What if GPs reject the DoH offer?

Tom Ireland examines the BMA's 'end of the world' scenario of mass resignation from the NHS.

As the profession waits for the poll about whether to accept the DoH's contract offer, the BMA has prepared a response to the idea of mass resignation.

The GPC has been briefing LMC leaders on the options for GPs to discuss before they vote. One of the options, should the profession vote 'no', is for GPs to threaten to quit - the BMA's 'end of the world' scenario.

BMA chairman Dr Hamish Meldrum and GPC chairman Dr Laurence Buckman both dismissed claims that the BMA was encouraging GPs to stage a mass resignation, insisting it was only a response to those who were thinking about leaving the NHS.

But health minister Ben Bradshaw issued a response to media claim of mass resignation plans.

'We hope that doctors will support our efforts in the interest of their patients, rather than following the sensationalist plan to leave the profession proposed by the BMA,' he said.

GPC deputy chairman Dr Richard Vautrey said it would be counter-productive: 'We are here to defend the NHS and it would be ludicrous to suggest everyone leave it.'

Private GPs
In the GPC briefing, LMC leaders were shown slides asking to consider whether GPs should leave the NHS and 'all go APMS and merge with corporations', because it asks, 'is it going to happen anyway?' Another slide demonstrated how GPs would operate privately, and said that considerable thought had been given to its financial viability.

'The cost to individual patients would not necessarily be huge. Total practice income divided by consultations equates to about £20-25 per consultation,' it said.

Dr Vautrey said there were already a few private GPs scattered in every primary care organisation, providing healthcare for people with health insurance, through companies like BUPA.

'Maybe, over time, we'll see more people with health insurance and it could become mainstream,' he said.

But there was neither the will to leave nor the capacity within the private sector for a mass walk-out to be effective in the short term, he said.

A report in this week's GP suggests that the profession may end up accepting the DoH offer, due to a large number of abstentions. Many GPs have expressed concern that there is no alternative.

The GPC slide show warned that if GPs were to quit, all current income streams would be lost, the profession would be seen as the 'wreckers of the NHS' and that GPs would 'face a very uncertain future'.

The dentistry effect
The situation is very different to dentistry, where there was a shortage of NHS dentists after many went private, because it had been easier for them to swap sectors, said Dr Vautrey.

'Dentistry is largely cosmetic, and so there were always additional private treatments patients could pay for, he added.

'There are huge hurdles to cross for private GPs. Simple things, like getting an NHS prescription through a private GP, stand in the way.'

Dr Vautrey added that rejecting the DoH proposal 'didn't necessarily mean turning your back on the NHS'.

'A no vote is very much about defending the NHS,' he said. 'It's about not accepting bullying tactics. A yes vote isn't necessarily signing up happily to the contract without voicing concern.'

Dr Buckman added: 'I don't believe in resignation and we certainly are not campaigning for it. As I speak today, I don't think it will be an option that many will entertain.'

Dr Buckman would not reveal how he thought the profession should vote but admitted that he believed the contract would 'get worse year on year either way', and warned that the dispute would be a 'long haul'.

'It isn't about whether you will work these hours and for this money; it's about preserving practices against a privatisation agenda,' he said.

For some GPs who have been calling for a higher-profile publicity campaign, the resignation debate could have provided the kind of exposure needed to get this message across effectively.


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