA’s GP committee has made the critical state of crisis in general practice in England absolutely clear to the government. GP services are buckling under the strain of soaring patient demand, declining budgets, staff shortages and unresourced work being moved from hospitals into the community. Many practices fear they are facing the possibility of closure, while nearly four in ten GPs have told a recent BMA survey they are considering quitting their jobs in the next five years. It is not surprising that many LMCs voiced their anger at this intolerable situation at this year’s annual conference.’
In response to the calls from the BMA, NHSE has accepted taking forward our proposals to alleviate the unsustainable pressures on practices. Crucially, NHSE has recognised that GPs need to work within manageable workload limits to ensure safe and quality patient care. The BMA will now be meeting NHS England to develop these proposals further, as well as putting pressure on NHSE to deliver on promises made in its General Practice Forward View plans, so that urgent support is delivered to frontline GP services.
The BMA’s GP committee will also be proceeding with a survey of the profession in September, to ensure that the profession’s priorities and views are properly taken on board when we continue our negotiations in the future. While the BMA is not proceeding with a ballot of the willingness of the profession to take action, we will review progress on tangible improvements to GP pressures, and consider any measures as necessary to enable GPs to provide safe quality care for patients.
Dr Jackie Applebee, chair of Tower Hamlets LMC, GPC representative from Doctors in Unite and proposer of original motion
I am concerned about the decision not to ballot. There was an overwhelming vote in favour of this at LMC conference. General practice is in extremis and this is widely acknowledged throughout the profession and the grassroots have by this vote showed the strength of feeling.
I understand that if NHS England has said that they accept all of the demands of the ‘Urgent Prescription for General Practice’ that some might perceive this to be a breakthrough, however it will take more than words.
We have been telling NHS England and the Government for a very long time that general practice is in crisis, but so far though they may appear to be listening nothing concrete has materialised. The GP Forward View does not give us the lifeline right here right now that general practice needs.
I understand they want to work through the proposals but I want to know exactly what that means and how long will it take, because general practice is crisis now and we don’t have time for more protracted talking.
I’m disappointed the ballot isn’t going ahead and I’m also disappointed not to have seen a list of industrial action measures that could be taken.
We could, I believe, close our lists en masse, this would help us to stick to a safe workload and help us to provide a safer service to the patients we already have registered. Whatever we do we all need to do it together, at the same time.
We need more than words and we need them now, there are doctors who could be brought back into the profession if the working conditions weren’t so awful.
Dr Dean Eggitt, medical secretary for Doncaster LMC and GPC member
The mass resignation issue, personally I think it’s a bad idea. So I think the legal teams were right to buy us some options in watering that down [in choosing the final wording of the motion]. But I do think we need to take a robust stance, it’s just deciding what that is.
The conference said ”if you don’t have a solution, a rescue package agreed between NHS England and the Department of Health, we now need to ballot the profession”. We haven’t got that. We’ve got an agreement that the Urgent Prescription is along the right sort of lines, and the GP Forward View is working towards delivering something.
But that’s not what conference mandated is it? Conference mandated we either have a rescue package in place, or we go out to ballot the profession. So everyone’s being a little bit cautious, they know we can work towards some sort of solution with the GP Forward View and the doors are open for negotiation. But the rescue package we’re supposed to deliver is not there.’
Dr David Wrigley, deputy chair of BMA Council and GPC member
I’m pleased NHSE have accepted that we have a crisis in general practice but they must act immediately given the seriousness of the situation.
Practices are closing, GPs are retiring early, young doctors are shunning a career in general practice, GP have a crushing and unsafe workload and to top it all year on year funding for general practice is falling.
NHS England need to act urgently in the next month, working with [health secretary Jeremy] Hunt, to sort this situation out before it is too late and the service collapses.’
Dr Ivan Camphor, medical secretary of Mid Mersey LMC
Just going to a ballot or industrial action leaves only one option whereas asking for their individual opinion is far more powerful and gives them much more strength and legitimacy to do what will be the next step.
I think it’s a sensible and pragmatic move – to ask the constituents about what is happening.
Morale is at an all-time low and I think there will be some element of frustration among GPs but as a national organisation the GPC needs to be well informed and well equipped and this is the right and proper way to go about it, personally.’
Dr Katie Bramall-Stainer, GPC representative for Hertfordshire and policy lead for representation
I stand by conference supporting those motions because they effectively gave GPC the negotiating hand in showing NHS England the real politik.
We’ve seen NHS England make ever more steps in our direction whilst we’ve stood firm.
GPC had sight of a letter from Ros Roughton back in July, we weren’t happy with it and stood firm and re-iterated the motion’s statement of need – that the Government had to accept the Urgent Prescription for General Practice.
So now this month we have seen evidence that NHS England wish to formally discuss the fifteen outstanding areas, to agree how each should be taken forward.
So the real question is what is NHSE going to do for practices and when. It is great we are finally seeing some action from Government, but as a GPC member I want to see results and I don’t want to see any more contracts being handed back by practices that simply can’t take any more.
Ultimately I don’t think GPs want to be taken away from their patients, the onus now is on us getting on to NHS England to deliver on its stated commitments.
The GPC will be very strongly holding it to account.
Dr Peter Holden, former GPC negotiator and GP in Derbyshire
Unless they get our expenses right, all bets are off.
There are two things I would say, I am always wary of weasel words like, ‘agree to review’, ‘have a review’, ‘understand the problems’, they’re all weasel words for ‘can we delay this any longer?’
There not only has to be a sensible restriction on our workload, what any one doctor can do in a day. But there has to be a hand in the pocket by the Treasury for our expenses, anything other than that is not a runner.
The expenses have to be put back to where they should be some years ago. If that results in a GP’s net income rising a little bit, so be it.
We have to stop GPs subsidising the NHS from their own pocket. Without that I cannot be invest and take on more staff.