LMCs prepare to debate GP crisis

This year's LMCs conference will focus on the pressure on GPs, writes Neil Roberts.

LMC representatives from across the UK will travel to York next week for what could be their most significant annual conference in many years.

In the 12 months since LMCs met in London at the 2013 conference to set GPC policy, a growing sense of crisis has enveloped general practice.

Concerns about funding and workload look likely to dominate the two-day event on 22-23 May at the York Barbican.

GPC chairman Dr Chaand Nagpaul told GP the conference comes at a 'critical juncture' for general practice and the NHS.

He warns governments across the UK that their plans to use GPs to shift more care into the community will fail if they ignore concerns expressed by LMCs next week.

'It would be real folly to make light of the strength of feeling and the messages that will come out of conference,' he says. 'Governments cannot afford to ignore the unarguable reality faced by GPs and patients.'

Dr Nagpaul argues there is a paradox of governments relying on general practice to carry their policies, while overseeing a crisis in workload, workforce and resourcing.

The agenda, Dr Nagpaul says, reflects the 'pulse of GPs'.

'It is clear we have very strong feelings around workload, workforce, recruitment, retention, morale and issues around infrastructure, and how we tackle the future.'

Workload, workforce

GPC Wales deputy chairman Dr David Bailey agrees: 'I think the twin issues of workload and workforce will define this year's conference.

'We are reaching a tipping point where practices all over the country are starting to struggle. That will be the number one theme.'

The workload debate kicks off the conference on Thursday morning. Morgannwg LMC will propose a motion warning that services are in danger of collapse because of unsustainable workload, with an 'imminent risk to the safety of patients'.

The motion will demand governments urgently recognise and resolve the problem. 'Workload is the number one issue,' says Dr Bailey, who warns that concerns over factors including resourcing and morale mean it may be too late to prevent people leaving the profession. 'It's the perfect storm, really,' he says.

Following the success of GPC negotiators across the UK in agreeing to slash the number of QOF indicators in the 2014/15 contract, Cornwall and Isles of Scilly LMC will propose that the remaining core clinical QOF points should be transferred into core funding.

The motion, incorporating similar demands from Sheffield, Leeds and Yorkshire regional BMA council, calls the QOF a 'box-ticking monster'.

Health secretary Jeremy Hunt said recently he would abolish all QOF targets if he could, prompting a GPC warning not to 'throw the baby out with the bathwater'.

Rows over GP access have blown up in the media several times over the past year, provoked by the government and NHS England's seven-day opening agenda.

Most recently, the prime minister's £50m Challenge Fund access pilots have divided GPs across England.

Although the level of interest far exceeded expectation, many GPs and GP leaders are sceptical about future funding and the effects on core services.

Wirral LMC will propose a motion to conference, incorporating submissions from 22 other committees, that rejects the 'concept of routine general practice care 8am-8pm seven days a week'.

It adds that GPs could only ever provide such a service if resources were provided 'to the satisfaction of the profession'.

Financial pressure

Medical director at Londonwide LMCs Dr Tony Grewal, who is currently grappling with the threat of practice closures from MPIG withdrawal across the capital, said the main themes of the conference would be the 'oppressive and malevolent management, financial and workload pressures on GPs, and the future of general practice'.

The threat to practices from the loss of MPIG correction factor payments has put general practice on the front pages of the national press in recent weeks.

LMC representatives will vote on a composite motion from 10 committees noting the 'devastating impact' of MPIG and PMS growth money withdrawal on many practices and calling on the GPC to negotiate specific funding for practices with vulnerable populations and those in rural areas.

Dr Nagpaul says the clear message from across the conference agenda is that GPs feel 'undervalued, unfairly targeted, unfairly subject to resource cuts and attacked from all corners', with work that is unresourced and money 'being taken away from their practices'.

Thirty-five LMCs submitted motions on the funding crisis. A composite motion will be proposed by GP representatives from Hertfordshire, demanding 'urgent and consistent investment in global sum and PMS baselines' and that a greater proportion of the NHS budget should be spent on general practice.

Following the government announcement in March that GPs would receive just 0.28% funding uplift to pay for a 1% pay rise, LMC representatives will vote on a motion condemning the Doctors' and Dentists' Review Body (DDRB) recommendation as 'unacceptable' and 'influenced too heavily' by ministers' claims that only 1% is affordable.

The motion asks GPC to consider whether GPs should 'continue to participate in DDRB arrangements'.

Payment by results

Dissatisfaction over funding arrangements has spurred three LMCs to call for a payment by results contract to replace the 'unfit for purpose' capitation formula. Kent LMC will propose a motion to say the current contract fails to resource actual workload.

One of the most controversial debates will come on proposals submitted by 10 LMCs to introduce patient charges for GP services.

A motion to be proposed by Wiltshire says it is 'no longer viable for general practice to provide all patients with all NHS services free at the point of delivery'. It drew sharp criticism within hours of the publication of the agenda document.

Writing for GPonline.com, BMA deputy chairman Dr Kailash Chand said while it was understandable for doctors to have concerns over unmanageable demand, billing patients was a 'spurious solution' which would undermine the core principle of the NHS and 'penalise the poor, the sick and the old'.

LMC representatives will spend part of the second day of the conference debating the 'future of general practice'.

A motion incorporating submissions from 15 committees says general practice 'cannot achieve its full potential while being seriously damaged' by disinvestment, MPIG withdrawal, the lack of premises investment and the 'rapid reduction in the number of GPs due to government policies'.

The message to governments from conference, Dr Grewal warns, should be that unless they start 'getting things right' on general practice, it would become unviable.

'If their intention is to destroy general practice, they need to be overt about it, and if their intention is not to destroy general practice, they need to look at what they are doing,' he said.

Expert view - Workforce is a key theme for LMCs conference

Dr Nigel Watson, chief executive, Wessex LMCs

'The GP workforce will certainly be one of the major issues at the conference. We are losing older ones and can't recruit enough younger ones.

'We have an ageing population, with more demands, and we need more resources.

'We need a national way forward to deliver that. Some of the conference is about getting clear ideas and sending an important message to the politicians.

'You don't value what you've got until you lose it, and we are in real danger of losing general practice unless we do something.

'That may involve some reform, which could be painful, but we need a sustainable future for general practice.'

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