As you are aware the BMA local medical committees annual conference took place on 18 and 19 May in Edinburgh, bringing together representatives from across the UK to debate a range of issues that affect general practice.
The conference is not a static, moment-in-time event, but one which has a living reality for the coming year, sending as it does clear messages to the Government from the profession, forming policies, and providing a mandate of work for the BMA GPs committee.
In my opening speech (which you can read here, or watch as a webcast here), I starkly highlighted the financial brick wall that the NHS and general practice has faced during the past year, against a backdrop of the electorate having been hoodwinked by the false promise that Brexit would result in an injection of £350m per week in the NHS, when in fact we are experiencing the opposite of continued austerity measures and cuts.
Despite this, GPC negotiated positive changes and investment into the GP contract in England, such as ending the avoiding unplanned admissions enhanced service, which has freed GPs and staff from the bureaucracy and workload of chasing statistics of care plans and reports. Practices can now claim full reimbursement of CQC (Care Quality Commission) fees, have guaranteed payment for the unpredictability of practice GP sickness absence, receive funding for expenses, and with a global sum that has increased by nearly £5 per head.
I reiterated that these contract improvements cannot address the overarching crisis in general practice resulting from a decade of neglect and disinvestment. Many of our pressures relate to a wider environment of unresourced workload shift from outside our contract, and being several thousand GPs short from ill-thought out workforce planning.
Rebuilding general practice cannot therefore occur overnight, and there is not a single magic bullet to address our multiple pressures. The only sustainable solution is for the new, elected Government to fund the NHS properly in line with European averages, in which general practice receives it fair and larger share.
Meanwhile, one practical measure that can happen now is to free up the one in four GP appointments that are potentially avoidable – that’s for patients who could more appropriately have seen another professional, patients who could have self-cared, or appointments taken up for completely bureaucratic purposes. This would in effect increase GP capacity by 25 per cent – far greater than the political mirage of 5,000 more GPs. This is why GPC has negotiated changes to the English hospital contract, aimed at ending inappropriate workload transfer on to GP practices, such as ceasing patients being told to see their GPs for rereferrals after a missed outpatient appointment, or ensuring that hospitals liaise directly with patients regarding hospital queries such as test results rather than ask them to contact their GPs.
In my speech I argued for professional unity, at a time when GPs increasingly want to work in different ways – some wanting partnerships, other salaried jobs, freelance work, portfolio working, through to specialist interests. We need to design models of general practice to embrace this contractual diversity, and pull together as a profession to support each other with common purpose.
This was reinforced by GPC sessional committee chair Zoe Norris, in her conference speech, which you can watch here. I equally emphasised the pressing need to support GP partners, who report the greatest levels of workload stress compared to other GP categories, and the risk to the entire profession – including sessional GPs – if the partnership model was to collapse.
The conference also heard from the devolved-nation BMA GPs committee chairs. Charlotte Jones outlined interim contractual improvements in Wales, where they have secured approximately an extra £27m to fund GP services as part of the new GP contract for 2017/18. That investment includes a contractual uplift of 2.7 per cent to cover a pay increase of 1 per cent and contributions towards the rising costs of professional indemnity and pensions administration.
The new money also includes an increase in funding for maternity, parental leave and sickness absence and a contribution towards the business improvement levy.
Alan McDevitt updated conference on negotiations for a major new GP contract in Scotland, which is aimed at reducing demand and workload in general practice through the reduction of some practice obligations. Those negotiations are ongoing and changes to the contract are likely to begin to be introduced in a phased manner during 2018. Scottish GPC will only present a contract to the profession when it is satisfied that it addresses their aims around reduced risk and reduced workload, and when there is sufficient information available to practices to make an informed decision.
Tom Black fed back on the dire situation in Northern Ireland, where GPs are bereft of a functioning government, and with no strategy, support or investment in general practice. Conference was loud and clear in its full backing for Northern Ireland GPs and their actions to protect themselves and patients from unsafe levels of work.
There were several themed parallel sessions, to allow more in-depth discussion of important areas such as rationing, working at scale, the future of QOF, managing workload, the GP Forward View and Urgent Prescription for General Practice.
The bedrock of conference is the debate of motions, which are derived from LMCs themselves, and covered a range of subjects such as the need for greater core funding, challenging CQC inspections, matters relating to sessional GPs, and addressing premises issues including ludicrous rises in service charges by NHS Property Services. A full list of motions that were passed can be viewed here
Conference restated that the GP Forward View in England is failing to deliver the resources necessary to sustain general practice, and called on GPC to ballot GPs on willingness to close their practice lists, in the face of unmanageable workload. GPC is taking this motion forward, and I will update you shortly regarding next steps.
Meanwhile, I can assure you that GPC will remain vigilant in ensuring that committed funds in the GP forward view are made available. However, since implementation of GPFV occurs locally, it is vital that GPs and LMCs hold CCGs to account to make sure resources are delivered to practices.
