Interview: Dr Richard Vautrey sets out top priorities to reverse the GP crisis

One week after being elected chair of the BMA's GP committee Dr Richard Vautrey is giving his first media interviews to the medical press at the union's central London HQ.

GPC chair Dr Richard Vautrey (Photo: BMA)

The Leeds GP is relaxed despite being on his third interview of the morning, with one more - and a photoshoot - still ahead of him.

Discussing the GPC election last month, in which he beat fellow executive member Dr Mark Sanford-Wood to the top job after serving as deputy under two previous chairs, Dr Vautrey describes the ‘heartening’ support he received from colleagues.

‘It was really humbling to have that support not just from GPC but then from the wider profession over subsequent days,' he told GPonline. 'And I've been overwhelmed by messages of thanks and also advice’, he says.

The mainstay of Dr Vautrey's election pitch to the committee was experience. ‘I have been part of the negotiating teams within BMA GPC since 2004. I've worked with subsequent chairs,' he says. ‘I've seen some real lows and some highs in that process.’

GP contract

He played an ‘instrumental’ role, he says, in turning around some of the effects of contract imposed by health secretary Jeremy Hunt in 2013/14 and in delivering significant extra resources for practices in the last two years above the levels of previous contracts.

And he lists reimbursement of CQC fees and the scrapping of the unplanned admissions DES as recent GPC achievements he has been an integral part of.

Now though, he says, the GPC needs to ‘do more’. ‘I'm certainly under no illusions that there is a lot, lot more that needs to be done to rescue us from this crisis,' he says.

For some GPC members last month’s election was a choice between Dr Vautrey’s experience, and change. But the Leeds GP doesn’t see his leadership as continuity. ‘I think what we've done before won't be good enough in the future,' he says. ‘I recognise that, we have to change.'

The service, he argues, is changing rapidly, and the GPC has to both respond to that, and lead the right kind of change, securing the best deal for the profession and the right investment to allow GPs to do their jobs safely.

Independent contractor status

GPs must ‘start leading the agenda’, says Dr Vautrey. ‘In many cases we've been too willing to just hope that somebody else will do something for us.'

‘The contract that we have - the independent contractor status - enables us to make independent decisions, which can help to control things and limit things and change things for the better within our own working life. So that is something that we need to look at more, and take some control over what we're doing more, and be more confident about doing that and making those decisions and sticking to them.’

Dr Vautrey takes the reins of the GPC in the middle of the indicative ballot on industrial action. While he refuses to say how his own practice will vote on proposals for co-ordinated closure of practice lists over the failure of the GP Forward View to deliver sustainable funding, Dr Vautrey is clear that should practices eventually vote for action, he is prepared to lead it.

But GPs must be aware of the risks, he warns, and the union must not repeat the 2012 pensions dispute when, he says, many GPs said they would support action but then ‘very few’ turned out. ‘So if we are going to do something we need to be absolutely confident that practices are behind us,' he says.

Read more: GPC chair 'ready to lead industrial action'

The junior doctors’ dispute last year demonstrated the BMA was ‘prepared to take action if our members want that action to be pursued and if we do do that then we would do it with the utmost vigour’.

Junior doctors, despite overwhelming public support, faced a barrage of hostility from parts of the media and politicians. Is Dr Vautrey prepared for that if he has to lead industrial action? ‘I've been around for many years now and have developed a degree of resilience,' he says. ‘We've been through some pretty tough times. And yes I was one of those doctors who was prepared to stand up on the day of the pensions dispute.

‘And so if it comes to it then yes, I will be there, speaking up for GPs, defending GPs and their right to take action, if that's what practices wants us to do, but we're a long way from that yet,' he adds.

Whatever the outcome of any ballots, he says, the government will have to address the underlying cause of GP anger: the underfunding, the work pressures and workforce crisis.

GP crisis

The GPC has long said the GP Forward View, the £2.4bn package of support revealed by NHS England in April 2016, is inadequate. Practices have not seen the tangible improvements on the ground they were promised, Dr Vautrey says.

