On July 18, my successor as chair of the UK General Practitioners’ Committee will be elected, and I will return to the relative obscurity of my north London practice.
For the past six years, I have had the privilege of leading the UK GPC negotiating team, whose main aim has been trying to keep general practice alive and thriving.
My education for the chairmanship included seven years as a negotiator and three as deputy to the former chair of the GPC and BMA, Dr Hamish Meldrum. But nothing could have prepared me for the enormous workload, pressure and intrigue that accompanies the top spot. Every day brings over 150 emails and many have included media work, as well as unexpected and unwelcome problems from politicians and the wilder reaches of the NHS.
All this time I have continued to run my single-handed practice with the help of some outstanding assistants.
I came in on a manifesto to defend, promote and expand the good work that GPs do – and I hope I have had a degree of success, despite the rocky terrain that as GPs we have had to travel over. At least those who are foolish enough to snipe at GPs without evidence know that we will hit back without hesitation.
I hope that I have managed to hold the various parts of the profession together – we have more in common than divides us – and reduced the democratic deficit at the GPC. We have more women, sessional, ethnic minority and younger GPs than when I first took over as chair, something that I am proud of. The GPC must not be complacent because there is still more that needs to be done to get a wider group of GPs active in what the BMA and LMCs do, and this is something I expect my successor to push on with strongly when they inherit the top seat.
I am also proud that I was part of the team that negotiated the new contract 10 years ago and was one of the small group that got the QOF up and running. This work is admired internationally, and has delivered real benefits to patients and rewarded GPs properly for the hard work they were doing then and have continued to do now – not least in providing a million consultations a day to patients.
Another improvement that I believe I helped to shape was the concept of revalidation – particularly making it part of our professionalism, rather than the administrative mess it threatened to be.
Unfortunately, during the second half of my tenure, things have become tougher. The economic crisis has hit all parts of society and general practice has been no exception. There is less money in the kitty than there used to be and that meant whichever party held the keys to Downing Street would have asked the NHS to operate on a tighter budget.
The proper way to do this would have been for the Government to hammer out a decent way forward with the GPC. Unfortunately, while this has happened at times, it hasn’t happened enough and our present problem with a recklessly bullying Government is a case in point. The last round of talks on the GP contract got us within touching distance of a tough but fair settlement, but then the Government pulled the plug and instead imposed an alarming set of contractual changes.
The QOF is now in danger of being reduced to a shrunken tick-box exercise rather than the flowering of evidence-based medicine that we hoped for. The latest changes contain some daft proposals, including offering points to practices for referring patients to education programmes that don’t exist in all parts of the country and asking people if they do gardening. The general thrust is for GPs to do more, and not just with fewer resources, but with a diminished level of support. This will put practices under huge pressure.
That is what you get when you dispense with sensible talks and go for draconian impositions: ill-thought-out policy that does not benefit patients.
GPs can do it
As I depart the stage, I am aware that many politicians and some commentators hanker for a non-existent past when we were available at all hours for anything. They don’t seem to understand that to expand general practice, we will need extra GPs and more funding.
The GP workforce can meet any challenge put in front of it – let’s not forget this is the workforce that delivered 50 million extra patient consultations in the five years after the implementation of the new contract. But to do this, we need to be backed up by politicians and managers who are committed to talking to NHS staff and backing us with extra support.
On July 19, I will return to my practice for four days a week and hope to turn some of my assistants into partners. I plan to expand my practice, despite the current pressures, and I will remain a GPC member for another year.
I have tried my best, and I wish my successor luck. Like me, they will need a good dose of it.
Dr Laurence Buckman is the outgoing chair of the UK GPC. He retires to practise as a single-handed GP in North London