Interview: Dr Chaand Nagpaul wants to restore GPs' sense of pride

Newly elected GPC chairman Dr Chaand Nagpaul tells Neil Roberts why ministers must work with the profession to avert a crisis.

Dr Chaand Nagpaul: fresh approach to talks with government (photo: Jason Heath Lancy)
Dr Chaand Nagpaul: fresh approach to talks with government (photo: Jason Heath Lancy)

Dr Chaand Nagpaul talks a lot about pride. He was 'immensely proud' to qualify as a GP 23 years ago, is proud of UK general practice, and is now proud to be GPC chairman.

He decided to become a GP on the first day he stepped into a practice as a student on attachment. 'I was awestruck by the incredible remit, magnitude, breadth and depth of care my trainer was providing. I decided this was what I wanted to do,' he says.

Now, as GPs' UK political leader, he wants to 'resurrect' that sense of 'pride and privilege'.

Competition

Back in 1990, Dr Nagpaul became a junior partner at his north London practice the day after qualifying. Then, general practice was the most competitive career option for medical graduates, he says. He was one of two successful candidates out of 180 applicants for his vocational training scheme and he beat 80 applicants to join the Harrow practice where he is now a senior partner.

Two decades on, in a boardroom at the BMA's plush central London HQ, we are talking about the serious shortfall of GPs entering the profession and a crisis in general practice.

The DH has 'no choice' but to boost GP numbers if it wants to achieve its 'stated aim of moving significant volumes of care out of hospital into the community', he says.

Since his election in July, Dr Nagpaul has spoken of a 'fresh approach' to government. The government's objectives, its popularity, depend on GPs and the success of general practice, he argues. Ministers must realise their mistakes, he says, and begin to see GPs as the solution to their problems, rather than the cause.

The GPC's top negotiator rejects the idea that the government may have its own political agenda that benefits from undermining the NHS.

Government must want to demonstrate to voters that the NHS is effective, he reasons. 'I can't see why a government would want to worsen services for patients.'

DH 'misguided'

The DH was 'misguided' in this year's contract imposition and while ministers may have felt they succeeded, the result is damaging patient care. 'I'd like to believe the DH has realised this was not the right approach, and will work with us to redress some of that,' he says.

Thoughtful and mild mannered, Dr Nagpaul does not come across as a political bruiser. He first came to medical politics by accident, he says, drawn into the fight over the 1990 contract imposition. 'I remember my maiden speech at LMC conference, about the government creating an internal market in the NHS.

'In many ways,' he adds with a wry smile, 'nothing has changed. Twenty years on, we have the same battles around government ideology and marketisation.'

General practice is in crisis, he says, and addressing workload through better funding to increase capacity is his first priority. Grassroots GPs, he says, want more recognition from government of their value.

He will demand that services shifted out of hospitals into the community come with proper funding and general practice capitation funding is not abused by government.

In June, NHS England deputy chief executive Dame Barbara Hakin told MPs patient access would 'doubtless' feature in negotiations with the GPC over the 2014/15 GP contract.

But Dr Nagpaul says access is not a significant problem for GPs, citing patient survey results showing 80% satisfaction. He says it would be 'unrealistic' for any public service to have a 100% satisfaction rate, particularly given the funding pressures and constraints primary care faces. 'I wouldn't want to compare it with the satisfaction rates of MPs,' he adds.

If ministers want to improve access, they should start by freeing up capacity, he argues. Dr Nagpaul says the best way to do that is to cut bureaucracy built into the current GP contract, particularly politically motivated additions to QOF that have moved the programme away from its evidence-based ethos.

QOF reform

Would he scrap QOF? No, he says, but he would like England to copy devolved nations where some QOF funding has transferred to core pay.

PMS funding is another pressing issue, he says. The profession is being 'held back' by uncertainty over PMS funding as NHS England reviews how it should be redistributed, but Dr Nagpaul warns a simplistic approach could undermine outliers.

The matter is out of the GPC's hands to some extent, he says, as it depends on NHS England identifying the PMS budget for redistribution.

'General practice is immensely important to me,' says Dr Nagpaul when asked how he sees the GP's role. Continuity of care is an integral aspect of the profession, he adds.

'The fact we look after families, in communities, is a special part of what general practice offers. Patients have an immense trust in their GP and we need to make sure that is not undermined by political policy-making.'

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