LMCs Conference 2011 - full coverage as it happened

LMC leaders from across the UK debated key issues affecting the profession during the 2011 LMCs conference. Here is our full coverage as it happened.

Video hightlights: 

UPDATES FROM THE MEETING

Friday

5pm A sensible-sounding motion supporting fit notes was backed by LMCs. The conference finishes off with a debate in which Gwent GP Dr Greg Graham fits an unbelievable array of male-related words into a gripe about first time speakers not being called maidens any more. If that's all there is left to discuss, it must be time to go home. And it is. That's it for 2011 - we'll report to you next year from Liverpool.

4.24pm 'An unfinished structure constructed without regard to the cost,' says one speaker, is the definition of a folly. Darzi centres fall into that category - LMCs vote to redistribute the funds that paid for them among other practices.

4.18pm LMCs warned earlier today that if GP contracts were merged into a single deal, it must remain a UK-wide deal.

4pm Dr Phil Dommett from Cornwall and Isles of Scilly says GPs should consider industrial action to protect pensions. But Dr Andrew Green from Yorkshire says GPs should never go on strike for their own financial interests. Dr Peter Holden says 'jaw-jaw will always be better than war-war'. It would damage GPs 'terribly' to vote for this, he warns. The motion calling for strikes to be considered is heavily defeated.

3.44pm LMCs vote that NHS pensions are affordable, and warn the government that cutting pension benefits will push people to retire early. A motion calling for the GPC not to rule out industrial action over pensions has been pushed back.

3.38pm 'Are you flashing it? ' Dr Church asks BMA pensions committee chairman Dr Andrew Dearden. Fortunately, she means his emergency speaker slip. The NHS pension scheme is making a clear surplus, Dr Dearden tells the conference - we're halfway through a debate on protecting pensions.

3.26pm GPs back a motion calling for any patient in police custody with an urgent medical problem to be able to see a GP.

3.22pm 'Why do pigs make poor patients,' asks one speaker. 'Because you have to kill them to cure them.' He's making a point about consortia learning the lessons from George Orwell's Animal Farm. Which I'm not going to explain.

3.18pm Here's our story on calls for practices to be compensated over unfair list cleansing.

3.15pm Conference votes to move to Liverpool next year. Dr Bradley embraces Dr Camphor, and climbs the stage like Pat Cash at Wimbledon to give conference chairwoman Dr Mary Church a kiss.

3.11pm The debate rumbles on. And on. One person says this year's venue is great. Others shout: 'Rubbish', and call for a return to Logan Hall, where the conference has been for years, in a nuclear holocaust-proof underground bunker. One confused member thinks we're still there. Dr Bradley says speakers against the move to Liverpool are in fact escaped mental patients. My laptop has melted into my legs.

3.02pm It was only a matter of time. Dr Nev Bradley, with his sidekick of choice Dr Ivan Camphor, is on stage in a comedy wig. He's a Scouser this time, making the case for the next conference to move to Liverpool. As he does every year. Dr Camphor still can't quite do a Scouse accent, after years of practice.

2.55pm Dr John Canning reports on the GP defence fund's financial state. It's OK, apart from a couple of LMCs won't cough up. One of these situations is 'being dealt with as we speak', he says. Thrown in the Thames with concrete boots? Or are they being beaten to a pulp in the toilets?

2.52pm Dr Greg Plaice appears on stage in shorts - an annual ritual. He's contributing to a debate on flu - LMCs deplore the government and congratulate themselves. Now that's a proper LMCs motion.

2.34pm Tough luck for anyone who hoped to escape revalidation - LMCs have voted against a campaign to delay it.

2.30pm LMCs vote for the GPC to remind the government that the Doctors and Dentists Review Body is a good thing. Meanwhile, LMCs have voted to give seats on the GPC to Dr Brian Balmer, Dr Laurence Buckman, Dr Beth McCarron-Nash, Dr John Canning, Dr Andrew Dearden, Dr Chaand Nagpaul, and for the first time Dr Mark Sanford-Wood, from Devon, and Dr Douglas Colville from Glasgow. 


