Can LMCs represent all GPs?

As the BMA looks at representation of salaried and sessional GPs, Judy Sands asks LMCs how they manage.

Dr Ian Millington
Dr Ian Millington

As the BMA strives to keep salaried and sessional GPs within its vast embrace, focus has begun to shift from GPC level to LMCs.

Dr Mark Selman, unveiled last week as chairman of a GPC working party on representation of sessional GPs, is keen to examine how LMCs can improve in this area (GP, 25 September).

LMCs say they struggle to attract sessional and salaried GPs to active committee roles.

But there is debate over whether this is because of the structure of LMCs or because salaried and sessional GPs are not keen to become involved.

Dr Jane Lothian, secretary at Northumberland LMC, says it has tried hard to boost sessional GP representation. But she says: 'Invariably as soon as we get someone good, they become known as a dynamic and enthusiastic doctor and are snapped up as a partner. Then we are back to the beginning.'

Dr Paul Roblin, Berkshire, Buckinghamshire and Oxfordshire LMCs chief executive, suggests that some GPs choose sessional or salaried careers because they are not interested in medico-politics.

'The reality at the moment is that our elections are open to everybody but far fewer sessional and salaried GPs come forward,' he says.

Justifiable reluctance
National Association of Sessional GPs (NASGP) chairman Dr Richard Fieldhouse says this is hardly surprising.

'If you are a sessional GP you are not going to stand up in a room of 20 GP partners and say that you think they all treat you really badly. You would never work again.

'At the same time, LMCs cannot get better at addressing salaried and sessional GP issues until there are more on their committees. It is a chicken and egg situation.

'I would always encourage sessional and salaried GPs to join their LMC,' he adds. 'If you can make it work for you it is a fantastic level for resolving issues.'

Dr Rachel McMahon, a salaried GP in Cleveland, agrees that local issues are better resolved through LMCs.

She argues that the LMC levy is paid by practices on behalf of all doctors, which means LMCs have a duty to do their best for salaried and sessional GPs as well as partners.

Morgannwg LMC secretary Dr Ian Millington claims the LMC is among the few to have successfully engaged with non-partners. It has six salaried and sessional representatives in a committee of 24 GPs.

'There's no doubt it is difficult reaching non-contract holders. But primary care organisations in Wales use a central administrator and we made a deal with them to send our newsletter to all GPs in our area,' he says.

'It seems to have worked in attracting more sessional and salaried GPs. We now have our own sessional GP group and we are developing a new website with a section for them.'

Dr Selman is keen to compile a list of LMC best practice, in a bid to implement similar changes across the UK.

But questions remain over whether LMCs can resolve the tension critics say dogs the BMA - can it adequately represent both employers and employees?

Resolving conflicts
Wessex LMCs chief executive Dr Nigel Watson admits it is difficult for LMCs when conflicts arise between salaried doctors and partners.

'We take the view that we are not employment lawyers, so we can only act as honest brokers and say what is fair and reasonable and what the majority of practices are doing. Otherwise we have to refer the disputes to the BMA.'

Mike Forster, lay secretary at Gloucestershire LMC, says the LMC plans to set up 'Chinese walls' for such cases, mirroring the BMA approach to disputes between partners, which involves hiring separate legal teams to represent each party.

But, along with other LMCs, he says disputes are not common. Establishing just how big a problem divisions between partners and other GPs are will be part of Dr Selman's remit. He is asking non-principals to report cases where they have felt unfairly dealt with by LMCs or the BMA.

'Ultimately we, as salaried and sessional GPs, have to do this work ourselves. We have to be pro-active in making sure the BMA and its structures work for us,' Dr Selman says.

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