THE conference of General Practitioners organised by the British Medical Association ( BMA) takes place this year at York today and tomorrow, 22nd and 23rd of May.
It is called ‘LMC (Local Medical Committee) Conference 2014 – General Practice facing the future.’
This annual conference always takes place a month before the Annual Representative Meeting of the entire BMA and focuses on issues affecting GPs.
At the centre of the conference is the battle over patient charges to see the doctor, which would represent a huge undermining of the NHS principle of care free at the point of use for all, funded by taxation.
Motion 27 calls for consideration of patient charges for GP services. The last part of this motion, from Wiltshire states ‘Conference calls on GPC to explore national charging for general practice services with the UK government.’
This motion has been timed for second place in the afternoon of the first day, directly following motion 26, which deplores the lack of funding for general practice and demands a greater share of NHS funding.
There is a great deal of feeling about this and Motion 26 is supported by 35 resolutions. These point out that with only around £70 per weighted patient per year provided by NHS England to GPs to provide essential and additional services, there is simply not enough money to sustain general practices.
They say funding has dropped from10% of NHS funding in 2003/4 to 7.4% now. Motion 27, calling for patient charges, could benefit therefore from the dismay that will be expressed over the drastic reductions in funding for general practice.
However there is certain to be a powerful movement from the floor to correctly pass 26 and defeat 27 as a motion that seeks to end the public provision of general practice and privatise it.
The incredible stress and burn-out now being experienced by GPs will become apparent at the outset of the morning, which starts with the theme of ‘Workload and patient safety’.
The first motion from Agenda Committee No. 8 states – ‘That conference warns of the unsustainable workload in general practice and;
(i) the consequent danger of collapse of services
(ii) the imminent risk of safety to patients
(iii) the threat to the health and welfare of GPs
(iv) demands that this is urgently recognised and resolved by the government.
The second motion of the morning from Wales, still worried about workload and trying to keep up with too many patients, asks GPC to define what areas of work can be relinquished to maintain safety!
The huge impact of the Health and Social Care Bill, is managed under the heading ‘Commissioning of Care’, in the third motion of the morning.
Motion 10 from the Agenda Committee avoids calling for the repeal of the Act, but calls the ‘Re-organisation of the NHS a shambles’ . . . and a ‘disorganised mess and instructs GPC to work to protect GPs from the problems it has caused.’
Motion 11 to be proposed by Nottinghamshire, is more strongly worded. That conference views with alarm proposals contained in NHS England’s interim response to the ‘call for action for general practice’ to make CCGs (CareCommissining Groups) co-commissioners of GP contracts and:
‘(i) believes that this will fatally damage relations between CCGs and their constituents
(ii) warns that this will undermine CCGs’ chances of success in other areas of commissioning
(iii) predicts this will undermine the credibility of CCGs (iv) asserts that conflicts of interests would be unacceptable (v) insists that GP core contracts should not be held by CCGs.’
This motion must be passed to call a halt to NHS England’s (NHSE’s) privatisation plans.
At the moment NHSE holds the contracts for primary care through its area teams, but has always stated its aim is to make CCGs (clinical commissioning groups) take over the commissioning and running of General practice.
Health Secretary Jeremy Hunt has committed himself to this change and the new head of NHSE, Simon Stevens has already started inviting CCGs to take on this job.
The fact is, the long term strategy of privatisation demands that local commissioning bodies both commission and provide primary care (and secondary and community care, as happens in the USA with the health maintenance organisations which also provide private insurance).
If motion 11 is not carried, then motion 12 is waiting to ambush conference.
Motion 12 from Merton & Wandsworth states ‘That conference believes that CCGs should commission general practice.’
In late morning, the distrust of GPs for the Care Quality Commission’s new inspections is expressed in Motion 16 which states ‘That conference deplores the CQCs plans for a simplistic rating systems for practices’ and calls amongst other things, for GPC to vehemently oppose them.
Supporting motions suggest that the £179m used to fund the CQC would be better spent on direct patient care rather than ‘a crude, not fit for purpose ratings system’.
Another issue that GPs feel very strongly about, is the government’s pressure to provide routine 8am to 8pm care 7 days a week. There are 22 resolutions underlying Motion 20 on this.
Motion 20 from the Agenda Committee rejects the concept of these lengthened hours, but says they can only be accepted if sufficient resources are provided.
The government has recently produced £50million for some pilot areas to try 8am to 8pm, 7 day working. Another very important issue is the removal of the Minimum Practice Income Guarantee (MPIG). The government plan to phase out MPIG over 7 years was reluctantly agreed to by GPC last year.
Only two weeks ago there was a mass meeting of GPs in Tower Hamlets over the threat of closure for 17 practices because of impending bankruptcy caused by reducing MPIG.
