Dr Jackie Applebee: General practice is in meltdown - closing lists would make patients safer

East London GP Dr Jackie Applebee proposed the LMC motion that has now led to the BMA balloting the profession on industrial action. Writing for GPonline, she explains why GPs must take action to protect practices and patients.

This week the GPC has begun balloting GPs in response to the Tower Hamlets motion passed at LMC conference in May which said:

'That conference believes that the GP Forward View is failing to deliver the resources necessary to sustain general practice and demands that GPC ballot GPs as to whether they would be prepared to collectively close their lists in response to this crisis.'

It is beyond doubt that general practice is in meltdown and to add insult to injury the public sector pay cap has meant that doctors have effectively taken a 22% pay cut in the last decade. Despite the best efforts of the GPC executive all we have been offered is a totally inadequate GP Forward View and a couple of other sweeteners such as reimbursement of CQC fees.

NHS funding

STPs will finally push us over the edge as patient care is moved out of hospitals into an already oversaturated community to 'save' £22bn in England.

Collectively closing our lists to manage our workload would benefit the safety of our registered patients.

Given that 84% of us said last year that our workload undermines our ability to provide safe patient care, most of us can surely argue that we can temporarily close on this basis and avoid being subject to breach notices.

While our lists are closed there would be lack of access for some but if we do nothing general practice will collapse and there will be access for no one.

We must explain to patients that we want to provide safe, comprehensive general practice to the whole population, but that in the current climate this is not possible. Many already understand this - 250,000 marched in defence of the NHS earlier this year.

GP careers

Petitions in surgeries can engage patients to join us in demanding that government enable general practice to become an attractive career for the doctors and nurses we need to provide a safe service. The government should enact BMA policies such as funding the NHS to the level of comparable countries and get rid of the NHS market, which fragments the health service and costs billions to administer.

The chaos of outsourcing to profit-driven companies must stop as must all of the time-wasting activities which take us away from patient facing care, including the hoops we must jump through to access the little pots of money in the GP Forward View. The Health and Social Care Act, with its myriad of committees and procurement panels, must be repealed.

The key to success is in the word 'collective'. We must all take part. Together we are strong. Of course there are risks and none of us will undertake this lightly but we cannot continue to work under these pressures. It is not safe for patients. If government won't listen we must make them listen.

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