LMCs Conference 2012 - Live Blog

Follow live updates from the 2012 LMCs conference in Liverpool as GP leaders from across the UK debate key issues affecting the profession on 22 and 23 May.

Wednesday 23 May

4.50pm

That's all from me, folks. I'm off to catch the train home. More in this week's GP magazine on all of the above.

4.47pm

Oh come on, says Dr John Grenville. Some doctors have to pay more for insurance because they're not very good. Crown indemnity would put GPs' independent contractor status at risk.

The vote goes against a national indemnity scheme, but LMCs recognise that there is a growing group of GPs unable to get insurance.

4.42pm

Dr Tony Grewal says he's seen six doctors in the last couple of years who have been unable to get insurance despite making huge efforts to learn from errors that led to them being unable to work for a spell. One doctor had £500,000 spent on taking him through GMC cases and support to return to work, but this was wasted because the defense organisations then refused to indemnify him.

4.38pm

My son is nuts,' says Dr John Allingham. He's a medical student and by the sounds of things, a bad driver. But he can still get car insurance, while a growing number of GPs can't get indemnity without paying eye-watering fees of up to £20,000 a year. They can work in hospital where Crown indemnity covers them. Shouldn't there be a similar deal for GPs?

4.30pm

It's time for 'do not resuscitate' forms to be standardised across the UK, says Dr Helena McKeown, from Wiltshire to help patients set out their views clearly.

But a change to using the term 'allow natural death' instead of 'do not resuscitate' would not be wise, says Dr Bill Beeby. He thinks this could confuse matters where patients who don't want to die need treatment. Conference begs to differ - it votes to switch.

4.27pm

I believe 'hallelujah' is the word. I've just turned to the final page of LMC conference motions.

4.17

I want to talk to you about faeces,' says Dr Rickman Godlee from Oxford. In the same way that people should pick up their dogs' poo, hospitals ought to deal with the problems that arise from when devices that they put into people go wrong.

'I'm fed up with hearing John Humphries say on the radio that something has gone wrong with a device and people should call their GP if they are worried,' Dr Godlee adds.

Dr Dean Marshall does himself no favours with a comment that the PIP breast implant scandal led to GPs being 'dumped' on. That was a poo gag, in case you missed it.

4.15pm

Stories on revalidation and hospitals' dirty tricks to drive up their income are up on our website.

4.06pm

The last speaker looked a lot like football's erstwhile resident rocket scientist Iain Dowie. I should know, I sat opposite him on the District Line a few weeks back. Dowie, that is, not the last speaker. I would tell you what the speaker was on about, but sadly the motion he's debating is not on the big screen and is nowhere to be found in the heaps of conference info we've been handed.

4.01pm

The motion being discussed is about whether a list of core services that general practice provides should be defined to stop the transfer of unfunded work from hospitals. Dr Jane Lothian thinks so. But the GPC, like the eloquent Dr Thorman, disagrees.

4pm

Neil Thorman is a first-time speaker from Yorkshire. That doesn't mean he's never opened his gob before, and he definitely knows how to use it. GPC negotiator Chaand Nagpaul agrees - he's just referred to the aforementioned Dr Thorman as 'eloquent'.

3.56pm

By the way, LMCs called for negotiation of enhanced services to support extra care of patients in care homes just now. The motion doesn't say who should do the negotiating, but hopefully the GPC will take the hint.

3.50pm

The North Yorks GP at the podium has forgotten his speech, but reckons this will make him popular, because he'll be brief. He's probably right.

He was quick. The next speaker says he won't make any more scrotum jokes (see below) but he will talk bollocks. Funding should be made available to pay for patients to be transported to GPs rather than GPs being expected to visit them at home. That's passed, but I'm not sure a patient laid up in bed waiting for a home visit would be overjoyed at the change.

3.25pm

The QOF motion is basically along the lines of: QOF wasn't bad when it started, but it's falling apart because it keeps changing and some pretty useless indicators have been added recently. That'll be the QP ones, mostly.

