GPs demand contract with safe working limits but reject core hours cut

LMCs have demanded a renegotiated GMS contract that includes 'safe working limits' - citing the mismatch between workload and workforce in general practice - but rejected calls to reduce core hours.

GPs vote at LMCs conference

GPs at the 2022 UK LMCs conference in York backed a string of motions highlighting concerns around workload pressures facing the profession.

LMC representatives backed a motion calling on BMA GP committee leaders across the UK 'to use data on safe workload to renegotiate the GMS contracts with workload limits in order to protect all general practice staff and patients'.

They warned that the public had emerged from two years of the COVID-19 pandemic with unrealistic expectations of general practice - and condemned as unacceptable 'continued political and media pressure for general practice to meet demand over need in a chronically underfunded health service'.

GP contracts

LMCs also backed a call for a review of the impact of contract negotiations on the 'stability and sustainability of GP practices', including a comparison between the four UK nations of contract outcomes.

However, LMC representatives rejected a motion calling for a reduction in general practice core hours from the current 8am to 6.30pm to 9am to 5pm - with just a third of delegates backing the call after an extended debate lasting more than half an hour.

Citing polling carried out as part of the Rebuild General Practice campaign launched earlier this year, Dr Rachel McMahon highlighted evidence that the vast majority of GPs now believe rising pressure has led to services being unsafe for patients - and evidence of the huge toll on GP wellbeing.

'How have we got here?' she asked the conference. 'Funding hasn't kept up with demand, and we work harder and harder.'

Workload pressure

She highlighted comments from a colleague who recently told her that the way GPs are currently required to work was 'unhuman'.

Part of the motion passed by the conference called for 'GPC UK to further develop, publicise and strongly advocate worked-up plans to introduce safe workload limits for general practice that do not constitute a breach of contract' - and Dr McMahon said she believed practices could implement limits like this themselves without waiting for contract reform.

She urged practices to 'show leadership' and said that safe working limits imposed in her own practice had been transformative for her wellbeing and for patient safety.

Dr Shaba Nabi, who proposed the motion on a reduction in core hours, told the conference about the huge pressure she had faced after putting forward the proposal, from comments on social media to requests to withdraw it.

GP workforce

She said pressure from within general practice not to debate a change in core hours showed 'how gaslit we are' as a profession. She told colleagues: 'Our hours are completely at odds with any sort of family life - so we continue haemorrhaging the GP workforce.'

A reduction in core hours would not deny paitents access to care but would keep them safer, she argued - pointing out that it could also boost recruitment and retention to general practice at a time when the workforce is in decline and polling shows that one in three GPs could quit within five years.

Dr Zishan Syed of Kent LMC urged GPs to back the reduction in core hours, arguing the status quo was unsafe and that the motion would send a strong message that working hours in general practice must be limited rather than expanded through mechanisms such as the PCN DES in England, which has imposed 'enhanced access' opening across PCNs in evenings and on Saturdays.

However, other speakers warned that a reduction in core hours would not solve the core problem of falling GP numbers and rising demand - and said that measures to tackle workload should come before a reduction in core hours.

Dr Emiline Dean of Somerset LMC said: 'What we need is less work, not less hours to do the same amount of work in.'

Another GP warned that a reduction in core hours could add to pressure on out-of-hours services, which she said were also subject to a mismatch between workforce and workload.

GPC UK chair Dr Phil White said he had been asked by Wales, Northern Ireland and Scotland to reject the call for a core hours cut - and argued that going down this path in England could lead to a salaried service, a claim rejected by Dr Nabi.

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