Although many LMCs already work in federations, many will need to work more closely together and pool resources, the groups’ leaders believe.
Funding from levies paid by member GPs cannot be increased because practice profits are in decline.
But LMC workload is rising because of the decrease in support available to practices from shrinking PCTs.
Pressure on LMCs is also increasing as they are forced to employ extra staff and work hard to forge relationships with new organisations springing up under the NHS reforms.
Wessex LMCs chief executive Dr Nigel Watson said that although PCTs were ‘sometimes seen as the enemy’, many had been supportive.
Loss of PCT expertise
‘Once they are gone, a lot of expertise will be lost. Practices will come looking for help and we will be there to support them,’ he said.
But in addition to filling the gap left by the removal of PCT support services, ‘the range of support LMCs will have to offer during and after the reforms will have to increase’ because they will have to develop relationships with a wide range of new organisations, he said.
‘We have a face on the local education and training board, we might want someone on a clinical senate. We have to have a relationship with clinical commissioning groups (CCGs), and with the local area teams of the NHS Commissioning Board,’ Dr Watson said.
LMCs will also need to have the staff to experiment with different ways of interacting with new organisations.
Dr Watson said some LMCs had observers who represent them at CCG board meetings.
But he said Wessex LMCs felt their link to the CCG ‘might be outside the board’.
‘We have business and liaison meetings with PCTs, we don’t sit on board meetings. It will be interesting to see how that pans out.’
Easier for large LMCs
The rising demands ‘makes it easier for large LMCs, with permanent staff’ to cope, he added.
GPC negotiator and Derbyshire GP Dr Peter Holden said he believed LMCs would cope with the additional pressure.
‘I believe they can cope. We’ve coped with change in the past – including the creation of the NHS,’ he said.
The real challenge this time came from the pace rather than the scale of the reform, Dr Holden added.
‘They may need to change the way they work a bit, and clusters of LMCs may need to cooperate to get a spread of expertise,’ he said.
But many already do this and he said that well run LMCs like his own, in Derbyshire, which keeps ‘a year’s operating cost on reserve at all times’ would be able to cope with any additional costs.
He conceded that NHS reforms would create ‘more LMC activity, certainly’.
But he added that LMCs should not forget that they didn’t need to ‘reinvent the wheel’ by duplicating services that the BMA’s GPC offers centrally.
Increased LMC levy
He added that ultimately, if LMCs needed to increase their levy, they should be able to make the case to members to do so. ‘GPs may feel they can’t pay an increased levy, but you should understand the cost of employing a lawyer or whatever on the high street, it will make LMC subs look an absolute bargain,’ he said.
‘And it’s a recognised practice expense – you can offset it against tax.’