The GP Forward View, he says, brought ‘an explicit commitment to the registered list and building on general practice, and a tacit acknowledgement that they have underinvested in general practice for the last decade ... and that has to be reversed’.

‘The problem,' he adds, ‘is we've not seen that delivery of resource quickly enough and in sufficient quantity to be able to make the real difference that we need at practice level.’

‘We have to force government to really deliver on their rhetoric in the coming year or so because if we don't, then more practices will close, more patients will lose their services, more GPs will become unwell because of stress and low morale.’

The GPC’s demands, outlined in the Urgent Prescription for General Practice, were accepted as a basis for talks by NHS England in autumn 2016 in response to a looming threat of a ballot for mass resignations. Dr Vautrey says the £2.5bn funding deficit GPC identified is still required.

GP funding

‘We can't wait five years for that funding to flow,' he says. ‘And while we have secured £230m-odd pounds this year of recurrent funding, and similar amounts last year, we need to see a step change in the funding level going into general practice to be able to make the changes and to expand our staff in a sustainable way. We need recurrent funding, not short-term fixes,’ he says.

He gives the example of the the clinical pharmacists scheme in the GP Forward View, through which NHS England supports pharmacists in practices with a reducing amount of funding over three years. ‘That funding should be coming out to practices, out to provider groups in localities to provide a sustainable long-term workforce expansion,’ says Dr Vautrey.

And practices need immediate new funding for premises, he adds, with a fundamental review of premises funding. GPs, he says, need confidence that the funding and workforce initiatives are sustainable.

One of the key demands of the Urgent Prescription was for a workload cap. It called for maximum number of patients GPs can see in a day, a demand reiterated by LMCs.

Dr Vautrey says that was ‘one of the key initiatives’ GPC would be working on this year. It will be complex work, though, he warns. ‘How do you compare one good quality consultation between a patient and a GP that last 30 minutes, that maybe deals with lots of complex problems, compared with 10 three-minute consultations on the telephone?’

Practices, he says, need to be able to use existing contract mechanisms to make the decision they have reached capacity and that it is no longer safe to practice beyond that point. ‘But then they need a pressure valve so they need a way of ensuring that patients who urgently need care can get it somewhere else,’ he adds. That could be through hubs or practice collaborations, as is already being done in some places.

Dr Vautrey accepts that greater collaboration and working at scale, as prompted by NHS England, is part of the future for general practice. Practices, he says, have always collaborated and it is ‘common sense’ to share knowledge and avoid ‘reinventing the wheel in every practice’. What he opposes, though, is attempts to dictate to practices how they must collaborate. Different approaches work better for different places.

What is required everywhere, he says, is the recurrent funding to support it. The £1.50 per head CCGs have been told by NHS England to spend on GP at-scale provision for two years is ‘nowhere near enough and not long enough to be able to give that support structure’, Dr Vautrey says.

‘That money is sat in CCGs. So we have money that supports the recurrent management costs and activity costs in CCGs. So as they become bigger, merge together, that funding needs to devolve to provider groups in their localities and areas so that every area has recurrent funding and it isn't taken from the baseline funding that practices have got.’

The money is there, in the system, he adds. ‘We need to ensure it's there, directed at provider groups and practices.'

Dr Vautrey, unsurprisingly, also rejects the view of Labour MP and GP Dr Paul Williams who told GPonline last week that the necessary move to at-scale provision should also mean a move towards a salaried service. For Dr Vautrey, the GMS and PMS contract model must be ‘cherished’ and built upon, not abandoned. Only the national contract, with guaranteed core funding, can provide the stability, the foundation necessary for practices to work at-scale in federations and collaborations with any additional workload practices choose to take on funded on top.

‘We need to expand our services,’ he says. ‘We need to not replace GPs with lesser trained staff and those who aren't able to to risk manage in the same way that GPs can because if we do that we're actually going to make the system worse not better.

‘The system of the NHS depends on GPs risk managing day in, day out. And without that and without skilled generalists doing that every day the NHS would be bust tomorrow. So we need to ensure that that's retained and built upon not replaced or lost.’

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