LMCs press for list closure debate and warn against privatisation

GPs will demand a chance to debate plans for mass closure of patient lists on Friday as doctors' leaders meet at the first-ever England LMCs conference.

Dr Jackie Applebee: backs debate on list closure
Dr Jackie Applebee: backs debate on list closure

One senior LMC member said it was surprising that the conference agenda committee had not prioritised for debate a single motion to discuss how the profession should follow up a vote earlier this year in favour of mass list closure.

Just over two months ago, 54% of 1,870 GP practices that voted in an indicative BMA ballot said they would be prepared to take part in both a mass formal application to close lists, or a temporary patient list suspension as a form of industrial action.

Another LMC leader said it 'beggars belief' that no motion on list closure had been prioritised for debate while a motion asking the GPC to look at how GPs can operate in a 'private, alternative model' has been listed as a priority motion.

Read more: Full conference coverage

GPonline reported last week that the motion on an 'alternative model' - tabled by Bedfordshire LMC - had drawn a sharp response from the RCGP, warning that privatisation 'in any shape or form' was not a solution to the GP crisis.

The issue of mass list closure has not been prioritised despite strongly worded motions on the subject put forward by LMCs.

Derbyshire LMC tabled a motion - not prioritised for debate - that reads: 'That conference is deeply disappointed by the willful manipulation of conference motions demonstrated by the obfuscation of the phrasing of the list closure ballot. The result was that most practices felt they would be in breach of contract by saying yes to the ballot. We demand the ballot to be re-held with more clarity and better engagement.'

Tower Hamlets LMC chair Dr Jackie Applebee said she had selected the Derbyshire motion among her chosen motions and would press for it to be discussed. She also pledged to speak against privatisation and hoped the conference would reject calls for the GPC to explore a private alternative model of general practice.

'I know that many GPs are struggling under the workload - the oft-quoted GPC survey last year where 84% who responded said that their workload impacted on their ability to provide safe patient care confirms this, but we don’t need to bail out of the NHS to address this.

GP workload

'We could of course, close our lists. Stay with the NHS, but manage our workload. Colleagues, in my view, should not use the crisis in the NHS to justify going into private practice. If they wish to practice privately that is their decision, but they could, as I said previously, stay in the NHS and manage their workload. That 54% of those who responded to the list closure survey said that they would consider temporarily closing their lists  shows that there is an appetite out there to take this action, and of course many practices are doing so anyway, Folkestone being one spectacular example.

'Many GPs reported that they weren't aware that the survey was taking place and hadn’t seen the communication from GPC. I do think that if there had been more publicity the response rate would have been much better.'

Northumberland LMC secretary Dr Jane Lothian said it was 'rather odd' that no motion on list closure had been prioritised for debate at the LMCs conference, although she added that in her area she felt there was 'little appetite' for mass list closure.

Dr Lothian predicted that the vote on a private alternative model of general practice would be thrown out by the conference, but she warned that it had been prompted by 'legitimate issues'.

She feared that if privatisation was not addressed head-on by the BMA and others it could come in 'by the back door'. The Northumberland LMC secretary added: 'I’m for the NHS but I don’t see why people shouldn’t be allowed to invest in private medicine if they want to - that choice exists in secondary care but not in general practice.'

Pressure to allow practices to provide some services for a fee to their patients would grow as cash-strapped CCGs cut back on basic services patients relied on such as ear syringing, she added.

But Dr Applebee warned: 'Do we really want to go back to pre-1948 days where GPs hired debt collectors to go out on a Friday afternoon to demand their fees from patients? The great thing about the NHS is that it is free at the point of delivery and available to everyone, regardless of ability to pay, we are the fifth largest economy in the world, we can afford the NHS and we should afford it.'

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