Motion 28 starts ‘That conference believes the loss of MPIG and PMS growth money will have a devastating impact on many practices’ and calls on GPC to negotiate specific funding for rural practices and those caring for especially vulnerable populations.
Further motions follow on the issues of pensions, pay and premises. Opposition is expressed to working to the age of 68 years and to the GPs pay cut.
Motion 32 on premises reads ‘That conference believes that the absence of a scheme by which new GP premises, for the 21st Century, can be cost effectively constructed where required, represents the biggest obstacle to improving the delivery of primary care.’ 24 resolutions support this motion.
The lack of government support for new premises for GP practices is definitely a massive impediment to the improvement of traditional primary care. The fact is that the government is in the process of breaking up traditional primary care, which they call ‘the corner shop model’.
So government money is only being used to change the model and help bring in much larger units of federated GPs, attractive to private sector management. The motions on ‘GP partnerships and federations’ hint in this direction.
Motion 35 from the Northern Ireland LMCs says ‘That conference calls on GPC to actively support the development of GP federations, and in particular to encourage the opportunity for every GP, whether partnered, salaried or sessional to be actively involved.’
An opposing motion follows and will only be put if 35 fails. From Mid Mersey, it says ‘That conference considers it neither necessary nor desirable for GPs to work in consortia’.
At 4 o’clock ‘The market/privatisation’ is discussed.
Motion 38 from Newcastle and North Tyneside says ‘That conference believes that the:
(i) government has accelerated the process of privatisation as increasing numbers of English NHS contracts since April 2013 are now delivered by private providers.
(ii) GPC should urgently publicise this privatisation to the public
(iii) GPC should campaign for the NHS in England to be provided by the public sector.
(iv) Devolved countries should be congratulated on their failure to reintroduce a market in health.
The rising use of zero hours contracts by employers is opposed in a motion from Sessional GPs. It says they do not offer security of tenure or any kind of leave. It condemns the indiscriminate use of such contracts.
Other motions condemn the unsatisfactory performance of primary care support services by shared business services’, saying it is not fit for purpose.
A motion condemns the General Medical Council as full of government appointed people, with no elected medical members, making it ‘another rent seeking government regulator’, and calls for the restoration of elections of doctors to make it democratic.
The second day sees a half hour open microphone session on Primary Care Workforce, including the recruitment crisis with ‘experienced GPs fleeing into retirement’, and ‘traditional British general practice an endangered species’. There are 50 motions in this bracket.
This is followed by a motion calling for GPC to negotiate for GPs to be paid through Payments by Results (PBR).
PBR was introduced into many aspects of hospital medicine from 2002-2005 replacing the block contract method of funding.
This dangerous motion calls for an activity-based contract with fee for item for service, rather than the capitation based funding system which pertains at present.
Further dissatisfaction is expressed in the next section ‘The future of general practice and the NHS.’ Agenda Committee motion 53, moved by Buckinghamshire, says: ‘That conference firmly believes that general practice is the solution to many of the current problems facing the NHS but general practice cannot achieve its full potential while being seriously damaged by:
‘(i) continuing disinvestment in general practice
‘(ii) the phasing out of MPIG financial support
‘(iii) the lack of premises investment
‘(iv) the rapid reduction in the number of GPs due to government policies.’
Motion 54 calls for the government to tell the public about rationing. In the afternoon in the section headed GP Education and Training, a particular worry is that no funding has been allocated for the new fourth year of training for GPs.
A huge amount of concern is expressed through 26 resolutions about the decision of government to extract patient data from GPs computers.
This is expressed in the first motion of the Information and management technology section. This welcomes the postponement of the government’s care.data plan to the Autumn.
It says that GPs have been put in a difficult position as they are supposed to protect patient confidentiality under the Data Protection Act, but now they must obey the demands of the Health and Social Care Act to allow their patient information to be put on a national database. It wants patients to give consent by opting in to this. It wants the information to only be used to improve healthcare delivery, and not sold for profit.
The logic of what the government has done, is expressed in the next motion 67, which states ‘That conference calls on the GPC to negotiate an end to GPs being custodians of a patient’s medical record now that GPs no longer have control over who accesses or uses it.’
It is clear that GPs are opposed to the government’s plans to use patients’ confidential data to further commercialise the NHS.
What is really required at the conference is an emergency motion that GPs and the BMA will seek an alliance with the TUC congress trade unions to take strike action, to restore proper funding to general practice and all aspects of NHS care, before the cuts and the market are allowed to destroy them.
Only the removal of this coalition government and its replacement with a workers government and socialist policies can protect our publicly provided NHS as a universal service.