3.22pm

The latest motion, again in public health, concerns flu jabs. LMCs urge the government not to wreck GPs' ability to get supplies of flu vaccine, and not to muck about with vaccination plans that undermine practices' flu campaigns.

Next to QOF - Dr Paula Cowan's up. Dr Mike Ingram announces that she's 'still a first-time speaker' although she spoke yesterday. It was obviously on something that didn't count.

3.18pm

LMCs cement their long love affair with local authorities with a warning that handing public health responsibility to them as part of the Health Act is one of the 'greatest flaws' in the legislation. There are a few other that spring to mind, so those are harsh words indeed.

2.55pm

Dr Andrew Mason from Cumbria has size 16 feet. He's happy for that to be in the public domain, but not his whole electronic patient record. Clinicians should only be able to look into specific parts when they can justify it.

LMCs aren't happy that the GP systems of choice programme is on the way out, and want clear rules on who can get into patient records, when.

2.45pm

Oxfordshire's Dr Paul Roblin says practices are finding the BMA model contract for salaried GPs 'financially onerous', and that partners think its terms are too generous - but LMCs reject motions to this effect.

One motion says practices sometimes ignore the contract without consequences. But Dr Pollock from Leeds says there are consequences - depressed, demoralised and undervalued salaried GPs. A good point, though not the one the initial motion was trying to make.

2.30pm

Sessional GPs - that's locums and salaried GPs - should get death in service benefits like everyone else, conference agrees.

Dr Stewart Kay hits out at the treatment of salaried doctors by large practices that take on huge numbers of these GPs, underpay them and neglect their right to CPD and other support - they have become a lost tribe, he says.

2.09pm

LMCs hit out at the 'woeful neglect' of investment in GP premises, backing motions calling for more funding and warning that plans to move work to primary care cannot possibly work unless more money is available. Some GPs receive rent that wouldn't pay for a family holiday to Majorca, apparently. Not sure that's the usual benchmark in premises funding.

2pm

The GMC and BMA should develop an appraisal system that will be accepted by the GMC as an alternative to local appraisal, LMCs agree. Dr Dean Marshall says the GMC has shirked responsibility for sorting out a form of appraisal that will work for all doctors.

LMCs also vote to make sure that NHS Commissioning Board plans to let the same person become a responsible officer and a primary care commissioning manager do not hand the same person responsibility for performance management and revalidation.

1.45pm

Meanwhile, just spotted out in the conference centre lobby that pensions ballot boxes have been - strategically? - placed next to the bins. Watch which one you shove your ballot paper in.

1.30pm

Back from lunch and into the big revalidation debate. Enhanced appraisal? Over our dead bodies, say LMC representatives. They back a motion warning enhanced appraisal has no legal or contractual basis.

12.25pm

Geri Halliwell is outside the building apparently. She used to be a Spice Girl, you know. Perhaps that's why everyone's left the main hall. Oh. It's time for reports on the GP charities - the exodus from the room at this stage is a time-honoured tradition. As is the warning from the chair that not staying to listen is rude.

Geri isn't this afternoon's star speaker, by the way. She's blissfully unaware of the LMC conference and swanning about at the X-Factor bash next door.

12.21pm

GPC chairman Dr Laurence Buckman warns that the 'potential for losses would be substantial' if the GPC tried to negotiate an alternative to Carr-Hill in the current cash-starved environment.

No one likes Carr-Hill (not you, Roy, your formula) but they vote against a change now.

12.16pm

Dr James Kelly - the speaker who earlier declared himself a Cockney who was feeling rough as a badger's arse - has downed a few pints of water and is letting rip against PMS reviews.

He mentioned pissing in the wind this time. Was that last night, or part of his argument? Either way, LMCs agreed with him and backed calls for equal funding across all practices, a halt to damaging PMS reviews and reinvestment in general practice of any cash stripped from practices.

