GPC and LMCs consider future after 100 years of representing GPs

Tuesday (28 February) marks the 100th anniversary of the first GPC meeting. See below for discussion about the future role of GPC and LMCs, some of which date back even further.

On 28 February, GPC members will convene at BMA House, 100 years to the day since the committee's first meeting in 1912. A number of existing LMCs date back even further, to the year before.

GPC chairman Dr Laurence Buckman says an Edwardian determination to have the voice of every GP heard resulted in a set of structures that have shown remarkable resilience over the past century.

'LMCs came first, then the conference of LMCs, then the GPC. It's the original ground up, democratic organisation.'

The original spark came from a rebellion by a group of northern GPs against the BMA during the turbulent days of Lloyd George's 1911 National Insurance Bill.


For all local doctors

'Even when the GPC ended up becoming a BMA subcommittee, it didn't change the fact that LMCs are for all local doctors, irrespective of whether they are BMA members or not,' Dr Buckman says.

'That's why the conference of LMCs is independent from the BMA. That's why the chair of conference and deputy chair are automatically elected to the GPC to ensure that conference policy is being carried out.

'Structures only stay in place if they are used and if those using them feel they work for them. Government and NHS managers have always struggled with LMC and GPC structures because they are truly democratic and representative.'

GPC member Dr John Canning says the committee today is more democratic than ever. Most regional seats on the GPC are now elected by grassroots GPs, rather than LMC leaders, he points out, with a third of seats coming up for election every year. 'The committee is made up of 80 people who have disparate views but work to a consensus,' he says.

Dr Canning insists the GPC will continue to be relevant for the foreseeable future. 'The consistent thing the GPC has done in the past 100 years is to represent GPs in conjunction with their provision of state-funded healthcare. The big question is, will the state continue to fund healthcare? The GPC will fight for universal access wherever you live in the UK.' 


Pay and resources

He says the GPC has fought to secure GPs' pay, but also for the resources they need to do their job. Whatever NHS system ministers adopt, GPs will need an organisation that represents their interests not only on funding, but also on training, handling of complaints, performance and other issues, he points out.

However, as clinical commissioning groups (CCGs) gain in size and strength, there are fears about the impact on LMCs. How will they negotiate relationships with groups that, like them, are GP-led and elected by local GPs?

Dr Brian Balmer, chief executive of Essex LMCs, says the primary purpose of a CCG is not to represent GPs, but to commission cost-effective services on behalf of the public. 'An LMC's statutory role is to represent every GP and practice. Those are two different things.'

Jane Lothian, medical secretary for Northumberland LMC, says that despite a high cross-over of members between CCGs and LMCs locally, they have always been clear about their roles. 'The LMC is the place to discuss what can't be discussed anywhere else, such as provider issues and federations, pastoral care, support for practices.'

Dr Charles Zuckerman, secretary of Birmingham LMC for 30 years, is more pessimistic, fearing LMCs could be dominated by corporate interests or undermined by lack of funding. 'The LMC can only exist while there is funding and GPs willing to pay. Whether that will remain I just don't know.'

But others say the demise of PCTs has created opportunities for LMCs to diversify.

'We're taking on more of the educational support PCTs used to do,' says Somerset LMC secretary Dr Harry Yoxall. 'But probably the biggest part of our role is now pastoral work, support for GPs who are struggling.'

Dr Nigel Watson, chief executive of Wessex LMCs, agrees, saying forward-thinking LMCs are looking at how to expand their roles in education and training and the support role PCTs used to provide.

'I don't think the role of the LMC is going to disappear. It could get stronger and larger but only if we're flexible and adapt.'

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