The GPC Gang

2.22pm GPs vote to oppose any attempt to impose time limits on contracts. Dr Hodson failed to attract much of a following, so the GPC will continue to push for the retention of MPIG and seniority pay.

2.17pm 'A bird in the hand is worth two in the bush,' says Dr Simon Hodson from Shropshire, for some reason. His maiden speech yesterday went down well, but today it's a different story. He's opposing a motion calling for MPIG and seniority pay to be protected and not lost. Dr Andrew Mimnagh from Sefton says yesterday's speech was beginners' luck.

2.11pm Like virginity, the UK contract is difficult to restore once lost, warns Dr Arnie McDowell from Northern Ireland. Some winceing in the audience.

2.06pm 'We remain a United Kingdom after all,' says a speaker - I look up thinking the Queen's arrived, perhaps to thank GPs for their comments about her consort's birthday. But it's a GP from Cambridgeshire talking about plans for a single GP contract across the UK.

1.57pm GPC chairman Dr Laurence Buckman invites GPs to email the GPC anytime. But he'll send anything offensive to the police. 'We know where you live.'

1.51pm Dr Buckman takes a moment to pay tribute to GPC Northern Ireland chairman Dr Brian Dunn, who is to retire. He has led on UK QOF negotiations and has been an outstanding negotiator, Dr Buckman says. LMC representatives rise as one for a lengthy ovation. Dr Dunn says in Northern Ireland people usually say nasty things when they like someone. Dr Buckman offers to do so.

1.47pm GPC chairman Dr Laurence Buckman makes an impassioned defence of the UK-wide GP contract. Divided, GPs would be taken to the cleaners by individual governments. Together, they can stand up for themselves.

*** 1.45pm Click here to take part in our online poll - should CQC registration for GP practices be scrapped? ***

1.42pm Congratulations to the technical wizards back at GP HQ - the live blog is now positively radiant with an array of LMCs photos.

1.38pm Question time for the GPC negotiators. One GP demands to be given 8% of GDP and says he'll run the NHS. Not sure he's realised he's meant to be asking a question for GPC negotiators to answer - unsurprisingly they're not sure what to say. One member of the audience tries to help, calling out: 'You're under arrest.' The speaker is ushered off.

12.30pm A mass evacuation of the main conference hall occurs as annual reports from the various GP charities loom. Some things never change at LMCs conferences. Back in the press room, on the monitor the unmistakeable voice of Dr John Givans, chairman of the Cameron Fund can be heard. But wherever he's speaking from isn't being filmed - the podium appears to be speaking by itself. His disembodied voice continues unperturbed.

12.20pm  Dr Taylor from Liverpool does a stand-up routine based on an imagined conversation between a patient with a strong Liverpool accent and an NHS 111 hotline. Suffice to say, the two interlocutors fail to get their message across. Local people need local services, he warns.

12.10pm Motions are carried calling for a series of improvements to IT systems to support NHS GPs. Meanwhile, NICE has recommended a series of public health additions to the QOF.


Voting at LMCs

12.05pm Prayers from LMC delegates to spare them from debates on general practice IT seem for a moment to have been heard as a huge, unexplained rumbling noise echoes through the conference hall. No one seems to know what it was, but the debates continue. Nothing can stop IT from having its moment in the sun. Moments earlier, a delegate fell as she stepped from the stage, but appeared to walk off OK, thankfully.

11.44am Here's a story on plans to renegotiate the QOF to cut bureaucracy.

11.40am Practices should not expect to act as arms of the home office, LMCs say. 'GPs are about providing general practice to the public,' GPC deputy chairman Dr Richard Vautrey says. Some PCTs have forced practices to ask patients wishing to register for proof of ID.

11.33am LMCs want payback too - the GPC has been tasked with negotiating backpayments for patients unfairly removed from lists.

