In the first debate on general practice at the BMA annual representative meeting in Bournemouth, doctors leaders unanimously backed a motion warning that workload pressure in general practice was 'unsafe and unsustainable'. The motion demanded urgent investment over and above GP Forward View pledges that will increase investment by £2.4bn per year by 2020/21.
The conference then overwhelmingly backed a second motion instructing the BMA to construct 'with or without government co-operation' a system to allow GP practices to declare hospital-style black alerts when they have hit their maximum safe capacity.
Former GPC executive member and Derbyshire GP Dr Peter Holden proposed the motion, warning it would give general practice a defence against the GMC for problems often triggered entirely by unmanageable workload.
Doctors voted heavily in support of the motion despite a warning from outgoing BMA chair Dr Mark Porter that the union could be overstepping its remit by drawing up guidance on how practices should handle emergencies.
Dr Holden told the conference that often complaints against general practice resulted not from problems with GPs themselves, but 'system failures outside their control'. Simply to cover colleagues' holidays, GPs were working for substantial parts of the year at one third above safe levels, he warned.
The government was unlikely to wish to highlight the pressure on the profession by creating a black alert system for GPs, Dr Holden said, and the BMA should take responsibility itself.
'We owe it to ourselves and to colleagues who have ended up in GMC investigation purely because of mistakes based on gross work overload,' he said.
'This is about the GPC producing a paper setting out the criteria under which you might declare. If not the BMA, then who? NHS England aren't going to do it - they do not want highlighting how big the pressure is. I am fed up with waiting and obfuscating.
'We as a profession need to start to define our own workload, define what is safe so that we can face out the GMC when the crunch comes. It is time we as a profession stood up and said we are the essential executive arm of the NHS, we are fed up of being pushed around and we are telling you - if it's black all next week, when the GMC comes knocking next week I can say, well you do know we're on black alert?'
Hospital doctor Dr Helen Fidler spoke against the motion, warning: 'Currently black alerts are consequent on NHS England guidance, and NHS England must take responsibility for us being on black alert.
'If that guidance were to come from the BMA and patients die, who will take the blame, and who will be held accountable - it will be an open goal for the government. We should ask NHS England to extend this to primary care. It is the BMA's responsibility to call for decent and humane funding for the health service, not to risk sharing responsibility for the parlous state of the NHS.'
Dr Porter added: 'The question is whether the BMA should attempt to put something like this in place - the BMA should attempt to take over responsibility for the emergency management of an overloaded, underfunded, on its knees, deficit-ridden collapsing national health service.
'I think our role is to advocate on behalf of patients and doctors, not to assume responsibility for the delivery of service that speaker after speaker has told us cannot be delivered with current levels of funding.'
But GPC chair and BMA chair elect Dr Chaand Nagpaul was among those who spoke in favour of the motion, warning that one in four GPs were too afraid to say they were struggling because of a 'fear of CQC reprisals'. He said that was why a clear system for declaring an alert was vital for the profession.
Proposing the earlier motion on workload pressure on general practice, deputy GPC chair Dr Richard Vautrey warned that the profession 'cannot wait for another practice to close, another GP to burnout another patient to be be put at risk'. He called for a removal of the bureaucracy that stood between practices and access to funding promised in the GP Forward View, and warned that promised funding and investment in staff was needed 'now, not in three years' time'.
Read the motions passed in full:
Motion 67 by YORKSHIRE REGIONAL COUNCIL: That this meeting believes the current workload pressure in general practice is unsafe and unsustainable, that a rapid expansion in the general practice workforce is required to deal with this and therefore calls for sustained investment above the commitments made in the GP Forward View to be made available as a matter of urgency.
Motion 69 by EAST MIDLANDS REGIONAL COUNCIL: That this meeting notes the regular declarations of "black alert" by hospitals and demands that a similar reporting system be created for general practice to indicate that maximum safe capacity has been reached and conference instructs BMA council and the GPC to construct such a system with or without government cooperation.