GPC has produced a specific focus on funding and support for general practice web resource to assist you in being aware of what schemes are available and the support you are entitled to.
I would finally like to thank Guy Watkins and Mary O’Brien (chair and deputy-chair of the UK conference) and the agenda committee for their tireless work in organising the conference, and who ensured that the two days went smoothly with fruitful debate.
Watch the LMCs conference
You can all watch the LMC conference on a webcast, and I would encourage those of you unfamiliar with the conference to have a peek to give you a flavour of our well-established democratic process of representing GPs.
With best wishes,
BMA GPs committee chair
UEMO Spring general assembly – BMA House 26 to 27 May 2017
I attended the Spring general assembly of UEMO (European Union of GPs) last week, which was hosted by the BMA in London.
Since 1992 UEMO has taken as its core mission: the task of studying and promoting the highest standards of training, practice and patient care within the field of general practice throughout Europe; defending the role of GPs in the respective healthcare systems of its member countries; and promoting the ethical, scientific, professional, social and economic interests of European GPs, and to secure their freedom of practice in the interest of their patients.
BMA council chair Mark Porter described the context of the NHS, how it affects general practice, and briefed delegates regarding the forthcoming UK general election and the BMA manifesto for health. Helen Stokes-Lampard, chair of the Royal College of GPs, outlined its work across Europe.
In my address as GPC chair, I gave an account of the crisis affecting general practice in the UK, and the areas that GPC is leading on to tackle these pressures, from managing demand and workload through to working collaboratively in various models to create resilience. My presentation was received with a great deal of interest from delegates across European nations. It was clear that there are similar pressures to the ones we are experiencing in several other European countries and in some instances different challenges in their particular contexts.
There is real opportunity for shared learning through our involvement with UEMO, which we remain committed to continuing to be a member of regardless of the UK leaving the EU as part of Brexit. While I highlighted the effects of chronic underfunding in the UK, there was a wide recognition of the innovation, drive and social entrepreneurialism of UK GPs, underpinned by our independent contractor status – and why we must fight to preserve this essential building block of general practice.
Of particular importance to our colleagues in Northern Ireland is that patient care is particularly at risk from Brexit. UEMO called on the EU to recognise the risks to patient safety if cross-border care on the island of Ireland is compromised, and to ensure four specific points:
– The ongoing cooperation of safe provision of cross-border patient services
– The free movement of patients and health professionals across the border
– The continued recognition of medical qualifications across borders on the island of Ireland
– Clarification of funding for joint medical research initiatives.
I would like to thank GPC member Mary McCarthy, who is vice-chair of UEMO and who put in an inordinate amount of work to organise this extremely successful event, and who was ably supported by GPC member Peter Holden – also a member of UEMO.
Meet the team – Paul Cundy
Paul Cundy qualified as a GP in 1987 and took up a partnership in Wimbledon Village in May 1988.
He was elected to his LMC and in 1995 he contested an election for regional representative on the GPC and has served continuously since then.
He became chair of the GPC IT committee in 1999, having stood aside on two occasions and in his third term he was appointed IT policy lead under the Meldrum reforms.
Paul first became interested in IT at school and has carried that interest through his career. During his 15 years as chair he has led and shaped IT policy since the mid 1990s and has been the principal sponsor of the GP2GP electronic records transfer programme, something that he first proposed in 1988.
He was involved in negotiating the IT section of the 2004 general medical services contract and subsequently the GP systems of choice arrangements.
Commenting on his appointment as policy lead for IT Paul said: ‘GP computing remains the jewel in the crown of NHS IT because of our strategy of collaborative common sense computing working in partnership with users, suppliers and all colours of administrations. We are in the process of connecting that crown to the other parts of a rapidly maturing IT environment in the wider community, secondary care and patients. I am delighted to be able to continue to play my part in that journey for the benefit of GPs and patients.’
A Vote for Health – general election 2017
In our BMA manifesto – A Vote for Health, we call on politicians, of all parties, to outline credible and sustainable plans that will safeguard the future of the fully funded and supported NHS that staff want and patients deserve.
The UK still has one of the best healthcare systems in the world, but years of underinvestment in the face of rising patient demand mean the NHS is now failing too many people – patients and their families – too often.
Simply put, the NHS is at breaking point. And it is against this backdrop that the general election will be fought.
General elections are the point at which the overall direction of the country is set, defining how public services are delivered and funded. It is all too easy for this election to become the ‘Brexit election’ and little else, at precisely the time when the health service needs the unrelenting focus of politicians from all parties. Whoever leads the next Government must address the priorities outlined in this document as a matter of urgency.
We have also carefully analysed the manifestoes of each of the main political parties and provide an overview here of the pledges that will impact upon our members and the health sector more widely.
You can show your support for that manifesto by adding the BMA twibbon and banners to your social media profile and by sharing the hashtag #NHSbreakingpoint