Dr Jackie Applebee: Why GPs should not fear voting to close patient lists

As the GPC ballot on practices' willingness to take part in collective closure of patient lists draws to a close this week, Dr Jackie Applebee says GPs should not fear taking a stand.

Tower Hamlets LMC chair Dr Jackie Applebee
Tower Hamlets LMC chair Dr Jackie Applebee

The BMA ballot on willingness to consider collective list closure to avert the crisis in general practice ends on Wednesday 10 August. If your practice hasn’t voted yet please do so now. The ballot paper will have been posted to one partner, but all doctors, including salaried GPs should be involved in the discussion.

The government has failed to listen to years of reasoned argument. A decisive 'yes' vote would send a clear message that GPs will no longer tolerate more of the same.

Partners may be concerned about receiving a contract breach notice if they take part, but BMA guidance says that GMS and PMS practices facing unmanageable workload difficulties 'have the contractual right to decline to register any new patients without having to go through the formal processes and without needing to obtain area team permission'.

GP workload

An overwhelming 84% of GPs in a GPC survey last year said that their workload undermined their ability to provide safe patient care.

Practices are closing, GPs are retiring in record numbers and recruitment is almost impossible. The workforce crisis is getting worse not better. Surely most practices can argue that they can temporarily suspend patient registrations on the grounds of patient safety and avoid a breach notice?

Practices in areas with high patient turnover may be worried about sharp drops of income as list sizes fall. This too could be mitigated by choosing a list size below which the practice felt able to provide a safe service, then opening and closing as the list rose or fell around this number, giving practices control.

Meanwhile, the requirement that practices opt out of additional and enhanced services if they close their patient list is no longer in the regulations. There will thus be no impact on the services practices are currently commissioned to provide and hence no loss of income from this source.

GP crisis

There are steps the government could take easily to avert the crisis facing general practice, which is of their making. They could:

  • Accept the GPC's Urgent Prescription for General Practice (UPGP) in full. UPGP is not sufficient to solve all of the problems but it would be a start.
  • Take responsibility for indemnity as they do with hospital doctors. Indemnity is spiralling out of control especially for doctors who work for out-of-hours services. GPs are voting with their feet, making some services unviable.
  • Allow patients to refer themselves directly for services such as antenatal care, weight management programmes and physiotherapy, removing this needless administrative burden from general practice.
  • Remove the hoops we must jump through for the tiny pots of money in the GP Forward View, and put this into our baselines to allow us to plan services confidently.
  • Assure rights of residency for non UK-born doctors and nurses so that these valuable NHS staff stay. Health secretary Jeremy Hunt promised 5,000 more GPs, it is unclear where these are going to come from in the time frame needed.
  • Bring primary care support services back in house and stop outsourcing.
  • Resource the NHS adequately. We are the fifth richest country in the world and can easily afford the NHS which remains the most cost effective health care system in the developed world.
  • Abolish the NHS market, which fragments the health service and costs billions to administer, employing thousands to produce and chase invoices. Health care is not a commodity, planning should be based on need.
  • Repeal the Health and Social Care Act, which has enshrined competition into the health service and given birth to a myriad of committees  that take clinicians away from patient facing care.
  • Abandon the STP project which calls for £22bn of 'efficiency savings' across 44 'footprints' in England. Most of the plans are predicated on the closure of hospitals and the transfer of work into the community. There is no evidence that this will save money and there is no capacity in the community to absorb this extra work.

The key to successful action is in the word 'collective'. We must all take part. Together we are strong. Of course there are risks and none of us will undertake this lightly but we cannot continue to work under current pressures. It is not safe for patients. If the government won't listen we must make them listen.

  • Dr Jackie Applebee is a Tower Hamlets GP and chair of Tower Hamlets LMC, and wrote this article for GPonline on behalf of the Socialist Health Association

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