The fightback of UK general practice is under way

The fightback of UK general practice is under way

BMA News

It is now two weeks since more than 300 GP representatives from across the UK convened in London for the special local medical committees conference.

In my opening speech, I declared that general practice is quite literally in a ‘state of emergency’, in which it is untenable and unsafe for GPs to continue to work against impossible odds, struggling to provide services to patients without the capacity nor the resources.

I highlighted that brutal funding cuts, unmanageable workload, soaring demand and a workforce crisis were having a devastating effect, with a 50 per cent increase in practice closures last year, which is the tip of the much bigger iceberg of practices at risk of implosion.

I reiterated the damaging impact of disproportionate, flawed over-regulation by the CQC (Care Quality Commission) as revealed in our recent CQC survey, taking GPs and nurses away from caring for patients, and adding fear and stress on a demoralised workforce, with three out of four GPs saying that they were more likely to want to leave the profession as a result.

Importantly, I outlined a range of solutions to resuscitate general practice from its current state of collapse, from immediate action to stabilise practices, to proactive support for the vast majority of practices who are teetering on the brink.

I highlighted the need to manage demand, with national and local policies to stem the barrage of unfunded and inappropriate workload shift into GP surgeries, together with a national self-care campaign, to signpost patients to other appropriate services.

Working in synergy

At a time of a gross shortage of GPs, I called for new resources for a skill mix of health professionals to support general practice. I described what we can do ourselves to manage workload, including developing collaborative alliances of practices to create resilience and sustainability, and to align the GP workforce with partners and sessional GPs working together in unity and synergy.

The bottom line is general practice desperately needs more funding on the back of a decade of disinvestment and escalating volumes of care in the community. I called upon the Government to do the right thing by patients’ and GPs alike; to ‘stop penny-pinching and be pound wise’ by investing in arguably the most cost-effective part of the health service, where £136 per patient per year pays for all-in unlimited care including home visits, and is less than the tariff of a single outpatient clinic attendance. You can read my speech, and watch my opening address.

My speech attracted coverage across the media, with ITV news bulletins carrying an interview with me throughout the day. The Guardian did a full feature on the special conference alongside other national and regional media. Our media team worked with the trade press to put in place a great deal of pre-coverage of the conference, including a set piece interview with Pulse. In GP, there were five opinion pieces in the day leading up to the conference from GPs, covering a range of topics, as well as an interview with me previewing the conference on GP online.

The profession speaks

The key purpose of the special conference was of course to hear from the democratic voice of LMC representatives, about solutions on how to ensure a safe and sustainable service’. There was impassioned debate and anger at successive Governments’ neglect of general practice and the damaging impact on GPs’ own health, and that of our patients.

Motions passed included:

  • The need to define safe working limits, including longer consultation times of at least 15 minutes
  • Ways to improve recruitment
  • Ending the current regulatory system of CQC
  • Reducing the burden of appraisals and validation
  • Addressing financial risks regarding premises ownership
  • Rejecting annual contract negotiations in favour of stability
  • Increased core resources and proper and fully funded GP expenses
  • Calls for Crown indemnity for all GP work.

A motion calling for home visits to care homes being part of a separate contract resulted in a sensationalist front-page story in the Daily Mail, as well as an article in the Guardian. This led to a day of frenetic media coverage, in which I was interviewed on Radio 4 Today, Radio 5 live and other stations.

It is noteworthy that what started with a negative newspaper headline resulted in publicity regarding the unmanageable pressures on GPs and the need for proper resourcing for non-core out of hospital work.

Our ultimatum to Government

The concluding motion on next steps received greatest publicity, calling on the BMA GPs committee to negotiate a rescue package with the Government, and that failure to do so within six months should result in practices taking action to limit workload, as well as GPC canvassing the profession on its willingness to submit undated resignations.

This motion therefore sets a clear ultimatum to Government: to work with us to deliver our Urgent Prescription for General Practice, or to suffer the consequence of being bereft of a GP service to meet the needs of the population. You can read more about the conference, or watch the webcast of the entire day, witlinks to specific areas of debate.

Finally, I would like to thank Guy Watkins, conference chair and also the rest of the agenda committee, for their dedication and hard work in sifting through 590 motions and pulling together a cohesive and concise agenda, in a remarkably short space of time. While the conference may have ended, the great fightback of UK general practice has truly begun.

For the latest news, visit

With best wishes,

Chaand Nagpaul

BMA GPs committee chair

Urgent prescription for general practice 

The BMA launched the first phase of its campaign, Urgent Prescription for General Practice, last week, in direct response to calls at the 2015 annual representative meeting for a campaign to highlight the pressures on general practice, and which echoes the views and feelings expressed during the debates at the special LMCs conference.

The GPC is driving this campaign forward under the leadership of executive member Beth McCarron.

The campaign was launched with analyses of our workload pressures survey presented as heat maps, highlighting pressure areas across England and Wales. These maps will be updated periodically to cover the range of questions asked.

The campaign has already received considerable media coverage following an exclusive deal brokered on the story between the BMA’s media office and the BBC. As a result our survey received blanket coverage across the BBC and included clips from a struggling practice that we arranged for the BBC to visit.

I appeared on BBC Breakfast TV, and our story was featured on BBC 1pm, 6pm, and 10pm news bulletins, throughout the day on the BBC News channel, BBC online,  Five Live, the Today programme on Radio Four, and our representatives appeared on well over a dozen BBC regional radio programmes. As part of the media approach, we also arranged an exclusive on the story with the Guardian which put the story on its front page. As well as coverage in other media outlets. The story was also carried on GP and Pulse.

This campaign is very much about sending concurrent local and national messages to the Government, to press for urgent action to stabilise general practice and provide the basis for a sustainable service for patients in the future.

GP practices are being provided with resource packs, which include various guidance and template letters that can also be downloaded from the BMA website, as well as the first wave of analyses from our workload pressures survey.

You can read more about the campaign and show your support and sign up to the campaign thunderclap to view and tweet at #gpincrisis or use the #gpincrisistwibbonto share infographics and further information about the campaign.

Junior doctors’ industrial action 

It is extremely disappointing to hear that the Government is intent on imposing a contract that is neither in the best interests of patients nor the many junior doctors who already work tirelessly, alongside colleagues in the NHS to provide 24-hour care.

We stand firmly behind our junior doctors in their decision not to accept a contract that is bad for the future of patient care, the profession and the NHS as a whole, and in their efforts to secure a fair and safe workload.

Read the BMA’s response to the health secretary’s announcement, and the letter of support for our junior colleagues, I signed together with the chairs of the BMA consultants committee and staff and associate specialists committee.

Zika guidance published

Zika virus guidance for primary care has now been published on the PHE (Public Health England) website, as well as on the BMA website. This is joint guidance between PHE, the BMA and Royal College of GPs and gives information and advice for practices when approached by patients who have travelled, or may be planning to travel to affected countries, and focuses on risks for pregnant women. Further information about the Zika virus and countries affected is available on the PHE website.





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