GP leaders sketch out principles for national association of LMCs

GP representatives have agreed a series of consensus statements around plans for a national association of LMCs - after a debate that exposed divided views on how it should work.

GPs vote at LMCs conference

GP representatives at the UK LMCs conference 2022 in York voted on a series of statements around the formation of a new national association of LMCs at the end of the conference, after an hour-long debate earlier on 11 May.

The conference heard warnings from senior GPs that the current BMA GP committee in England was simply 'not working' - and that a completely new representative body was the solution, potentially stripping out GP representation from the BMA.

Some speakers suggested a National Association of LMCs should be majority controlled by GP partners - amid concerns expressed earlier in the conference from some doctors that the BMA had not sufficiently stood up for the partnership model of general practice.

GP representation

Other speakers saw the potential organisation as something that should not compete with the BMA GP committee, but instead function as a mechanism to connect LMCs and share information and support - while others raised concerns that creating the new body would simply be a 'black hole' that duplicated BMA work and swallowed money.

LMC representatives voted on a list of 'consensus statements' developed by the conference agenda committee from comments in the debate. LMCs strongly agreed the organisation should operate on a single nation basis rather than UK-wide, should offer LMCs 'guidance, support and best practice' and that it should not 'replicate or replace' the BMA GP committee.

LMCs also agreed that they should not take on additional responsibility or functions through a national association of LMCs without funding to support this.

The themed debate at the LMCs conference was framed based on a string of motions submitted by LMCs that were often heavily critical of the profession's current leadership or leadership structures - and came after growing signs of discontent within the BMA GP committee.

Leadership

GPonline reported last month on a draft letter from LMCs to the GP committee that called for stronger action to stop the 'slow death' of the contractor model of general practice. Meanwhile, two senior GPs quit policy roles in the committee last year after it returned to talks with NHS England in the wake of a no confidence vote in the health service leadership over comments around face-to-face appointments.

The committee has faced further criticism after NHS England imposed contract changes for 2022/23 and pressure to move towards industrial action around GP involvement in PCNs.

Dr Clare Sieber, of Surrey and Sussex LMCs - who recently stood down from a GPC role - told the conference: 'I believe we need a new representative body. This just isn’t working. The BMA GP committee in my opinion is not representing our needs and I don’t believe it ever can.

'I have been on the GP committee, I am happy to give examples. I believe no amount of reform or review will begin to improve things.'

Reform

Dr Sieber dismissed concerns that forming a new organisation would show division and weaked the BMA relationship with government - arguing that in England the relationship between the DHSC and the BMA was 'already pretty poor'.

She questioned whether GPs were best off within the BMA, and alluding to calls for a professional negotiating team to take over from the current BMA structure for representing GPs in contract talks, she said: 'Nor do I believe we need to remain inside the tent. The tent is poorly pitched, it is leaking. No one in the tent is a professional camper…maybe we don’t need a tent anymore. Let’s be bold and overcome our inertia for once.'

Dr Ivan Camphor, from Mid Mersey LMC, told the conference: 'GPC England is broken. It doesn’t work, it is divided. It doesn’t provide us with the leadership and direction and vision for the future. Our negotiations haven’t gone anywhere.'

However, he warned that problems with existing representation were not a reason to create a new structure - but a reason to fix what general practice has now. He said: 'We are just creating another structure upon a structure that doesn’t work. We can’t justify having a new organisation when the organisation we are already paying for isn’t working.'

Some speakers backed calls for a National Association of LMCs - but made clear they believed it should exist to offer operational and technical support to LMCs, and not to compete or strip away functions from the BMA GP committee.

Derbyshire GP Dr Peter Holden warned against blaming the BMA for government refusal to negotiate or listen to general practice. He said: 'Let’s not confuse broken with government intransigence.

National association

'Please understand that we need a National Association of LMCs for a lot of business support that we need as LMCs to support you because we understand being a contractor and the salaried status in general practice in a way that the BMA seems to have forgotten. But it is how you slice up the negotiating rights - and you slice those up at your peril. Don’t divide the negotiating.'

Nottinghamshire LMC chief executive Michael Wright said: 'I am really passionate about this. The idea of some sort of national body that comes together and shares experiences and shares resources, that talks together and gets the best of what we do collectively is a no brainer.'

He warned that the detail would be important, but he said a new association was the 'right approach'. However, he added: 'Representation we have to be really careful with. I don’t think we should rival the GP committee, I think we should work with the GP committee and I think any collection of LMCs should work with our union. For me that is one of our unique selling points as an LMC that providers, federations, PCNs don’t have - we have a hotline to our negotiations nationally.

'We need to strengthen that bond. It does need strengthening, it needs more teeth at national level, we all know that.' But he added: 'I am a little worried if we go off and do something separate as LMCs we could be steered in the wrong way.'

GP funding

Sessional committee chair Dr Ben Molyneux said he understood that many GPs were fed up, but warned that creating a new association to represent LMCs was a 'terrible idea'.

'Wearing a new collective badge won’t change the reality around us. The BMA GP committee is having a really tough time and rapidly needs to take a hard look in the mirror I agree, although the ultimate problem is government and funding and not whether we are part of the BMA or not.

'From a purely pragmatic perspective a National Association of LMCs would not be able to do the job. The BMA employs hundreds of staff which we have access to. If there was a limitless pot I would still say it was a bad idea because it will likely lead to partners being represented by this organisation, sessionals by the BMA, a trench in between us and nobody happy. We have already heard several partners saying they need to be a majority in this imaginary organistion before it even exists. This is a dangerous experiment I believe would be a costly failure we live to regret.'

Former BMA GP committee chair Dr Laurence Buckman warned that proper representation for general practice in a single body was vital. Longstanding GP committee member Dr Fay Wilson agreed - telling the conference: 'There is a great idea in here that is getting lost. Mutual support of LMCs by and with each other with support from the GPDF. This should not be a vehicle for attacking our leaders.

'If we set up an alternative negotiating team we deserve what will happen to us and it will be much much worse.'

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