12.12pm

LMCs just took roughly a millisecond to unanimously agree that the Doctors and Dentists Pay Review Body should recognise rising GP and tougher consultations.

Delegates also called for funding for GPs' role in completing firearms certificates, and hit out at companies for abusing the data protection act to demand data from GPs that they ought to pay for.

12.06pm

Here's a quick run through some of the coverage of the LMCs conference on GPonline.com - a video of former BMA pensions committee chairman Dr Andrew Dearden on why GPs should vote in the pensions ballot and a story on the debates on pensions are available - along with stories on a whole range of other issues. Skim through the coverage here.

11.55am

GPs call for work capability assessments to be scrapped because they are not working. One GP tells a story about finding a patient lifting a huge bag of compost at home despite being signed off unfit to work. Fit notes are taking a kicking now. Dr Greg Graham says no one understands them. LMCs pass motions calling for the forms to be 'limited to a factual description of the illness or injury'. The DWP should publicise them more.

11.48am

LMCs reject call for new national contract - as we heard earlier, at a time when there's not much money around, GPC leaders are worried about what a new deal might look like. But LMCs have backed motions warning of growing anger among GPs over funding variations between practices, and that the variety of contractual arrangements in use are increasing health inequalities.

11.35am

Dr Una Duffy from Bedfordshire has invited the GPC negotiators to 'grow a pair'. She, and Dr Phil Dommett from Cornwall think the GPC needs to improve representation of grassroots GPs, and that votes the GPC doesn't think are timely should not be blocked. GPC chairman Dr Laurence Buckman begs to differ. LMCs kick out a motion stating that the conference last year underestimated the strength of feeling about pension reforms among grassroots GPs.

11.10am

It is time to stand up and be counted. The BMA is up against a government prepared to renege on commitments,' GPC member Dr Fay Wilson, showing her firebrand credentials are fully intact. Changes to pensions were agreed three years ago, but now what's happening? 'The treasury is coming back to dip into our savings – if we are not prepared to stand up they’ll be back next year to tax our lump sums and the next year to take them away completely.

LMCs vote for a motion deploring the threat to pensions. They vote for disengagement from commissioning to be included in industrial action.

10.25am

The soapbox event now - where GPs stand up to vent about whatever issue is troubling them. Notional rent is being slashed in Wales. Unbelievably expensive 'special' medications wasting money. Both of these are issues GP has covered in recent months and weeks, here for example.

Some public health concerns, and one about, er, the loss of wrinkles on a scrotum.

10.10am

The jibes from southerners have provoked a response from some 'Scousers'. Nev Bradley and Ivan Camphor are at the mic (see pic last year - this year's model looks much the same). Ivan, after many years of trying, still sounds like he's clearing his throat or suffering a horrible ailment when he attempts a Liverpool accent. Nev's sounds more genuine. In their view you'd have to be 'one chunk short of a pineapple' to want the conference ever to return to London.

10.07am

Self confessed Cockney Dr James Kelly from Kent says he feels as rough as a badger's arse this morning, and no city that makes him feel that way should be allowed to host a conference. He's running through the full range of Liverpool jibes - the Liverpool football team's going to be sponsored by Butlins next year since both their seasons end in November, and a load of really not very PC stuff I have no intention of repeating.

10.04am

Dr Williams has now been handed a gift by deputy conference chairman Dr Mike Ingram to help with his 'double incompetence' - he's being mocked for being unable to put together a coherent motion. The stem didn't flow from the root, or something. Now that is a real faux pas.

Believe it or not the conference is now discussing whether it was 'exceptionally wise' to move the conference to Liverpool this year.

10.01am

Dr Peter Williams says he was booed off stage years ago for backing the MRCGP exam. Boos ring out - they still hate him for it.

Hall seems a bit emptier today than on day one - how many delegates are lost in at the X Factor auditions going on at the building next door?

