GPC 'should be split' to create separate committee for locum and salaried doctors

Locum and salaried doctors can no longer be represented by the same committee within the BMA that represents GP partners, according to a leading locum representative.

National Association of Sessional GPs (NASGP) founder and chair Dr Richard Fieldhouse has called for the BMA's GP committee to be split into two separate committees with equal influence - one to represent partners and another for locum and salaried doctors.

Each of these committees should have the same weight within the BMA as the existing GPC, or other BMA committees such as those for consultants or junior doctors, he believes - replacing the existing arrangement under which sessional doctors are represented by a subcommittee within the GPC.

Dr Fieldhouse - himself a former member of the GPC - said that 'what salaried and locum GPs share with partners is probably more than their differences'. But he argued that there was 'very much a conflict of interest' when it came to negotiating over pay and terms of employment for partners and sessional GPs.

Representation

'Name one other organisation anywhere in the world that claims to represent both the workers and the employers equally - I can't think of one,' he said.

The West Sussex GP said that sessional doctors' experience of the recent five-year GP contract agreement, a recently-published BMA model contract for locum employment with practices and issues around pensions all suggested that independent representation was vital as a matter of urgency.

Locum GPs have faced huge pressure from practices to reduce their rates following the publication of the five-year GP contract agreement earlier this year, he said, because it suggested that locums should reduce their fees to reflect reduced costs under the state-backed indemnity scheme.

Dr Fieldhouse has argued however that many locums' fees have never been increased to reflect soaring indemnity costs - often because practices they worked for said they couldn't afford to pay more. The contract agreement has put many under huge pressure, he said - and would never have been written this way if locums had had a full say in drawing it up.

NHS pensions

He added that BMA attempts to stop changes to NHS pensions that are set to increase costs for locums came too late, and that a recently-published model contract failed to cover key points that are vital for locums - in particular clauses for late cancellation and to cover late payment.

He said these problems seemed 'symptomatic of that culture, that sessional GPs do not seem to be as important as partners'.

Strong representation of sessional doctors is particularly key, the NASGP argues, given that locum and salaried doctors now outnumber partners potentially by as much as two to one in England.

NHS Digital statistics on the GP workforce show that in December 2018 there were 44,396 GPs in England - of whom 21,620 (49%) were partners. But these figures include just under 5,000 locum GPs - far short of the 17,000 the NASGP estimates actually exist. Factoring in these doctors would make partners perhaps just a third of the GP workforce.

Shared interests

'Although there are large areas of commonality between partners and salaried GPs,' Dr Fieldhouse said, 'there are also areas that are very, very independent of each other. There is very much a conflict of interest when it comes to a partner deciding what a locum should put in their contract.'

Dr Fieldhouse said he had first raised the idea of a separate committee for sessional GPs more than a decade ago, and that changes such as the establishment of the sessional subcommittee within the GPC, and more representation for non-partners have still fallen short.

'It has still not given us parity - it still doesn't allow us to be independent when there are areas on which there is conflict.'

Dr Fieldhouse added that 'in an ideal world' it should have been possible within the existing GPC to give sessional GPs the 'power, accountability and independence they need'. But he argued that so far this had failed to materialise - and that separate committees were now the only way to resolve the problem.

Speaking at last month's UK LMCs conference, GPC sessional GP subcommittee chair Dr Zoe Norris criticised ‘difficult rhetoric’ from ‘some LMCs, the GPC and in the BMA’ around sessional GPs, and said: 'It’s a continual source of frustration for me [that some LMCs] don’t seem to think [sessional GPs are] an important part of their work.’

The BMA has been asked to comment.

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