11.30am LMCs chose not to vote for revalidation to be put on hold moments ago. Dr Tony Grewal steps up to hit out at list cleaning initiatives that strip funding unfairly from practices - in one area 100,000 patients failed to reply to PCT letters checking they existed. No doubts on this one - unanimous votes for the GPC to negotiate a fair list-validation system and deploring the current method.

11.20am As LMC motion after LMC motion washes over delegates at the 2011 conference, it can be easy to forget that an outside world not only exists, but continues to operate as normal. The NHS Future Forum will be reporting on Monday.

11.14am Dr Philip Melluish from Devon makes the first foray into rhyming debate in a debate over PCTs overburdening GPs with demands for certificates to prove they know how to do the constituent parts of their jobs. Thanks to a PCT twit, we must all have a certificate, lets tell them what  we think and get rid of this sh..' he says. Dr Andrew Mimnagh tells of dragging a PCT envoy out of his practice after he was warned of the health and safety risks of handling a sheaf of paper, among other harrowing tales. LMCs vote that being on a performers list, with a valid GMC certificate, should be all a GP needs to practise.

11am LMCs vote for a minimum out-of hours price per patient. The GPC wanted conference to approve that only as a reference, but was ignored. They'll have to negotiate it anyway now - it's just become GPC policy after a re-run of the first attempt at an electronic vote. I think the Mermaid Centre's system crashed in sympathy with my own long-suffering laptop.

10.57am Still on out-of-hours, and a debate this time that could go either way. Dr Fay Wilson, medical director for the Birmingham-based BADGER out-of-hours co-op, says a minimum per patient price for out-of-hours services would stop the current race to the bottom that exists in the absence of any form of out-of-hours funding tariff. An electronic vote to decide goes pear-shaped, and only seems to register a handful of voters.


Dr Fay Wilson

10.45am Dr Fay Wilson steps up with an emergency speaker slip and tells it like it is. Backing calls to reject a return to a requirement on GPs to take part in out-of-hours, she says: 'We don't want a conscript army. We don't want all you clapped out middle aged blokes.' Dr Peter Holden ups the ante still further: 'You will pass this motion over my dead body,' he says. Terrified LMC members do as they are told, and reject it.

10.40am Dr Michael Ingram will be deputy chairman at next year's conference, alongside chairwoman Dr Mary Church. 'Booo,' says the audience. Oh, but they were listening to the next speaker, who had the temerity to suggest all GPs should do out-of-hours. 'Rubbish,' says one GP filing out of the main hall.

10.26am Here's our story on LMCs calling for the CQC to be scrapped.

10.24am LMCs vote not to have next year's conference on a bank holiday. Do people really need to vote about these things? They also find time to congratulate Prince Philip on his birthday, during a debate about patient-reported outcome measures, which LMCs warn are not proven in primary care.

10.10am LMCs have voted for decisions about whether the NHS should pay for high cost drugs to continue to be made by a national body. Concerns about GP consortia having to make these decisions are a big part of GP concerns about the government's NHS reforms.

10am Dr Nev Bradley, from Wirral LMC, can usually be relied upon to take to the podium dressed as a mafioso with huge fake teeth, or wearing at the very least a novelty hat. But to shock all round, he's dressed normally and addressing a serious motion this time. There's an inconsistency between GPs being asked to refer less, but screen and treat more, he warns. Conference agrees.

9.51am GPs are a bargain. Hopitals waste loads of money. So says Dr Mark Corcoran from Avon LMC. The consultant half of the BMA probably votes for the mirror image of this motion every year. But Camden's Dr Paddy Glackin says hospitals are a 'black hole, passing patients from consultant to consultant'. The government's quality, innovation, productivity and prevention efficiency targets aren't addressing this, he warns. Worse still, they're cutting practice income.