9.50am

LMC have backed a motion on longer training being a good thing. GP trainees need 'enhanced' out-of-hours training, too. A motion put forward by Glasgow LMCs wins approval too - training practices need more funding.

9.45am

Plans to extend GP training are a good idea, but not at any price, the conference hears. It needs to be fully funded. Dr Rupa Parmar, from Avon, thinks clinical commissioning groups should commission extra GP training to help GPs take on work they move out of hospital, too.

9.36am

We're off to a unanimous start - CQC registration is a 'bridge too far'. Clear as mud. Registration should not cost practices anything. I get that one. And the other two - CQC standards for GP practices should not be based on hospital settings and the watchdog should use proper evidence to decide which practices need a visit from its terrifying inspectors.

9.33am

Standards developed for secondary care do not necessarily translate to a general practice setting,' warns one speaker. He's talking about impending registration with the Care Quality Commission. CQC bosses will be glad to hear one myth has been exposed - you don't have to have carpets in consulting rooms. That's a relief.

9.20am

Hello, we're back for the second day of the LMCs conference 2012.

It's the 'ask the negotiators' session to start off the day. Small practices are being lost as single handers who have had 'every drop of juice wrung from them' quit and PCTs disperse their lists, says one speaker.

GPC Wales chairman Dr David Bailey has admitted that the quality and productivity indicators added to the QOF are not desirable, but simply 'the price we had to pay' to keep QOF at 1,000 points. Meanwhile, GPC chairman Dr Laurence Buckman pretty much rules out a new contract anytime soon, pointing out that although everyone wants rid of MPIG among other things, the lack of funding currently available means any new deal would mean an unacceptable range of winners and losers.

 

TUESDAY 22 May

5.30pm

And that's it for today. Some pretty dire warnings and grim tales about the pressures the profession is facing across the UK - as Dr Buckman said at the start of the day: let's hope someone is listening.

See you tomorrow.

5.22pm

Welcome to Liverpool, the capital of North Wales,' says Dr Bill Harris. He actually said it in Welsh, though. Then in English. The point is, FP69 forms that are used to remove patients from practice lists are discriminatory. They discriminate against people whose first language isn't English, and people who are vulnerable.

5.17pm

Dr Robert Morley of Birmingham LMC takes to the podium to hit out at a decision to give the NHS Shared Business Service a six-year deal to run the NHS Commissioning Board's and CCG finance and accounting functions. He says this lays 'stark bollock naked' the government's plan to privatise this element of the NHS.

5.10pm

That was the narrowest of margins - 48% of LMC representatives backed being able to offer services privately, 47% opposed it. The vote defied a GPC appeal to oppose it, and leaves the GPC with a difficult quandary to tackle in Dr Buckman's final year.

5.05pm

Well there's a shocker. LMCs have just narrowly voted for the GPC to negotiate a change in the GP contract to let patients pay their GP for treatment not funded by the NHS.

5.02pm

This is a contentious issue. Dr Greg Place from Nottinghamshire, warns conference against changing the contract to allow patients to receive care not available on the NHS to their patients on a private basis. This is a line we should not cross, he says.

But Dr Jag Kallray says he should be able to give flu jabs privately, for example, if patients are not eligible for this on the NHS.

GPC contracts committee chairman Dr John Canning is having none of it - the boundary should not be blurred on GPs providing free care.

4.58pm

I'm not a deskilled robot,' says Dr Joanne Watt. She likes the help of algorithms and other tools because she hasn't got the time to read all the evidence every time she makes a decision. But it isn't about that, LMCs decide - they just don't want to be micro-managed. A motion warning about the damaging impact of tick box targets and algorithms on GPs' 'intelligent and compassionate delivery of care tailored to individual needs' is carried.

4.52pm

Referral management centres and the use of 'referral algorithms' often not based on evidence, risk reducing GPs to 'deskilled robots'. Dr Amanda Craig, from Brent, says she's been waging a one-person war against referral management.  

