Dr Chaand Nagpaul should be feeling the heat. The day after he was elected as the profession’s new leader in a GPC meeting filled with high drama, Pulse is grilling him on his plans in the sunny private garden at the back of BMA House in 30-degree temperatures.
But despite the sweltering heat, he retains his cool. Asked whether he really knows what he has got himself into, he smiles and responds wryly: ‘Oh, I know.’
The new GPC chair is facing a full-to-bursting in-tray, with an implacable health secretary bent on reforming out-of-hours care, NHS managers plotting a wholesale redesign of primary care provision and GPs struggling to cope with an exponentially increasing workload and diminishing funding.
During the interview, his phone buzzes with an alarming frequency, and he is clearly a man with a lot on his plate, but his responses remain calm and focused.
His overall strategy seems to be built around an argument that greater investment in GPs will help the Government achieve its wider aims for the NHS. He says: ‘I would like to use my chairmanship to get the Government to understand that general practice is actually a solution to the pressures, and that supporting GPs will benefit the Government because it will help the NHS function more effectively.
‘The funding of a GP practice is around £100 per head and that pays for unlimited access for a patient to GP services over a year. The cost of a single outpatient appointment is about £200.
‘General practice is remarkable value for money and investing a little bit extra would give GPs the ability to produce that much extra and actually reduce the pressures on the NHS.’
He faces an uphill battle though to convince ministers of this at a time of an unprecedented squeeze on NHS funding. His predecessor for the past six years, Dr Laurence Buckman, struggled to win anything more than below-inflation funding increases. Now NHS England is predicting a £30bn black hole in its finances by 2020/21 in addition to the £20bn savings required by 2015.
Dr Nagpaul insists he is not asking for the Government to spend more on the NHS: ‘What we are asking is for them to value the effectiveness of general practice. That is what I hope the Government will grasp this year.’
But as Pulse recently revealed, 43% of GPs are at high risk of burnout, with practices stretched to breaking point and unlikely to be able to take on more work. Will some have to go to the wall before the Government sits up and takes notice?
Dr Nagpaul says, understatedly: ‘It would be to the Government’s detriment if they let the battle go that far.
‘GP burnout is the consequence of a system that places too much work on GPs, which is beyond their capacity to deliver, [with GPs] working in an environment subject to political ideology, rules and pressures that devalue them and take away their professionalism.
‘The solution [would be for] the Government to negotiate an arrangement with us that puts patient care ahead of ideology.’
Many would say this is wishful thinking as a general election looms in less than two years’ time, and he refuses to be drawn on whether the GPC has been in discussions with the Labour Party over its plan to merge NHS and social care budgets.
He says: ‘GPC and the BMA always have a dialogue with all of the major parties, [who] all have a role to play in the politics of the NHS. We would need to get our heads around more of what Labour is proposing but they haven’t made their minds up yet anyway – they are consulting.’
After being a GPC negotiator for six years, and serving on the GPC since 1996, he is an old hand at the annual contractual negotiations. But a lot is riding on those skills this year.
Dr Nagpaul sees negotiations as an opportunity to row back on some of the damaging changes imposed on the profession this year.
He says: ‘There is ample evidence that the imposition has made GPs work beyond capacity and has not improved patient services.
He adds: ‘I would like to stand up for what is right for general practice, for patients and GPs. But I am really hoping the Government will see the folly of getting into battle with us when the important thing is actually to work with GPS.
The key areas for negotiations for him, he says, will be to keep the UK-wide contract intact as the devolved nations push in different directions, and to ensure the QOF remains proportionate and evidence based.
He says he supports NHS England’s idea of a smaller framework as it will lead to happier GPs and more satisfied patients
He says: ‘There are elements of the QOF that sadden me because I have always been a supporter of improving quality, but now there are elements that make GPs feel devalued.
‘Ultimately the key thing for patients is the core care they receive from their GP. They aren’t actually interested in the DESs and the enhanced services and the margins of QOF. What they want is to get an appointment with their GP when they are ill; they want to be given the time and the attention in the consulting room [when] in fact many of these additional burdens are taking GPs away from their core duties.’
But Dr Nagpaul warns that any funding taken out of QOF should be placed back into core GP funding and not used for other incentives – as it was this year with the new DESs introduced in England.
He explains: ‘We would like England to follow the example of the devolved nations, where the governments have removed elements of the QOF and put that into core GP funding. The core work has magnified and it makes sense to give GPs financial security rather than jumping through hoops to win that money back.’
But the main issue for many GPs will be the call from the health secretary for the profession to take back some sort of responsibility for the out-of-hours care of their patients.
Dr Nagpaul is adamant: ‘The idea of talking about GPs being personally responsible contractually is a red herring and isn’t actually addressing the problem.’
He adds: ‘What we should be focusing on is enabling GPs to commission effective out-of-hours services. We have produced a paper explaining how we believe out-of-hours care can improve and a lot of it depends on the Government supporting GPs to commission effective out-of-hours services.’
‘You can’t divorce GP out-of-hours services from NHS 111, walk-in centres, unscheduled work settings such as Darzi clinics and minor injury units. What we would like is instead of focusing on the narrow issue of GP out of hours, to actually give GPs on CCGs real commissioning ability to improve unscheduled care in the out-of-hours period.’
Dr Nagpaul may be a cool customer, but he is determined to defend GPs’ interests with passion when it counts.
Dr Chaand Nagpaul on…
…his main aim as GPC chair
I would like to get the Government to understand that general practice is a solution to the pressures [in the NHS]
…taking back out-of-hours responsibility
It is a red herring and isn’t actually addressing the problem
I am hoping the Government will see the folly of getting into battle with us
• GP in Stanmore, north London
• Qualified as a GP in 1989
• Served on the GPC since 1996 and a negotiator since 2007
• Has sat on 11 BMA subcommittees and chaired two