New GPC negotiator Dr Beth McCarron-Nash
In the centre of a sunny courtyard at BMA House, Dr Beth McCarron-Nash is grinning broadly. 'This is a turn up for the books, isn't it?'
You can forgive her for being pleased. A few days earlier, after 10 years on the GPC, the Devon GP had been elected as negotiator. Dr McCarron-Nash stands out from her colleagues. Not only is she the only woman on the team but, at 35, she is also the youngest of the negotiators.
She downplayed the effect these things would have on her work. 'Anyone on the GPC is there to represent all GPs,' she said. 'I don't think you need to be a woman to represent women.'
A range of experiences
Instead, she felt it was the breadth of her experience that was her real strength. Today she is happily settled as a partner of a large practice in Honiton. But the first decade of her career was spent in a variety of roles.
'I'm married to someone who was in the Air Force, so like a lot of young, female GPs I followed my partner around the country,' she said. 'So I'm unique as a negotiator in that I've worked under all contracts, except APMS, and in all sorts of practice.'
Her travels highlighted some startling differences in the range of practices - and patients - out there. Just before moving to Devon she spent a year as a flexible career scheme doctor at a Berkshire practice; an area so affluent that 90 per cent of patients had private medical insurance.
A year before that, though, she had been working for Leeds PCT, helping underperforming practices to improve, and spending two days a week in practice in deprived inner-city Chapeltown. 'Some of those practices weren't even computerised,' she said. 'At one most of the patients didn't have phones and couldn't make an appointment, so we'd just open up at 10am and sit there until people turned up.'
Her career differs strikingly from the traditional image of the young GP, setting up a practice and staying put for 40 years. But this puts her in a good position to understand the profession, she argued. 'The work force and its needs are changing. That breadth of experience will be important in future negotiations.'
Many of Dr McCarron-Nash's negotiating priorities will be familiar: no sudden removal of MPIG, protection against the unilateral imposition of polyclinics, and a defence of independent contractor status.
Some of her ideas do stand out, however. Firstly, she thinks the profession needs to work on its PR. 'GPs have been portrayed in a very negative light in certain parts of the media. So I think it's important we become much more savvy about how we communicate.' To that end, she was behind the BMA's 'Support Your Surgery' campaign.
Another issue close to Dr McCarron-Nash's heart is the shortage of partnerships. She struggled to find one herself, and said she warned former GPC chairman Dr John Chisholm back in 2003 that a practice-based contract would cut the incentive to take on new partners. 'I don't think the negotiating team really took that on board,' she said.
Five years on, she has some sympathy for those practices which do not want to share the wealth. 'It's an incredibly difficult time, with income falling, and the uncertainties over MPIG. It's exceptionally difficult to take anyone on,' she said.
'But,' she added, 'we must start looking to our future. If we don't address the issue of offering partnerships to our younger colleagues, we will be our own downfall.'
No work for some GPs
This lack of attention given to the plight of younger GPs is clearly a source of frustration for Dr McCarron-Nash. When asked for her view on pensions, she said she was concerned - but pivoted instantly to what she saw as a more pressing issue.
'A lot of the younger GPs are more concerned about the fact they haven't got any work,' she said. 'If you ask a lot of that generation they're so disenfranchised that a lot of them are looking at setting up private pensions. Some think the NHS isn't even going to be their main employer.'
This, she warned, could prove the biggest long-term threat to general practice. As our survey this week shows, young GPs who cannot find work in traditional practices are increasingly feeling drawn to private APMS practices.
'Unless we engage the young work force and promote the partnership model,' said Dr McCarron-Nash, 'they will feel no loyalty to the NHS. Because the NHS has shown no loyalty to them.'
What new GPs think
"I haven't thought about private practice. I do worry that polyclinics are a factory setting, where you do the same thing again and again. But location is quite important to me, so why would I rule anything out?"
Dr Mayoor Agerwal, training for general practice, London
"At the moment, I categorically wouldn't work in a polyclinic, and I'd prefer not to work in private practice. But it's so difficult as we don't know where things are going."
Dr Olivia Dorman, GP registrar, Northern Ireland
"I'd work in a polyclinic, because I have special interests I want to develop. Whether I'd work for a private company would depend on what it can offer me."
Dr Emma Rankin, FY1, Scotland.
GP is putting together a panel of 35 GPs aged under 35 to represent the future face of general practice and we want to know whether you would like to be involved.
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