4.45pm

Dr Malcolm Kendrick's granny told him a joke once. He's forgotten most of it. But it had some funny voices in it, which is better than nothing. But not as good as a punchline.

4.40pm

Dr Greg Graham came into general practice when Charles I was on the throne. He's talking about plans to help GPs come back into work after an absence from work. His health board, for one, is 'more interested in looking after it's own arse'.

On the subject of workforce, LMCs just carried a motion calling for the GPC to promote general practice, not to lower standards of entry to boost numbers, and to stop resources being cut and pushing GPs out.

4.25pm

Dr Sarah Khan is a recently-qualified GP, who followed her father into general practice despite howls of derision from her fellow medical students. Many of whom ended up joining her in the end, she says. But now recruitment is dwindling. LMCs need to do more to protect the profession.

Dr Richard Van Mellaerts, from Kingston and Richmond says his kids are currently dead set on careers in the fire service. Alongside Fireman Sam in Pontypandy. He wouldn't advise them to follow him into general practice in its current state, he says. He admits to eating the curry last night. I wonder if he paid?

4.20pm

Dr Black has a solution for appraisal and revalidation. Doctors who are above average will be known as 'twits'. Those under par will be known as 'twats'. Twats will be forced to be mentored by twits in a process that will be known as 'twaddle'. Laughter rings round the hall. LMCs prefer this version to the rather formal-sounding process Professor Lewis set out on behalf of the GMC earlier.

4.15pm

Sorry I'm not called Brian,' says Dr Tom Black. He's the Northern Ireland chairman, and this is a novel opening gambit in his first conference speech as chairman. But it's only fair. The names of his two predecessors? I'll leave you to guess.

4.09pm

Dr Bailey has given way to Dr Debbie Waters from Gwent - there is a lack of clarity on who is responsible for patients who live on the border between England and Wales and receive care from services on both sides. Patients are falling through the gaps. LMCs vote to back a motion calling for clarity.

4.05pm

It's Dr David Bailey now - the GPC Wales chairman. 'Good morning,' he says cheerily. It hasn't been morning for ages, he realises. GPs in Wales won't agree changes that extend their working hours he says. The Welsh government needs a better plan to improve premises. Welsh health boards are trying to squeeze more and more work out of GP practices.

4pm

Dr Marshall confesses to being a 'difficult person' - perhaps that was it. No, they love him after all, a lengthy standing ovation for Dr Marshall after he thanks colleagues and prepares for life after the GPC Scotland chairmanship.

3.55pm

Have GPC Scotland chairman Dr Dean Marshall's looks faded? This time last year he was roared onto the stage like a rock star. Perhaps it's his role as revalidation lead for the GPC that has put people off - his welcome is, well, a bit muted.

3.50pm

It takes an electronic vote to confirm it, but LMCs back a motion calling for LMC observers to sit in on all CCG board meetings. That concludes the session on commissioning. On to reports from Scotland, Wales and Northern Ireland.

3.46pm

Given the years of opposition to holding an LMC conference in Liverpool, there have been very few grumbles. One intrepid speaker moaned briefly earlier, but put a sock in it when a low grumble of disapproval echoed round the room. Dr Shamim Rose has just welcomed everyone to the city - as she points out, it's lovely and sunny. Not in here it's not.

3.42pm

Dr Nagpaul has a different hat on. Not a real hat, unfortunately. He's just switched from speaking as a GPC negotiator to speaking for the Edgware and Hendon division he represents. Is there anyone else in the division? Maybe it's a one-man band. LMCs back a motion calling for CCGs to support local NHS services as preferred providers. 

3.37pm

By 2016 commissioning support will be a de facto outsourced service, warns Dr Chaand Nagpaul. LMCs back motions calling for commissioning support to be NHS-led, not sold to the private sector, managed and retained in-house by CCGs. CCGs should not have commissioning support imposed, LMCs warn. Motions are carried to this effect.