Dr Mark Corcoran

9.46am Morgannwg LMC's Dr Charles Danino says he's worried about primary care organisations asking for patient-identifiable information to check on QOF pay claims from practices. GPC Wales chairman and GPC negotiator Dr David Bailey says he has sleepless nights about that too. Well, he didn't actually say that. He's worried though. LMCs back a motion on this - they share the speakers' concerns.

9.33am Dr Tiffin from Cambridgeshire takes to the stage carrying a small sheep. Are we all sheep following QOF targets slavishly, she asks. Is QOF our shepherd? Animal themes continue with Dr Gupta from Kent, speaking next. It's QOF monkeys he's worried about though.

9.25am QOF targets must continue to be evidence based, conference agrees. Borders LMC's Dr Gillian Arbuckle reveals that last night's after-dinner speaker unveiled a new polypill to cure all ills - sounded like a 'paracetamoxyetlyasea-something-or-other'. Let's hope that wasn't the best gag of the night. 

9.16am Conference ignores a warning from the GPC, and votes for the CQC to be abolished. This country is paralyzing itself with red tape and bureaucracy, warns Mark Corcoran of Avon LMCs. CQC registration is part of this. There's no proof CQC registration will improve general practice. And it's a waste of paper because of hundreds of pages of forms required. GPC chairman Dr Laurence Buckman is smiling as he walks up the aisle at the conference, despite the vote.

9.14am LMCs back motions calling for CQC registration to be reasonable, evidence-based and funded by the government. They opt not to boycott registration, however, after a warning from the GPC's Dr John Canning that to so would be illegal.

9.10am CQC needs to leave GPs to get on with their jobs and focus on sorting out care homes, says one speaker. Dr Ivan Camphor from Mid Mersey warns charging GPs for CQC registration is nothing but a pay cut. The conference opts to vote straight away - there were plenty of speakers lining up, but no one was looking likely to back the CQC.

9.02am CQC - it stands for 'crazy quizzical chaos' according to Bethan Rees of Hertfordshire LMC. The system needs to be simplified before it goes ahead. Earlier, the first attempt to use the microphone of the day went awry - conference chairwoman leant forward and shouted 'IS THIS WORKING?' into the microphone. It was. Rather well.

8.58am Hubbub from the main hall suggests all but a handful of stragglers made it back to the Mermaid Centre for day two of the 2011 LMCs conference after the excesses of last night's LMCs dinner. Debate on registration with the Care Quality Commission is set to get the agenda underway for day two any time now.

Thursday

5.30pm Strong motions continue at the end of the day. Following shootings by taxi driver Derrick Bird in Cumbria last year, Cumbria LMC's Dr Colin Patterson calls for changes to gun licensing. But Londonwide LMCs' Dr Tony Grewal says the motions would not have stopped the tragedy. Parts of the motion are carried. And that's a wrap. See you tomorow folks.


Dr Tony Grewal

5.20pm Day one of the LMCs conference 2011 is drawing to close. If truth be told, the last hour or so has felt like a lifetime. There was the suggestion of a snore from an LMC member seated near me, but a closer look suggested he was merely clearing his throat. Having said that, just when you suspect there's nothing else of interest, up pops someone like Dr Rosie Hamlin from Doncaster. Paediatrics is an essential part of GPs' jobs, she says and any attempt to create specialist children's GPs must be opposed.


Dr Rosie Hamlin

5.15pm Sensibly, rather than risk a vote, the motion on paid-for services is dropped and the conference moves to next business. Read our stories about the risk of NHS privatisation if the Health Bill goes ahead and GPs' staunch resistance against removing practice boundaries.

5pm Here's a tough one for GPs. Bradford and Airedale's Dr Jag Picknett says if patients want a health-related service not available on the NHS, they'd probably be happiest to have their own GP provide it as a paid-for service on the side. But North Yorkshire GP Dr Sean O'Connell warns that if GPs commission services - and make the decisions about what is available on the NHS - this could create a major conflict of interest.

4.55pm LMCs back motions calling for referral decisions to be based on patients' clinical needs, and calls for GP views to be heard in judging the appropriateness of referral targets.

