LMCs warn of 'existential threat' to GP partnership model

Plans to nationalise general practice or push GPs to integrate with hospitals are an existential threat to the profession, LMCs have warned - as GPs expressed support for creating a BMA subcommittee to represent partners.

BMA House entrance

GP leaders at the UK LMCs conference in York warned on 10 May that a nationalised general practice service was not in the best interests of patients, and urged BMA leaders to take 'all necessary action' to defend the GP partnership model and independent contractor status.

They voted for BMA leaders to model the impact of a move to a GP salaried service - warning that the move would cost far more than the existing system, and that the government did not recognise the value of independent contractor general practice.

LMCs also backed - as a reference and by a slim margin - part of a motion that called for the BMA's GP committee to form a separate 'contract holders subcommittee to represent and discuss GP partnership contract issues'.

Nationalised general practice

Rejection of a nationalised GP service and warnings over the impact of 'vertical integration' with hospitals from the LMCs conference comes after a think-tank report backed by health and social care secretary Sajid Javid called for the end of the GMS contract within a decade.

Warnings over the need to defend the independent contractor model also come after deep concerns in general practice over the imposition of GP contract changes for 2022/23 by NHS leaders in England, and over the expansion of the PCN DES and the failure to shift more funding into core practice income.

BMA GP leaders have urged the profession to remain united in the face of unprecedented pressures in the wake of two years of the COVID-19 pandemic - but the call for a separate committee for partners highlights concerns from some parts of the profession that the doctors' union is struggling to represent the growing proportion of GPs who are sessional at the same time as partners.

In an earlier speech at the conference on 10 May, sessional committee chair Dr Ben Molyneux confirmed that he had begun the process of trying to create a separate branch of practice committee to represent sessional GPs within the BMA.

Independent contractors

Dr Chandra Kanneganti of North Staffordshire LMC told the conference: 'Let there be no doubt conference that the abject failure of the government to recognise the value of the independent contractor model will not only lead to the demise of general practice as we know it, but will also lead to the end of the NHS that serves the health needs of every person in this country.'

He warned that integration of general practice with hospitals would end the family doctor service and lead to more and more elements of GP services being lost to the private sector, where only the well-off would be able to access them.

Dr Kanneganti accused the BMA's GP committee of failing to get behind the independent contractor model - and said this meant a GP contract holders committee was needed to stand up for partners.

A number of others speakers warned that - particularly now that sessional GPs make up more than half of the profession - discussions on the GP contract within the BMA should not be limited to partners. Dr Simon Wright from Dorset LMC urged LMCs not to take 'steps that divide us further' and arguing that creating divisions would be a 'retrograde step'.

The element of the motion on creating a separate subcommittee for partners was voted on as a reference - meaning it does not become BMA GP committee policy, although the committee will be expected to recognise the spirit of the motion and bear that in mind when forming policy or in negotiations on behalf of the profession.

In comments to GPonline earlier this month, BMA GP committee deputy chair Dr Kieran Sharrock called for the profession to 'pull together' at a time when a declining workforce is facing unprecedented workload pressure.

He said the GP committee was committed to the independent contractor model, adding: 'The profession can rest assured that GPC England offers the strongest possible support for the independent contractor model as the cornerstone of general practice. The voices of grassroots GPs will be instrumental in how we move forward.'

Conference motion in full:

AGENDA COMMITTEE TO BE PROPOSED BY NORTH STAFFORDSHIRE: That conference believes that a 'nationalised general practice service' is not in the best interest of patients or doctors and:
(i) believes there is an abject failure of governments to recognise the value of the independent contractor model for delivery of primary care
(ii) believes vertical integration is an existential threat to the independent contractor model and the role of the GP partner
(iii) calls for clear modelling of the impact of a fully employed GP service in all UK countries to be undertaken by GPC UK
(iv) calls on GPCs to take all necessary action to defend and promote the partnership model and independent contractor status of general practice in the UK
(v) instructs the GPC to form a separate GP contract holders subcommittee to represent and discuss GP partnership contract issues.

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