During the 3,500-word speech, LMC leaders erupted into applause at the first special LMCs conference in a decade as the GPC chairman hit out at soaring workload and falling GP income, warning patients were being short changed and put at risk.
'Patients are being short-changed on a daily basis,' Dr Nagpaul warned, 'with nine in 10 GPs stating that workload pressures are damaging the quality of care to patients. This is a disgrace in a system in which the government promotes quality and safety as central to the NHS.
'It’s not safe nor sustainable for GPs to see patients with complex multiple morbidity in ten minutes, many of whom will be on over 10 different medications, and with heightened risk of medical error. It’s not safe for GPs to have up to 70 patient contacts daily in the style of a conveyor belt, and on top of that plough through hundreds of clinic letters, pathology results and reams of repeat prescriptions.
'It’s not safe for GPs to be examining patients while simultaneously having to take urgent calls from hospitals, district nurses and social workers, and also be called for an emergency home visit at the same time. It is not safe for practices struggling with unfilled vacancies to be forced to carry on registering patients when they haven’t the doctors or nurses.
'And it’s not safe to fuel the political hyperbole of routine seven days services, taking GPs away from ill elderly housebound patients in greater need. To put it simply, it is not safe to carry on the way we are, and which is why this conference is highlighting that general practice is quite literally in a state of emergency.'
The GPC chairman said GPs now deal with 370m consultations a year - an increase of 150,000 a day compared with seven years ago - while investment as a proportion of the total NHS budget has fallen from around 11% to less than 8%.
He demanded a workload cap for general practice, warning that 'it is not safe to carry on the way we are, and which is why this conference is highlighting that general practice is quite literally in a state of emergency'.
Citing findings from the huge BMA poll of practices into the impact of CQC inspections, Dr Nagpaul said: 'It’s tragic that GPs and practices live in a climate of fear, in which the CQC takes no account of your circumstances, and blames, names and shames you even if you’re running on empty with skeleton staff, or locked into inadequate premises not of your own choosing. Eight out of 10 practices said preparing for CQC inspections was 'very stressful' at a time of already rock bottom morale, and 80% of GPs stated they’re more likely to want to leave the profession as a result.'
Governemnt pledges to boost the GP workforce were 'an irrelevance' given its obliviousness to GP retention problems, he warned. 'The pronouncements of 5,000 extra GPs by 2020 is an irrelevance given the government’s total oblivion to the elephant in the room - which is retention. The government’s own commissioned GP worklife survey from the University of Manchester published just three months ago shows 38% of GPs intend to quit in the next five years, even higher than our own BMA statistics - that represents a loss of over 10,000 GPs that will wipe out any increase in recruitment,' he said.
Dr Nagpaul added: 'What we need to know is what the government is going to now do to enable 1m patients daily to receive a safe and sustainable GP service today.
'I’m constantly told by ministers that the greatest battle is getting money out of treasury. My message to the chancellor is to use his financial nouse- stop penny-pinching and be pound wise, grab yourself a bargain while there are GPs out there because once they're gone they’re gone.'
'Today marks the great fightback of UK general practice. I urge government to do the right thing for patients and equally the right thing for a GP workforce whose goodwill continues to be shamefully exploited. And to protect and nurture a discipline that’s not just the jewel in the NHS’s crown but a beacon of personalised continuity of care internationally. And to make 2016 the year in which we begin the revival of UK general practice so that we have a future generation of GPs to look after a future generation of patients.'