4.45pm Referrals are proving a topic close to GPs' heart. They're queuing in large numbers next to the podium to speak on this one. One speaker warns of abuses of Choose and Book, taking control of referrals away from GPs. Another warns of unfair targets and unnecessary pathways. Dr Chaand Nagpaul says the GPC will do everything to ensure the doctor-patient relationship is not contaminated by referral inducements.

4.35pm Croydon, south London GP Dr Kansagra gives a strong warning in support of a motion calling for GP referrals not to be influenced by financial inducements. GPs could risk breaching GMC guidance if referral targets and incentives continue to spread, he warns. But a GP involved in commissioning, Dr Sean O'Connell, says thresholds and targets for referrals may not all be bad. On a personal note, I think my laptop is in danger of setting fire to my legs.

4.29pm Glasgow's Dr John Ip says NHS24 - Scotland's equivalent of NHS Direct - is a waste of money. He's proposing a motion pointing out that it costs £64 million a year, but passes 80% of calls it receives to other providers to handle. It's carried - just the one abstention.

4.24pm One speaker urges the GPC to promote not just more partnerships, but also to consider job-share partnerships to reflect the modern workforce.

4.18pm Derbyshire LMC secretary Dr John Grenville says more than a hundred NHS staff in his area find out tomorrow if their applications for voluntary redundancy have been successful. 'An awful lot of staff to lose in one go,' he says. He wants to thank them for their work - little reciprocation for this sentiment from the audience however. 


Dr John Grenville

4.12pm It's soap-box time at the LMCs conference. A string of GPs are lined up against the wall beside the podium. Joanna Watt from Northamptonshire warns consortia should not be able to strip practices of their contracts. On a lighter note, Adam Skinner berates the GPC for failing to discuss a motion he proposed about pharmacists, and says for good measure that last year's venue was better. So there.

4.05pm LMCs back calls for more support for sessional GPs, voting for a motion warning of the dangers of professional isolation for sessionals.

4pm In a sign perhaps that even the most steadfast LMC leaders' minds have begun to wander - a note appears on the big screen behind the podium asking if anyone has a spare dinner ticket.

3.57pm Just when we were starting to think GPs had all begun to speak with a single voice, a motion splits the vote - electronic keypads are out for the first time in 2011's conference. Everything to do with saving deaneries gets the green light from LMCs.

3.53pm Dr Anwar from Leicestershire and Rutland LMC calls for unanimous support for a motion warning that GP training standards are variable across the country. The polite, but rather minimal applause he receives suggests his wish is unlikely to be granted. I look up from my keyboard and the next speaker has just said something about people being abused in public places. I think he's against the motion, but it's hard to be sure.

3.45pm The RCGP's eportfolio is taking a real battering. There's been more derisory laughter on this topic than any other today. It's probably more unpopular than even David Cameron. Not surprisingly conference vote for it to be scrapped - to put it politely. 


3.28pm Classic tactic for getting on the podium from Londonwide LMCs chairwoman Dr Michelle Drage. Steps up to speak against a motion warning the NHS reforms put GP training at risk, but only to say the motion isn't strong enough, so really she's more than in favour. 'Booo,' says the audience, but in a friendly sort of way. Read our latest blog on how LMCs must work with consortia for the sake of the NHS.


Dr Michelle Drage

3.17pm The vote opposing the scrapping of practice boundaries is a done deal, but two troublemakers somewhere in the crown block a unanimous vote. Hissing all round. But the vast majority of LMC representatives agree removing practice boundaries would put continuity of care at risk, undermine GP consortia and should be 'staunchly resisted' by the GPC.

3.15pm And now we're on to a major bugbear for GPs - practice boundaries. One speaker kicks off by pointing out how daft it would be if you could call in binmen from a neighbouring area if you didn't like the colour of their vans. Or if you could call police from a different area if you didn't think your local bobbies would solve a crime. 


