General practice is in crisis - can the LMCs conference make a difference?

In the 102 years since the GPC was founded in 1913, many LMCs conferences have featured debates about a crisis in general practice.

Ever-present motions about workforce, workload and soaring pressure on GPs will once again dominate the 2015 conference in London later this month.

But this year, warnings of the greatest crisis since the inception of general practices are more than mere hyperbole.

GP stress warning

Earlier this year the BMA’s largest-ever poll of GPs found more than 90% say heavy workload is undermining patient care, 16% face ‘unmanageable stress’, and a third could retire within five years.

Allied to vacant GP jobs and the ongoing struggle to fill training posts – if that isn’t a crisis, what is?

At a time like this, LMCs have a vital role to play in using the national conference to shape the profession’s response.

But at the worst possible time, the conference itself is facing something of a crisis. At least one LMC refused to submit motions for debate this year, warning that the conference was failing to represent grassroots GPs.

We are going round and round and not finding solutions to the GP crisis. That is what GPs on the ground are fed up with.'

Dr Ivan Camphor, Mid Mersey LMC

BMA leaders have admitted that a ‘large number of motions’ were submitted this year questioning how the conference works.

In a bid to tackle the concerns, this year’s LMCs conference will feature 90-minute breakout sessions to discuss what LMCs, the GPC and the conference should be ‘delivering for GPs over the next few years’.

Doncaster LMC made the decision not to submit motions this year over concerns about its effectiveness.

Its medical secretary Dr Dean Eggitt said GPC representatives intervening in debates to sway their outcome was unfair.

He added: ‘The conference is very political, and the fact that it’s done in the public eye means that that people won’t necessarily tell you what they’re thinking.’

GP representation

Representation of GPs in their first five years in the profession was a particular concern, he added.

Dr Eggitt proposed a motion at last year’s conference that the GPC should not be allowed to persuade delegates to vote in favour or against motions.

‘Unfortunately, this motion was lost, and with it, Doncaster's faith in conference to achieve any true representation of grass roots GPs also died,’ he said.

GPC deputy chairman Dr Richard Vautrey told GPonline that the breakout groups at this year’s conference could lead to changes in its format in future.

‘We have encouraged the agenda committee to establish breakout groups this year to enable more of those attending to have an opportunity to have their voice heard and in particular to discuss how we can improve and develop the way LMCs, GPC and conference itself works,’ he said.

Mid-Mersey medical secretary Dr Ivan Camphor said general practice was ‘on its knees’.

The conference, once again, would be ‘depressing’, he warned. ‘But sometimes it’s better to be depressing,’ he added. ‘You find your level and work up. We have to be honest and find an answer – at the moment we are going round and round and not finding solutions. That is what GPs on the ground are fed up with.’

LMC conference reforms

He hoped the LMC conference break-out groups were a much better format to ‘give people a chance to talk openly about their frustrations’.

‘Often at conference we just hear prepared speeches. People say their piece and leave – this may be different,’ he said.

Derbyshire LMC secretary Dr John Grenville agreed it was important to make sure LMCs genuinely represent their constituents, and welcomed the new format.

He warned that expectations must remain realistic, however. ‘There are things people want the BMA to do that are impossible. Such as going on strike over pensions – it doesn’t work,’ he said.

Whatever the format, Dr Grenville added, the conference would be negligent not to debate the crisis general practice faces. ‘It’s a  big issue. There is a workforce crisis and we are seeing practices collapsing. We need to send a strong message to government and NHS England – we have been warning you about this for years and you are about to see patients suffering as a result of your neglect.’

LMCs conference: the big issues

Funding Wiltshire LMC to call for guaranteed average net funding, reimbursement of net expenses, and increased funding to reflect higher consultation rates. GPs from Kent to demand replacement of current formula-based contract with payment by activity. Leeds LMC will argue that the PM’s challenge fund is undermining GP out-of-hours services. Workload Glasgow LMC will warn that rising workload is leading to an exodus of doctors and call for urgent action. Workforce Hull and East Yorks LMC will call on the government to take action to address GP funding, recruitment and retention. Salaried GP service Liverpool LMC will propose that GPC explores establishing a fully salaried GP service. Supporting motions from other LMCs suggest the ‘days of the independent contractor status are numbered’., and the ‘partnership model is stifling recruitment’. Patient safety A motion to be proposed by Devon LMC calls for a maximum list size of 1,500 patients per GP, 15-minute consultations, and powers to declare major incidents and capacity shutdowns at times of system stress, and to close their lists. The motion also calls for the European Working Time Directive to be applied. Access Hertfordshire LMC will propose to conference that GPC should end the out-of-area registration scheme, which it says has been a disaster that fragments patient care. Unplanned admissions Avon will call for the unplanned admissions enhanced service to be scrapped, warning that it has failed and left doctors focused on process, not patients. Premises Conference will debate a call for a long-term increase in premises funding. New models of care Manchester LMCs will ask conference to back their role in new devolved decision-making bodies and instruct the GPC to ensure primary care funding streams. Leeds GPs will suggest that NHS England’s Five Year Forward View fails to address the crisis in general practice and insist that new models of care must not lead to pooling of GMS/PMS global sum funding. Leeds will also suggest new models must support organisations working together rather than create single employing bodies. Goodwill GPs from Gloucestershire will call for the ban on practices selling 'goodwill' for essential services to be lifted. LMC representatives in neighbouring Wiltshire will suggest practices be allowed to form limited liability partnerships to mitigate financial risk. Private fees and NHS work Buckinghamshire LMC will call for core GP services to be defined. Representatives from Gloucestershire will call for the right to sell top up services to registered NHS patients.