3.26pm

A handful of other stories are up on GPonline.com too: click here to see the full selection and to read the text of GPC chairman Dr Laurence Buckman's fifth LMC conference speech earlier today.

3.25pm

Quality bonus payments to CCGs could undermine the doctor-patient relationship, LMC leaders agree.

3.17pm

GPs should be able to sack their CCG leaders if they're not happy with them, LMCs have declared.

3.11pm

Just because I work for a CCG doesn't mean I've defected to the dark side,' says Dr Fiona Armstrong, from Kent. LMCs need to be intimately involved in CCGs, she says.

Dr Nigel Watson allowing every GP to vote in CCG elections is the only way to get everyone involved. Because CCGs are membership organisations local GPs must have a right to recall them if they are rubbish. Some little dictatorships are springing up, where CCGs are bringing their 'cronies' in - GPs must have the power to stop this.

3.08pm

We're hearing about why CCG members should be elected by local GPs on a one GP, one vote basis. But hovering on the big screen above the podium, the really important issues are being flagged up. The two GPs who failed to pay for their curry last night have been urged to fess up to Dr Kumar.

3.04pm

Derbyshire's Dr John Grenville was in full flow when a commotion at the back of the hall cut him short. Is there a GP in the house? Someone had collapsed, but is now recovering and conference has resumed after a brief interlude.

2.56pm

GPs vote for the GPC to remind the profession of the importance of managing conflicts of interest well as they take on commissioning. They back the creation of an 'external reference group' to support GPs.


2.50pm

Dr Anthony O'Brien, from Devon, was initially introduced as Mary by the big screen behind the speakers' podium. He wasn't put off and warned that CCG constitutions should set out a clear role for LMCs.

2.44pm

Dr Rae is adamant. 'A really strong message has to come from this conference.' It does. A motion warning that the Health Act has changed GPs' initial impressions of commissioning, that bureaucracy will undermine commissioners and warning of potential dangers of the role of private companies' involvement in commissioning is carried.

2.39pm

Newcastle and Tyneside's Dr George Rae says GP involvement in commissioning is to be welcomed, but large parts of it are at risk of being turned over to the private sector.

2.25pm

Patients are being discharged too fast from hospital, LMCs warn. The number of patients booted out of hospital before test results are known is increasing, and they are being put at risk.

Dr Adam Jenkins warns that hospitals are discharging patients after a single 'DNA' - a 'callous practice' - or when patients ask to delay a follow up appointment. Patients are at risk, and GPs are at medico-legal risk, he warns.

2pm

Work is moving to primary care from secondary care at an alarming rate and GPs are being handed unlimited funding to deal with it. Oh, hang on, that wasn't it. There's no money at all.

Commissioners need to recognise that GPs need funding to take on more work, and loading practices with extra work without resources could put practices at risk.

1pm

Lunch. But not before a significant vote on practice boundaries. We know what pretty much all GPs seem to think of the pilots, but LMCs have just voted for them to be scrapped.

See you after lunch.

12.50pm

Prof Lewis has escaped. He avoidwed physical attack by LMC members, but underwent a prolonged verbal assault. Dr Terry John rounded the assault off with a warning that a GMC letter had led to a 'madcap variety' of local approaches to appraisal and revalidation.

12.45pm

Flying planes is easy by comparison with general practice, argues Dr Bill Beeby. Well, that's a given. On more relevant matters, he thinks it's wrong that he's been told some things are not needed for revalidation, but remain essential for appraisal. The two need to marry up.

12.40pm

Sefton's Dr Ivan Camphor, soberly dressed (see below for last year's outfit) says that revalidation without remediation is 'like beauty without the beast'. Many GPs may think it's tough to tell which is which.

Prof Lewis says needing remediation doesn't prevent revalidation, but Londonwide LMCs' Dr Tony Grewal steps up to say that the two issues cannot be separated. He berates the GMC for paying for private health insurance for its staff while funding for remediation has not been sorted out.