Dr Georgina Brown


3.10pm
Glasgow LMC's Dr Georgina Brown, who proposed a motion deploring ill health still being worst among the most deprived members of society, speaks out strongly against comments from Dr Bill Harris that this situation was as inevitable as rain falling heavily in the Welsh valleys. Dr Brown said there was evidence something could, and should be done. A call to reform the Carr-Hill formula that underpins GP contract funding is thrown out, but motions are passed calling for health reforms to address inequalities in core practice funding. Health reforms must not increase inequalities, LMCs agree.

3.03pm There's a sudden hush as Dr O'Reilly from Kensington and Chelsea speaks on a motion about health inequalities. The motion wants changes to funding to cut health inequalities. Dr O'Reilly warns that intravenous drug users in his patch have life expectancies of just 34 years. But NHS reforms may put services for these vulnerable groups at risk, he warns. 'If things go on as they are, most of us will either close or restrict our services in the next few years. I'm here on their behalf to ask for your help. We need something to change that will enable us to go on looking after some of the sickest people around.' Warm applause as he thanks the audience for listening.

2.50pm GPC Wales chairman Dr David Bailey points to some unpopular government plans - 8-8 opening hours. Over-50 health checks would be useless, he says. 'Maybe they don't visit the GP because there's nothing wrong with them,' he suggests. GPs in Wales are providing 50% more consultations than 10 years ago - they can't do more, Dr Bailey adds. One thing Wales would like to import from England is the average annual remuneration GPs receive - estimates have previously said GPs in Wales work 10% or more harder than English GPs, for less pay. Ouch. A latecomer to the hall mutters: 'Is this dispensing? I'm not interested in that.' Dr Bailey is a dispenser, but that wasn't what he was on about.

2.45pm A Scottish motion was carried calling for GP commissioning in Scotland, Dr Dunn wants the same in Northern Ireland. A standing ovation and hearty applause for the departing Dr Dunn. Ever competitive, the Welsh delegation gives a huge cheer as their chairman Dr David Bailey takes to the stage. 

2.41pm Northern Ireland chairman Dr Brian Dunn says the big cheers for Dean Marshall were just a sympathy vote - he needed an ego boost. He then shamelessly courts the sympathy vote himself: 'This is my last conference as chairman.' 'Aaah,' says everyone. Until he admits that every year under his leadership has been a tough one. 'Maybe I've been unlucky. Maybe I've been a spectacularly bad chairman.'


Dr Brian Dunn

2.35pm Dr Marshall's speech isn't quite as sexy as his entrance to the stage, but he challenged the government's stance on premises development, which makes it 'impossible for practices to move to better premises, and penalises those who own their own premises'. Community health partnerships - Scotland's primary care organisations - have failed to bridge the gap between primary and secondary care, he warns. He also plans to continue to fight against health checks for over-40s. 'Even the English government opposes that, which must tell you something.'

2.30pm Time for updates from the Celtic nations' GPC chairmen - Dr Dean Marshall kicks off, arriving to the stage to a pop star's welcome. 'Please, you'll upset my fellow chairmen if you cheer for too long,' he says modestly.

2.28pm On the subject of whether the regulator Monitor can support competition and integration of care at the same time, here's our recent exclusive interview with House of Commons health select committee chairman Stephen Dorrell

2.21pm LMCs didn't like the idea of privatisation ten minutes ago, and they still don't. Monitor should not promote competition, but co-operation instead, they believe. That's subtly different from the government's stance - it wants the regulator to do both.

2.08pm 'Oleaginous blandishments' from the private sector may threaten the NHS, according to Avon's Dr Miriam Ainsworth. Wouldn't want to step in one of those by mistake.

*** By the way, you can vote on whether Dr Buckman got his message on the NHS right in our online poll. ***

LMCs vote in favour of a motion warning that the Health Bill would lead to privatisation of the NHS. This must not be allowed to happen, most LMC representatives agree.

