There can be little doubt that general practice will face its ‘Dunkirk moment’ in 2017. Our profession lies exhausted by repeated assaults from a triumphant government intent on stamping out any resistance. We have seen our allies topple one by one – the junior doctors, the consultants – and it is our turn to face the onslaught. Already we are being bombarded by exhortation to surrender to the inevitable. This is now a visceral battle for survival, with nothing but blood, sweat and tears ahead.
Just as in the dark days of June 1940, this is a time for fighting leaders. We do not need polite diplomats reminiscent of a more gentlemanly era who practise appeasement, and who think ‘peace in our time’ can be achieved around a table with politicians who bully, intimidate and lie their way to victory.
Since 2004, GPs have endured a string of defeats, with feeble defence from BMA leaders appointed to protect them. Pensions devalued. QOF goalposts changed. Revalidation hoop-jumping. Ridiculous CQC inspections. Vilification by press and politicians. Practices and people pushed to breaking point and, sadly, beyond.
It is not time for the BMA to be complacent
At each attack, the BMA strategy has been to negotiate to limit the damage. But rarely to counter-attack, and when finally it did over pensions, it was an ineffectual, half-hearted riposte destined to be a failure from the outset.
The grassroots are angry. They are clamouring on social media to overturn years of complacency from leaders who have focused far too often on process and too little on results. The BMA power kegs are not just kept dry, they are degrading from lack of use. It is not time for the BMA to be complacent. The consultants have fired a warning shot with recognition of the HSCA to negotiate on their behalf. This should send shock waves through the BMA establishment. GPs could be next to seek independent recognition.
For many, the final straw was the GPC executive overturning the 2016 Special LMC Conference motion to seek undated resignations from GP members. This desire for action was trampled into dust by leaders lacking the courage for a fight. One of the biggest factors stifling action whenever GPC has actually summoned courage to plan some action is the need to have this ‘approved’ by the overcautious bulk of the BMA and by the ever infighting BMA Council.
Many grassroots GPs think it is time for these passive leaders to step aside. We need a new leadership willing to fight, and without significant conflicts of interest. Revolution is in the air. It may be via an internal coup within the GPC itself to appoint activists not frightened to call for industrial action. It may be via formation of an independent National Association of LMCs – after all, why should the LMCs pay the levy if their instructions at conference are flagrantly ignored? It may be via one of the online associations gathering momentum, such as GP Survival, who while still embryonic with 6,000 members, are listening to grassroots GPs, not ignoring them from the comfortable armchairs of Tavistock House and Euston Square.
For too long, the BMA have put the survival of the NHS as their primary goal, willing to sacrifice their members on the altar of that sacred cow. Now it is time for them to produce a fully costed ‘Plan B’, demonstrating willingness to take general practice out of the NHS if necessary, should government resources fail to deliver what could be the most effective primary care service in the world.
Time is short. General practice is close to unconditional surrender. The BMA leadership must finally fight back, or step aside and let others willing do so. Thousands of grassroots GPs want action. As Churchill said as the tide turned in the last war: ‘This is not the end. This is not the beginning of the end. But it is, perhaps, the end of the beginning.’ Now is the time to call us to arms.
Dr Alan Woodall is a GP partner in Wales and founder of GP Survival