12.30pm

GPs should not prescribe for self or family if it is outwith their normal practice,' says Prof Lewis, in response to a query from a GP from Avon who asked why doctors shouldn't be trusted to manage their own health, within reason.

12.26pm

A suggestion that doctors could undergo a test every five years instead of revalidation is batted away by Prof Lewis - it would have created a huge 'industry of exam creation' and the idea was ruled out at an early stage by the GMC.

12.22pm

Prof Lewis is asked why although his message about revalidation was simple and non-threatening, the message from PCTs and others is not.

12.20pm

I've never used the phrase "enhanced appraisal",' Prof Lewis says. He's wrapped up now - a brave effort given his late call-up, but little more than polite applause from LMC members. They're lining up to ask questions. The first, from Dr Peter Gledhill, hits out at the complexity of revalidation, and says at this stage it should be in better shape.

12.15pm

Remediation should not be a delaying factor for revalidation, Prof Lewis says. GPC chairman Dr Buckman looks like he's dozing off. Could that affect his revalidation?

12.13pm

GPC revalidation Dr Dean Marshall shakes his head as he listens to Prof Lewis go through LMC motions that will follow his presentation, setting out why each is not a real problem. He says collecting feedback from large numbers of fellow health professionals should not be a problem and that any delay in revalidation would be wrong.

12.05pm

Prof Lewis points to data showing that 73.7% of doctors underwent appraisal in 2010/11 - the rate among GPs UK-wide is higher, he says.

11.58am

'I'm here, and revalidation soon will be too,' Professor Malcolm Lewis tells the conference. He nearly wasn't here - he's a last-minute stand-in for GMC chairman Niall Dickson, who was unable to attend due to an 'accident'. Hope he's OK. Dr Lewis is talking about revalidation.

11.51am

GPs carry a motion warning that the NHS reforms in England are a 'smokescreen' for privatisation, and will make scapegoats of GPs as the health service deteriorates.


Voting at LMCs conference 2012

11.50am

Political dishonesty is endemic and will continue to be so while the government controls the NHS and uses it as a political football to win votes.' So says Dr Paula Cowan.

11.45am

LMCs, true to form, and probably quite sensibly, opt not to vote on the motion. Lansley and Cameron are spared. Damp trousers are not an issue.

11.42am

Dr Alun Griffiths from Bradford and Airedale says calling for Lansley and Cameron to quit would be like 'wetting yourself in dark trousers - it gives you a nice warm feeling but no one will notice'.

11.40am

11.36am

I'll make my political stance clear - I last had a pasty just days ago,' says Dr Adam Skinner. 'Resignation is too good for Lansley - he should be shackled to the ship and go down with it.' The real culprits for letting the Health Act through are the Liberal Democrats, who could have stopped it.

Their colour is yellow indeed, says Dr Skinner.

11.34am

A big moment now - this is the kind of motion LMCs normally duck out of backing. Dr Andrew Mimnagh is calling on his fellow LMC representatives to call on Andrew Lansley and David Cameron to quit.

11.30am

Dr Joanna Bayley disagrees - she buys the argument that politicians need to be able to discuss policy freely. GPC negotiator Dr Chaand Nagpaul is having none of that though. He says it's the height of hypocrisy for the government to refuse to publish the report. LMC representatives agree, overwhelmingly.

11.27am

Dr Adam Skinner from Kent says he's never agreed with Andrew Lansley before. But he bets the health secretary's right that the release of the NHS risk register - which the government has blocked from public view despite a series of legal rulings - would make some waves.

11.23am

Dr Gerard Reissman from Newcastle and North Tyneside is proposing a motion warning that the Health Act will increase health inequality. A vote to call on GPs to consider withdrawing from clinical commissioning groups (CCGs) and other NHS management roles is tight - it's the first electronic vote. 41% back it, but 49% don't. 