2pm Debates are underway again - most of the 400-500 GPs here today are back in the main conference hall for a debate on the dangers of the government's 'any willing provider' policy.

Watch Dr Buckman send a strong warning to prime minister David Cameron in our exclusive video interview with the GPC chairman.

1.14pm Here's a story from earlier today - Dr Buckman didn't rule out industrial action, but didn't want to be forced to ballot the profession on whether they wanted to join consortia.

1pm It's lunchtime. Most of the not-half-bad sandwiches here in the press room are long gone already. Last vote before lunch was a motion calling for 'commissioning support units' - groups of managers potentially hived off from the ruins of PCTs - to remain part of the NHS. LMCs vote in favour of this - they don't want consortia taking advice from managers repackaged as private firms or social enterprises. It's a big 'no' to inheriting PCTs debts too, and a call for the powers of the NHS Commissioning Board to be kept in check. Time for some instant coffee.

12.51pm Dr Buckman has just walked past, and told a BMA press officer: 'I've done GP.' A video interview with the GPC chairman will be with you as soon as our techno-geeks can edit it into shape.

Here's our video of his speech earlier today.

12.47pm LMCs vote to save themselves, cynics might say. But that was a key vote - LMCs will have a key role to play in representing the profession as changes to the NHS go ahead. The conference backs unanimously a call to enshrine in the Health Bill the role of LMCs to represent GPs, with negotiating rights over their role in consortia.

12.43pm Dr George Rae says the GPC is approaching its 100th birthday. A letter from the Queen seems unlikely. But he warns LMCs need statutory protection in the Health Bill to empower them to stand up for GPs, particularly if they fall foul of GP consortia in the future.

12.35pm Dr Mohammed Jiva says he hopes the prime minister is a fan of the Apprentice, and will tell Andrew Lansley: 'You're fired.' It was only a matter of time until someone used that line. GPs should have a majority on consortia boards, with members democratically elected, the conference agrees. They also call for support for consortia in terms of IT, HR functions and other areas. Doctors in consortia must have legal protection against complaints, the LMCs agree.

12.15pm A protracted debate about the constitution of GP consortia is ongoing. First time speaker Dr Shergill from Ealing, Hammersmith, Fulham and Hounslow calls for adequate remuneration for GPs taking on commissioning roles. Cleveland's Dr John Canning  calls for a clear split between poachers and gamekeepers - no secondary care providers on consortia boards.

11.55am Confusion on the big screen in the press room - the speaker bore a startling resemblance to GP's own reporter Susie Sell. No name appeared on the monitor. Then it claimed the speaker was Cleveland's Dr John Canning. It wasn't. First-time speaker Dr Winstanley from Southwark is eventually unmasked.

11.53am Unsurprisingly, given earlier votes condemning the Health Bill, LMCs have voted against a motion referring to the Bill as 'a great opportunity to improve the effectiveness of of health care delivery to our patients'. That was never going to slip through.

11.51am My plea for plenty of strong coffee to keep us going through the debates seems to have fallen on the same sort of wax-filled ears Dr Buckman accused the government of having. It's instant coffee only. Hell on earth.

11.45am More of the same really - conference backs a motion warning that the Health Bill is a threat to doctors' duty to put their patients first. One speaker warns that GPs can't possibly vote against the motion - even the prime minister is worried about the Health Bill, he points out.

11.28am LMCs conference votes that the Health Bill poses 'the greatest threat to the NHS since its inception'. But a warning over the cost of balloting the profession over whether they want to be in commissioning consortia seems to have put people off - they vote against the ballot.

11.23am Here's our story on Dr Buckman's keynote speech, by the way.

11.20am Just when you thought we were in for the most one-sided debate in LMCs history (and there have been a few) Dr Ivan Camphor from Mid Mersey steps up and says the Health Bill is not a threat, but a great opportunity for GPs. He mentions savings from management cuts in his area and benefits from the reforms to date. Noise from the room suggests he's in a minority.

