Calls to explore alternatives to GP contracts narrowly defeated at LMCs conference

A motion calling for research into possible options for delivering general practice outside of GMS, PMS and APMS contracts has been narrowly defeated at the UK LMCs conference.

LMC conference vote: This year's conference is taking place online
LMC conference vote: This year's conference is taking place online

The conference, which is being held online this year, actually voted in favour of the move (see full motion below), however, it did not secure the two-thirds majority required for it to become policy. Any motion that will require funding from the General Practice Defence Fund (GPDF), as this one did, needs at least two-thirds of delegates to vote in favour in order to pass.

LMCs rejected calls to fund research into how issues around premises could be resolved if partners wanted to become salaried GPs, while the vote was tied on whether to investigate the risks and benefits of integrating GP contracts with other NHS providers.

Contract options

Dr Natalie Rodriguez McCullough from Cambridgeshire LMC who proposed the motion said the intention was to create a paper 'that gives us the options that are available so that we know what's going on and what could happen'.

She said: 'In England we know there's an ongoing divestment from GMS to PCNs with an eye on integrated care systems. Despite us saving the NHS millions every day as the most cost effective route to deliver patient services the voice of general practice is being severely diminished. We are expected to just get on with it.

'Our destiny can be in our hands but we need to be proactive, not reactive. We need to plan our future on our terms.'

'All-you-can-eat contract'

Dr Zishan Syed from Kent LMC said current GP contracts were not fit for purpose.

'In 2021 we can't seriously be expected to meet the healthcare needs of our population with an all-you-can eat contract of £93.46 for an infinite number of attendances by a single patient per year. What we need is an activity-based contract,' he argued.

'If we continue this present model of general practice, more and more surgeries are going to shut down. Things are not working. GPs continue to leave this country, or leave the NHS, because the contract is not working.'

Dr Paul Evans from Gateshead and Tyneside LMC argued that current GP contracts had led 'to a fall in GP partner numbers, a fall in GP income in real terms, a fall in GP whole-time equivalents, a rise in patients per GP whole-time equivalent, in GP working hours and GP stress, illness and sadly worse'.

'What we are doing now isn't working,' he added.

Contract change risks

However, Dr Penelope Jarrett from Lambeth LMC in London said that moving away from the GMS contract was a risk.

'To my mind, we have a very good contract in the GMS contract - every time we have tried to move away from that things have been worse,' she said. 'We've had fundholding, we've had PMS and more recently we've had APMS contracts. All of these have led to their own problems, in particular I would highlight increasing inequalities and fragmentation of care.'

Dr Jarrett added that while investigating the possible risks of integration with other providers might be useful, 'all the other risks we already know. We don't need to investigate them, we need to support the GMS contract.'

Dr Ronnie Burns from GPC Scotland also argued in favour of current contractual arrangements. 'Personally, the partnership model works well. I have a, probably, permanent working relationship with my partners, patients and staff,' he said. 'I'm invested in the process and I feel productive, protected and I'm progressing purposely through my journey as a family GP. I struggle to see that being the case, working as a GP for AXA/PPP healthcare.'

The motion in full

That conference calls upon GPDF to commission and fund research into the creation of an options paper for GPC UK to review prior to April 2022 that will investigate:

(i) the benefits/risks options and costs associated with the provision of UK general practice outside of the GMS / PMS / APMS contract model. REJECTED - A majority voted in favour of the motion but it did not secure the two-thirds majority required

ii) how those independent contractors who wish to become employed GPs may be facilitated to do so with regard to their estates and premises across a number of examples on a local, national or UK basis - REJECTED

(iii) modelling around the longer term consequences of risks/benefits to practices of having aligned contracts with staff and/or premises with other NHS providers/trusts. REJECTED - Tied vote, but rejected because it did not secure the two thirds majority required.

Voted on as a reference
(iv) how the future of a separately negotiated model around NHS and non NHS provision of general medical services could be facilitated. PASSED

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