General practice is in crisis - with falling GP numbers, partners in decline, spiralling patient demand, low morale and potential industrial action on the horizon - and Dr Jameel also faces the challenge of forging relationships with a new health secretary and NHS England chief executive.
Given this challenging backdrop as she takes over at the helm of the BMA GP committee for England, what are some of the top priorities she will need to address?
Negotiate a genuine support package
Last month the government published its access plan and ‘support package’ for general practice. The package included a £250m ‘winter access fund’ - but doctors’ leaders said that what had been billed as a lifeline for GPs offered ‘very little’ in the way of support, and threatened to increase pressure on practices.
BMA analysis found that 19 of 29 measures in the plans failed to offer new support to practices - and the access plan brought punitive measures, with NHS organisations ordered to identify and intervene at up to one in five practices in their area offering the lowest proportion of appointments face-to-face. GPs also fear the publication of data that could lead to crude ‘naming and shaming’ over in-person care.
The GP committee has unanimously rejected the government plans - and has carried out an indicative ballot over forms of industrial action. The new chair now faces tough decisions over whether to press ahead with that action or perhaps using data on GPs’ willingness to take part in protests short of a strike as leverage to secure an improved support package.
Moves to reduce bureaucracy for GPs could prove deliverable - the BMA has called for another suspension of QOF targets and other steps to cut workload - but the government and NHS England offered limited measures on this front in the package published last month.
The union has also indicated in the past that it wants more support for a ‘struggling workforce’ who, it says, shouldn’t be pushed to the limits to get through winter. A public campaign supported by a major government figure to tackle abuse against GP staff is something else the BMA has previously requested - but while the government has said abuse against NHS staff is unacceptable, it also continues to push the message that patients should be able to see GPs however they choose.
Dr Jameel will have a high-profile opportunity shortly to spell out the pressure GPs are under and what is needed to turn the tide in an inquiry into the future of general practice led by the House of Commons health select committee.
Unify the profession
A motion listed for debate at the England LMCs conference on 25 November highlights concerns about ‘an apparent loss of connection between grassroots GPs and their elected representatives on GPC England’.
The motion calls for more transparency around ‘successes and failures’ of negotiation over contracts - suggests the possibility of bringing in ‘professional negotiators’ to replace part of the role played by the GP committee executive team, and demands access for grassroots GPs to the voting records of their representatives.
Alongside these concerns over a divide between the grassroots and the GP committee, there are also deep divisions within the committee itself. Earlier this year two long-standing members stood down from policy roles within the committee - warning they had ‘no confidence in the current GPC England leadership and no longer wish to be associated with it via these roles’.
Meanwhile, divisions are also clear over GPs’ role in structures such as primary care networks (PCNs) - which have been welcomed in some areas for bringing practices together and delivering new staff, but continue to attract criticism over the workload involved, and are labelled in a motion up for debate at the LMCs conference as a ‘Trojan Horse’ that threatens the future of the independent contractor model of general practice (see more below).
Building trust with grassroots GPs and bringing the committee together as much as possible will be a vital task for Dr Jameel.
Future of the GP contract
The five-year contract deal that began from 2019 came with guaranteed funding increases each year - but GP leaders have been saying for some time that the deal must be revisited. Funding rises programmed into the deal fell short of the 3% pay award for the wider NHS workforce for 2021/22 - leaving practices with a hole in their finances.
The original package, while significant, came with investment below the level GP leaders had demanded - and since then the COVID-19 pandemic has redrawn the landscape - driving up pressure on a workforce that was already overstretched, underfunded and supporting an ageing, increasingly complex population of growing size.
Numbers of GP partners remain in freefall - the number of full-time equivalent partners has dropped by nearly a fifth over the past four years - and this rapid decline must be slowed or stopped if the independent contractor model is to have a future.
Vast sums of funding for primary care available through PCNs as part of the five-year contract have not benefited practices everywhere and risk being lost to general practice in many areas - and there are calls for more of that funding to come into the core contract to support all practices.
LMCs in England are also discussing calls for alternative approaches - a return to something more like the pre-2004 system of item of service payments to try to make sure funding reflects rising workload is among ideas mooted.
Clarify position on PCNs
One of the standout motions heading into this year’s England LMC conference surrounds PCNs. These networks were supposed to ‘help to solve the workforce shortage in general practice’ and are the vehicle for delivering hundreds of millions of pounds in funding to primary care.
However, not all GPs are sold on the idea, with many highlighting the huge workload that has come to be associated with PCNs - particularly surrounding the recruitment of allied healthcare staff. GPs leading networks have said that this is taking away from precious clinical time, while GPonline has reported on multi-million pound underspends within additional roles reimbursement scheme (ARRS) budgets.
Some LMCs fear PCNs threaten GPs’ status as independent contractors, and believe the PCN DES should not be extended beyond the end of the five-year GP contract - while withdrawal from the networks is among forms of industrial action on the table for general practice.
Others have praised the model and pointed out its benefits. Some GPs have said that extra staff brought in through the ARRS have been influential in helping patients during the pandemic, taking workload off of GPs and other members of the primary care team. PCNs have also been the fulcrum around which practice teams have collaborated to deliver a hugely successful COVID-19 vaccination campaign - and where the model has worked well, GPs would be resistant to it being stripped away.
With general practice split over their advantages, Dr Jameel will need to balance carefully how the GP committee approaches PCNs in the remaining half of the network contract DES. The BMA has already hinted that it is alarmed at large amounts of funding being lost to general practice through ARRS underspends - and has stressed that successful recruitment is the key to the success of PCNs. The new chair’s thinking could be swayed by LMC conference debates and the union’s ballot on industrial action.
Implementing Romney review advice
In 2019, GPonline published stories that exposed a sexist culture within the BMA as women within its GP committee spoke out about their experiences - triggering the landmark Romney review. The review’s findings echoed behaviours reported by this website - with women on the committee facing bullying, belittling and sexist comments, and sexual harassment.
The BMA says it has ‘worked hard to implement the recommendations of the Romney review’ through training for staff and elected members, a mentoring programme, an independent 24-hour helpline and a new independent complaint investigation process.
However, doctors have yet to come forward and take responsibility for subjecting colleagues to unacceptable behaviour - suggesting some of those responsible for the cultural problems within the BMA may still be there.
When GPonline published stories uncovering BMA sexism, Dr Jameel said it was ‘unacceptable’ that individuals within the GP committee had ‘failed to live up to the high standards’ expected of them - and warned it was ‘imperative that all doctors, staff and representatives feel respected and welcome within the BMA, regardless of gender, age, sexuality or race’.