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Your move, Mr Lansley

The fallout from the Ubani case seems to have set the GPC on a collision course with a future Tory Government, says PulseToday editor Steve Nowottny

Make no mistake, Dr Laurence Buckman’s latest comments on the future of out-of-hours care have gone down well with grassroots GPs.

It took just a few minutes after we broke the story this morning, reporting his pledge that the GPC would not negotiate a return to responsibility for delivering out-of-hours, for the rank-and-file to make their approval known.

‘Excellent Dr Buckman, I salute you,’ said one GP. ‘Spot on here,’ said a second. ‘Absolutely spot on,’ chipped in a third.

But while Dr Buckman will no doubt be cheered by the backing, it comes as a bit of a mixed blessing. There’s a bit of wriggle room in the statement, to be sure (‘Things may well evolve as they always do,’ he cautioned) but the thrust of it was fairly specific, it’ll-get-quoted-back-at-you-if-you-back-down specific.

‘Can I get this clear: we are not about to renegotiate the GMS contract (or the PMS contracts that flow from it) with anyone,’ he wrote. ‘GPC will not negotiate a return to responsibility for delivering out-of-hours.’

Which is a bit of a problem, given the Conservatives have publicly pledged to do exactly that. Commenting on the Ubani case last month, shadow health secretary Andrew Lansley was explicit.

‘When Labour took responsibility for out-of-hours care away from GPs they made a serious error,’ he said. ‘GPs are best placed to ensure patients are treated properly and that these awful events are never repeated again.’

Ever since delegates at the 2008 LMCs conference narrowly voted for a motion calling on the GPC to consider moves for GPs to take on responsibility for commissioning out-of-hours, the profession’s leaders have for the most part done everything possible to dance around the issue.

Taking on commissioning was very different to taking on provision, they explained. The Tories’ plans would absolutely not mean a return to the bad old days pre-GMS contract, of 3am home visits and struggling to read house numbers by torch light.

Well… maybe. But as more than one GP has pointed out since then, pre-GMS contract not that many GPs were necessarily involved in provision of out-of-hours either. What they were actually often doing was effectively commissioning, taking responsibility for out-of-hours care but providing it through local arrangements or GP cooperatives.

It is, perhaps, an argument the GPC were hoping never to have to thrash out. But in the wake of the Ubani case, and the Tories set on handing GPs responsibility for commissioning, it suddenly looks increasingly likely that it’s going to be the argument that shapes the next round of contract negotiations.

The battle has not yet begun, and won’t, of course, unless the Conservatives win the general election. But Dr Laurence Buckman’s comments today make it very clear he’s ready for one.

Steve Nowottny