High list turnover, illegal migrants and prevalence pay cuts have driven inner-city practice down to a new nadir, GPs have warned.
Inner-city GPs have had a 'terrible' year, according to Camden and Islington LMC secretary Dr Paddy Glackin.
'You are constantly chasing your tail to stay viable,' added Londonwide LMCs joint chief executive Dr Michelle Drage.
Unrest among inner-city GPs is now threatening professional cohesion as they fear their interests are not represented.
'At some point, inner-city GPs must ask why we pay our GPC levy when we continue to lose out,' Dr Glackin said.
'If people get pushed far enough they will seek other means of representation. I think the appetite for this is beginning to grow at LMC level.'
Unregistered patients make up 10-15 per cent of inner-city populations, Dr Glackin said.
This creates a 'farce of fair share allocations' as patients are on GP lists but PCTs are not funded for them. 'In Newham the unregistered population is 50,000 more than stated.'
Dr Robert Morley, chief executive of Birmingham LMCs, warned: 'When the PCT is not funded, practices pick up the tab. Unregistered patients should be recognised historically via MPIG. But if it's a growing problem, they won't be.'
'If a patient is not entitled to NHS care and needs immediate treatment, we treat and our pay does not recognise this,' he said.
High turnover of 25-30 per cent of GP lists in most of inner London puts practices in a 'qualitatively different situation' to those with the average 5 per cent turnover rate, Dr Glackin said.
Dr Rob Barnett, secretary of Liverpool LMC, added: 'The greater the turnover, the less likely it is that the practice will get to grips with the patient on immunisations and QOF.'
This year's LMCs' confer-ence rejected calls for special representation for inner-city GPs. 'We spend a lot of time talking about the problems of being a rural doctor, where is the focus on inner cities?' said Dr Drage.
GPC chairman Dr Laurence Buckman said the GPC devotes time to all groups of GPs. He pointed out that several negotiators practice in inner-city areas.
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