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In full: Buckman’s out-of-hours letter



Read the full text of Dr Laurence Buckman’s pledge for the GPC not to take back responsibility for out-of-hours care.

(Please click here to read Pulse’s original story on Dr Buckman’s comments).

Message from Dr Laurence Buckman, Sunday 7 February

This week has seen yet another irritating attempt to rewrite history. The word on the street is that the GPC negotiators of 2000/3 led by John Chisholm (and including Hamish Meldrum, Peter Holden, Tony Calland and myself) hoodwinked NHS Employers into the dodgy GMS contract that is the cause of patient deaths in the OOH period. I just want to understand this: a disgraced German “Plastic Surgeon and GP” comes over here, is a bit tired, works for a company created in the light of the government’s commercialised NHS and kills someone – and UK GPs in general, and GPC in particular, are to blame. Others have also tried to set the record straight, but for completeness I should add my contribution.

The new GMS contract was born out of necessity because of workload, recruitment and retention issues. There was universal agreement that something had to be done and the government wanted to break the GP monopoly anyway so it suited them. They also were convinced that NHS Direct could do it better. We agonised over the consequences of this decision, but it was and remains clear that the vast majority of GPs do not want to give a 24 hour commitment and were exhausted from trying to do so. Like all of you, I have had the experience of being woken at 3am to be told that the patient could not sleep.

It would have been possible for GP co-ops and their near relatives to have been the preferred providers for OOH but PCTs driven by SHAs were determined to go private and we now see the consequences of doing it cheap for the benefit of shareholders: deliberate underbidding and cost cutting, as well as the utterly predictable disasters. Some providers have been perfectly OK – usually those that grew from former co-ops – but some have been poor from the outset and no-one would listen when we said so.

As some have noted, not every GP was either good at, or provided, OOH before the “wicked” GMS contract came to pass and “lazy GPs stole money from the sick while doing less work”. The majority of GPs had already effectively opted out through deputising and co-ops and some of the former enterprises were only just acceptable. One thing in favour of such services was that the better one were policed by the BMA (outside London) and by LMCs in London. Medicine has moved on since then and medical services have evolved in many ways that offer better care to patients – and GPs are in the vanguard of that. The rosy retrospectoscope is a very deluding instrument.

It is sad that so many politicians believe that the GPC is to blame. It is disturbing that many press commentators think the same, though they have had their minds bent by an enormous industry of spin – the same one that makes out that GPs have coined it at taxpayers expense. The new GMS contract negotiations were repeatedly interfered with by politicians, in particular Alan Milburn (who increased the amount of income that GPs would earn from the QOF, against our advice), the Treasury (run by we know who) and Blair’s advisers in No10. What we have now is a product of their complete faith in their own decision-making, mixed with a certainty on our side that what we had done was fit to put to the profession for their support. To pretend that we engineered some piece of deceit to get politicians off their own hook is malicious and I hope that nobody inside the BMA or LMCs gives this any truck. John Chisholm and his team worked with NHS Employers (led by a decent now-SHA-CE Mike Farrar) to reach a wise agreement, not some elaborate con-trick. That we got anywhere close is to all of their credit and no thanks to a bunch of politicians and their advisers who have devoted many of their waking hours to making GPs feel like they and their jobs are valueless.

Can I get this clear: we are not about to renegotiate the GMS contract (or the PMS contracts that flow from it) with anyone. Things may well evolve as they always do but I am not going to see a reasonable attempt at improving the healthcare of the British people messed up by the ignorant or those scheming for votes.

Furthermore, GPC will not negotiate a return to responsibility for delivering OOH. We think GPs should be involved in giving advice to the commissioners of the service and we have offered to help ministers in this regard. We have several GPC members who are or have been actively involved in delivering OOH services, as well as LMC secretaries and chairmen who have ideas as to how this could be done. The offer has been taken up and I will let everyone know more when there is more news.

Dr Laurence Buckman
GPC chair