11.15am Apologies for the slight hiatus in online updates... even in the new hi-tech surroundings of the Mermaid Centre, some technical basics remain - computers need somewhere to plug them in.

Iona Heath wrapped up the debate saying she wished Andrew Lansley and David Cameron were the type of politician to turn up in person at the LMCs conference and listen to GPs. But she wasn't being political of course.

10.43am RCGP president Dr Iona Heath sets up a debate about the NHS reforms with a speech that draws the morning's second standing ovation. She says she can't make political statements, but warns the Health Bill risks distracting from the real issues world healthcare faces - including increasing medicalisation of care, health inequalities and poor end-of-life care.

10.29am GPs vote against a motion warning that the NHS is unaffordable in its current form after warnings from speakers that it would give politicians an easy soundbite.

10.27am Read our blog on the tough-talking in GPC chairman Dr Laurence Buckman's speech


10.19am Debate begins on the NHS economic crisis and rationing. Conference should not back any motion that suggests there isn't enough money to fund the NHS - there's plenty of money about, but the government chooses not to spend it on the NHS, says Dr Reissman from Newcastle and North Tyneside LMCs.

10.12am A 40-second plus standing ovation for Dr Buckman as he rounds off a well-received speech with a call to let GPs get on with their jobs. His closing remarks included a defiant statement that GPs will not forgive attempts to damage the pensions they have worked hard for. His speech was peppered with references to the BMA opinion poll which found many GPs may quit over the NHS reforms.

10.10am Abolishing practice boundaries is a 'barking idea' Dr Buckman warns. Is ear wax the reason why the government won't listen, he asks. Or deafness? I think that may be the more likely. Care Quality Commission registration must not start again until funding and details of registration are confirmed - GPs should not pay, he says.

10.05am Negotiations have been tough this year in tough financial circumstances - GPs have nothing left to cut, Dr Buckman says.

10.03am The government is wrong to equate GPs joining consortia with support for its reforms, Dr Buckman says - laughter erupts when he says: 'Getting into the lifeboats is not the same as supporting the sinking of the Titanic.'

10am Biggest applause of the day so far - GPs will not take money for reducing care to patients, Dr Buckman says. He's talking about the proposed quality premium for successful GP consortia, which he condemns as 'utterly unethical'.

9.56 am The government could have solved all its NHS woes by listening to the profession earlier, Dr Buckman says. When the Future Forum reports on the findings of NHS reform, we'll find out if they've been listening this time, he says. Anger about competition and the idea of GPs being employed by foundation trusts spark hearty applause.


Dr Laurence Buckman

9.51am Dr Buckman says the Health Bill will 'change  the face of the NHS forever'. The NHS is not being cut to the bone, instead 'whole limbs are being amputated', he warns.

9.48 BMA press officers are handing out copies of GPC chairman Dr Laurence Buckman's speech, which is moments away. Let's hope its a stormer.

9.40am News flash: Conference has voted to hold the 2012 event in Barbados, by a sizeable majority. I'm claiming that on expenses. Unfortunately it was only a trial vote to test the electronic voting system. Shame.

9.35am Although GP's deputy editor Neil Durham claimed pretty much the same thing last year, this year's conference does feel pretty crucial, given its timing as the Health Bill flounders.

9.20am Conference about to start, and LMC people pouring into the Mermaid Centre in London. A few complaints from the punters - conference has moved here for the first time. The usual venue, Logan Hall, is spitting distance from BMA House. This year's venue is a few miles away, and the nearest tube station is closed until later this year... GPC members have been spotted wandering the streets struggling to master the map functions on their smart phones.

Wednesday 5.30pm
With the conference less than 24 hours away, GPs involved with LMCs have been tough to get hold of today. We're gearing up for the conference tomorrow morning and hoping that a half-decent wifi connection and plenty of strong coffee will keep us going while LMC leaders send a strong message to the government and keep us entertained with some barnstorming speechifying and the usual array of novelty props and visual aids.

See you tomorrow morning.

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