Dr Brian Balmer interview: Putting the GPC on the front foot

The GPC's newest negotiator, Dr Brian Balmer, talks to David Millett.

Dr Balmer: 'I'd like people to start noticing the GPC is doing things a bit differently. I'd quite like to surprise a few people.' (Photo: Nathan Clarke)

'I've been in the GPC for about nine or 10 years, and I've often been rather critical about the way we do things,' says Dr Brian Balmer.

The GPC's newest negotiator says the GPC is 'too reactive - always waiting for someone else to make the first move'.

'I'd like people to start noticing the GPC is doing things a bit differently. I'd quite like to surprise a few people.'

These frank words suggest that beneath the relaxed, affable exterior, Dr Balmer is determined to shake things up at GPC headquarters.

Despite the gloom around general practice, he seems in high spirits.

The night before our interview, his youngest daughter's boyfriend asked for her hand in marriage.

'I'm very happy - my two lovely daughters each have a lovely fella. Not many dads can say that. One got married this year, and it looks like I'll get shot of the other next year,' he says.

It is perhaps unsurprising that his prospective son-in-law sought permission first - Dr Balmer is a man used to being in control.

He has been Essex LMC chief executive for more than 15 years, a position he has retained since taking over as a negotiator from GPC stalwart Dr Peter Holden in July.

GP sessions

Dr Balmer still finds time to work sessions as a GP on top of these roles. With an easy laugh, he says he has been a GP for 'far too long', later confiding he completed his training in 1986. 'Somebody will be able to work out I'm really old from that answer.'

As a negotiator, he will take the lead on practice finance - including premises, PMS contracts and dispensing - and GP networks, the latter being a topic the GPC will start to push a lot more, he says.

'GP networks are very much flavour of the month. The big thing I'd like to do in that is put the GPC much more in the position where we're seen to be one of the leading organisations driving it forwards and helping GPs get together in forms that suit them and at a time that suits them.

'I'm convinced we need a different sort of structure in primary care in future, and it is very hard to see a future without GPs in networks and federations.'

Asked whether he thinks general practice is in crisis, as fellow senior GPs often say, he responds: 'Crisis? I don't like the word. Every time someone says "crisis", it gets worse. But I think it's not in good shape. I've never seen a headline saying morale is so high, but it's difficult to imagine it getting much lower.

'We've had a couple of very bad years, but I think we're close to a turnaround. Otherwise, I definitely would not have taken on this job.'

He names workforce problems as one of the biggest threats facing general practice. 'We have a workforce problem and part of it is I don't think we've changed jobs as quickly as the workforce has changed. I think at times we are much too inflexible.

'There's a new workforce which is quite different from, for example, my generation. They function differently, their attitude towards the NHS is different and they're far more part-time than us - that's the big one. We've been a bit slow to adapt to that.

'The biggest danger of all is the workload on individual practitioners. It's got to a point where experienced GPs are saying: "I'm leaving because I can't do my job any more," and that's a terrible situation.'

Defining GPs' work

These problems have become entrenched in general practice. What can the GPC do to make things better? 'We need to be serious about defining what people should not be doing unless they're funded, and I think we should be prepared to take some flak about it if necessary.

'We need to work on our own constituents to start limiting what people are taking on, and we need to start packaging some of the extra work and say this will only be done if it's funded.

'If they want to move more care into the community, they have to stop this barrage of extra responsibilities that keep falling on the GP.'

Co-commissioning, he believes, is another major threat. 'I don't see the logic in a lot of what NHS England is talking about. It has realised you cannot do everything the same because England is extremely varied.

'But if you don't have some national stability, it's a recipe for chaos.'

Co-commissioning could cause CCGs to unravel, he warns, and cast their integrity into question.

'We seem to have CCGs who have said, we'd quite like to hold contracts but we don't want to do anything nasty like performance management. That's nonsense. Either you're going to manage a contract or you're not.

'A CCG cannot remain clinically led if it holds the contracts of those clinicians and their colleagues. I think CCGs were quite a good idea, and co-commissioning might send them backwards.'

Can the profession stand up to the challenge and make it through the rough patch? Dr Balmer has no doubts.

'I think the greatest hope is GPs' talent and enthusiasm - give them a bit of encouragement and the right opportunities, and GPs are capable of doing far more than anybody else realises.

'I think the world and the NHS has become more complicated, but individual GPs and GPs working together can achieve a huge amount.

'Otherwise I wouldn't bother coming in. I'd buy that boat and get a nice tan and go fishing for my lunch.'

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