General Practitioners Committee Annual report 2008
March 2008
Foreword
This year has not been the easiest to kick off my Chairmanship but it certainly has been interesting. The campaign against GPs has escalated and we have seen moves tantamount to selling off primary care to the private sector as fast as possible. None of this has a mandate from the public, and yet GPs are seeing deliberate attempts at erosion of public confidence in us and the threatened absorption of English practices into polyclinics or “health centres”. The pace of “reform” has continued unhampered by evidence, agreement, cooperation, engagement, or transparency. I suspect that this year will see the further enforcement of the next bout of changes foretold in the Next Stage Review of the NHS. I would like us to unite around a common goal – developing the NHS for our patients’ benefit, whilst holding on to the things that they value and retaining a practice and working pattern that is fulfilling.
This means recruiting more aspiring GPs into practices – not easy at this time, raising standards of practice and encouraging consistently high quality care for all. Although most of these threats are English, GPs in Scotland and Wales need to be vigilant as their governments are also looking to England to take a lead in changing the way GPs work. GPs have always been modernisers and innovators. We welcome practice development but we cannot go along with implementation of evidence-free policy.
Five years after the introduction of the new GMS contract we should be consolidating what we have and looking to the horizon. The surge in morale of three years ago has been frittered away by government and the level of mistrust has never been higher. This cannot be good for the NHS or our patients.
This year will undoubtedly see attempted assaults on the MPIG that keeps 90% of GMS practices afloat. We must never give this up until Global Sum increases make the Correction Factor unnecessary, something clearly not on the cards right now. We must therefore refute the untruth that MPIG is only for particular types of practice in particular areas – it is almost universal and essential in keeping many GPs solvent. PMS practices have similarly had a harrowing time this year as many PCOs have tried to erode the growth monies that made a difference to them. We will continue to try to establish a PMS MPIG for those practices that wish to return to GMS, and GPC will support all LMCs in their quest to keep PMS funds intact.
This last tumultuous year has seen the BMA prove that the government’s intention to cap GP pensions retrospectively was illegal. There was a disgraceful attempt to force GPs to work in extended hours by uttering threats to our profession, and a sprint for private and commercial care to take over general practice in the absence of any evidence that patients, the public, the NHS or doctors want this. I do not remember a time when so many have been so unhappy with the direction the NHS is taking but that does not alter our determination to work with ministers as much as we can to deliver an improving service for our patients. What a shame that the sole plank of government policy was to force GPs to work in unsafe and minimalist conditions at night and weekends to benefit a minority of voters while those who need us most will benefit little if at all. GPC will observe the new patient survey very carefully to ensure that it truly gathers patient opinion.
Like me, you will have been saddened that negotiations were interfered with by government in December; you will have been irritated by the peculiar method of “negotiation” with the GPC, and the subsequent poll of opinion that perforce only included two unacceptable options. Of course, the GPC could have given you any number of alternatives but we were not offered any and it was important that you could say what you wanted and were able to express your feelings as so many GPs did. I am sorry that we had to express anger rather than willing cooperation but we had to demonstrate the strength of feeling after the government repeatedly said that the GPC were out of touch with GPs. You proved how in touch we are with overwhelming support for our stand against
bullying. It cannot be good for the NHS that 97% of GPs have no confidence in the government’s handling of the NHS.
The final straw has been the strange pay “award” by the DDRB, the ready acceptance by government of another effective pay cut for GPs whose expenses have risen, and the need, yet again, for the GPC to threaten legal action.
The reasons for government behaviour become clear when one discovers that the new favoured model of health care is to be offered to private providers. Many NHS GPs will conclude that the government wants to get rid of GMS and PMS GPs.
The appalling DDRB recommendation to cut the supplement for new GP Specialty Registrars yet again, and the promise that they will do worse next year, is disappointing, unimaginative and will damage recruitment into general practice for a generation. At a time when we need more GPs, to make younger intending GPs work for less seems perverse.
If that is the bad news, what’s good? The unity within the profession and the determination to prevent the deliberate dismantling of our practices has made me proud. LMCs and GPs have supported local and national activity to highlight our concerns. The professional press officers and parliamentary staff of the Public Affairs Division of the BMA have worked tirelessly (and often without thanks from our members) to present our messages to the public. They have advised many of you on your local stories and supported you in putting our case to anyone who will listen. Many of you have already spoken to your MPs and I hope that every GP will try to contact the one person in your area who can get the voice of reason to be heard. Our Parliamentary Unit will always advise you how to go about this.
Although GPs outside England have had less local unpleasantness, they have still had to cope with changes demanded by Westminster, luckily none of them related to the future commercialisation of the NHS in England. All GPs have to work within the same framework and to deliver care on a shrinking income and the four nation deal still holds for the most part.
Where we have all done well for our patients – the QOF and our quality of care generally – I am pleased to say that the sustained efforts GPs and their staff put into ensuring the highest standards remain considerable. We should celebrate the performance of our colleagues. GPs who strive to deliver the best will make it harder for those who would denigrate us. Many of our critics just don’t “get it”: we are GPs because we want to share the magic relationship of healing with caring for families in their environments. The localism and continuity that makes patients seek us out is the key feature that separates us from large institutions run for shareholders. We value our patients too highly to dismantle holism for a clinic full of unknown doctors who will know medicine but not the family or the history across different medical disciplines. The generalist is the one who guides patients to the specialist and acts as their adviser through every problem they chose to bring. We must never forget that when days darken.
Laurence Buckman
Chairman
General Practitioners Committee
GPC annual report 2008 (541k)
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GPC annual report 2008 - Executive summary (261k)
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