11.11am

BMA chairman Dr Hamish Meldrum himself takes the stand to defend his efforts to get rid of the Health Act - GPs are debating a motion hitting out at the BMA for taking too long to 'wake up to the malignant effects' of the Act. The motion is lost.


Dr Hamish Meldrum at LMCs Conference 2012

10.50am

Dr Shaun Millns-Sizer from Bradford and Airedale is up next - a first-time speaker. He's nervous, he says. But his point is well made - the government should not waste money on daft NHS reorganisation and needs to be honest about rationing.

10.43pm

No nihilists here then - the vote is lost. A shame, because the point GPs wanted to make was a strong one that no one here disagreed with - GPs are struggling to cope with pay freezes and rising workload. More careful wording of motions needed next time.

10.37am

General practice is not sustainable in its current form - Cleveland LMC chairman Dr John Canning stresses this is not about charging patients. It's about more funding to provide the current service in the way people want.

Hang on though - scarcely a conference goes by without an emergency intervention from Dr Fay Wilson - a former conference chairwoman - and this one is no different. But despite calls to 'move to next business', LMC representatives want a vote. Dr Buckman agrees GPs are overworked, but to vote this through would be 'therapeutic nihilism'.


Dr Fay Wilson at the LMCs conference 2012

10.22am

'You said you weren't radically changing the NHS - we don't believe you Mr Cameron.' Dr David Wrigley hits out at the government for undermining the NHS. The motion was, of course, carried.

 

 


Dr David Wrigley at LMCs Conference 2012

 

10.20am

This next motion looks a shoo-in for a unanimous vote too - Somerset's Dr Nicholas Bray is arguing, basically, that GPs are responsible for everything good about the NHS.

10.15am

Bradford and Airedale's Dr Hilla Cox tells the conference patient advocacy and holistic care are under attack. No one's inclined to disagree - the motion passes unanimously.

10.08am

'Please, someone listen before we run out of GPs,' pleads the GPC chairman - pensions cuts, increasing workload and other pressures are hitting the profession hard, while premises investment isn't coming.

He wraps up the speech with thanks to a trio of influential Scots - Dr Mary Church, Dr Dean Marshall and BMA chairman Dr Hamish Meldrum. Despite a couple of positive footnotes in the speech, Dr Buckman says these are 'tough, uncertain and not very happy times'.

The hall rises slowly to its feet to deliver a 55-second ovation - that's 15 seconds more than last year I seem to remember.

10.05am

CCGs must be elected, NHS 111 can work if it's properly implemented, as can CQC regulation and revalidation. But will it work like that? Dr Buckman fears it won't.

10am

The following horrors are all coming your way because of the Health Act, which has opened up the NHS to be picked off by private providers:

  • Enforced procurement of practices through APMS deals when GMS or PMS would do.
  • Quality rewards that pay GPs to cut corners on cost grounds.
  • Micro-management of GP performance.

9.55am

We are fed up of hearing other people's visions for the future of the health service, says Dr Buckman - 'people who have visions need injections'. Most patients say most GPs are good at most things, Dr Buckman says - he wins warm applause for telling politicians that it wouldn't hurt them to acknowledge that once in a while.

9.50am

First up today...  Dr Laurence Buckman gives his fifth speech as GPC chairman. Each year the profession has faced something new and terrible, he tells the conference.

 


 

 

Monday 21 May

 


1pm

This year's LMC conference is less than 24 hours away.

After a long campaign involving innumerable daft props and significant chutzpah, Dr Nev Bradley and Dr Ivan Camphor (pictured) have finally dragged the conference to Liverpool.

Last year's live blog kicked off with a warning from GPC chairman Dr Laurence Buckman that NHS funding shortages meant the service was not just being cut to the bone. Instead, 'whole limbs are being amputated', he warned at the time. By now, presumably, it's been reduced to little more than a torso. Let's hope that like Monty Python's Black Knight, the service can behave like it's 'just a flesh wound'.

 


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