The most important word any resilient GP needs to learn is how to say “No”. Our profession is well paid, and the argument is not about pay. The conditions of work, the restriction of choices, and the shape of the job have become so onerous that many feel like zombies. In a national incident such as a train crash the Drs need to ensure they are safe before treating the victims. They need to secure the site. They need to make decisions which perhaps amputate on site, or allow some victims pain killers only, whilst others are saved. The train crash which the UK health services are now having is similar. As Clare Gerada is correct; “we have to look after ourselves first”.
GP leaders at next month’s LMCs conference will discuss whether the NHS can survive chronic underfunding, whether GP contractor status has ‘reached the end of the road, and whether industrial action should be back on the table to defend the profession.
The conference in Edinburgh on 18-19 May could also discuss whether deceased GPs could be resurrected to ease the GP workforce crisis, and call for health secretary Jeremy Hunt to be sacked ‘for presiding over the worst time in the history of the NHS, missing targets, longer waiting lists and low morale’.
Pressure looks to be growing from the profession for a wide-ranging overhaul of GP funding, with LMCs set to warn that overall funding is too low, and that distribution through the Carr-Hill formula and other contract mechanisms is unfair.
Motions put forward by LMCs warn that no funding mechanism will deliver fair funding for GP practices until overall funding is increased. The GPC warned earlier this year that despite pledges to raise funding through NHS England’s GP Forward View, the profession remains underfunded by billions of pounds.
But LMCs will question whether the existing funding formula gets the balance right between different priorities, with a motion put forward by Glasgow LMC warning that ‘careful consideration has to be given to the balance of the funding formula between deprived patients, remote and rural patients, elderly patients and those patients not in any of these groups who may face their funding being eroded’.
GP leaders will also call for a list of core GP services to be defined – a step the GPC has long opposed – in part to maintain services as new care models take shape across the NHS. The GPC has consistently argued that it is simpler to define non-core work, for example using its Urgent Prescription document to list services that practices should receive additional funding for.
The conference will also hit out at the rising cost of indemnity, warning that increased fees are driving GPs out of the profession. LMCs will argue for greater transparency from medico-legal organisations about risk criteria that can lead to sharp rises for individual GPs.
GPs will also warn that contract uplifts have not covered rising indemnity costs in full, and that direct reimbursement of costs would be a better option for practices than payments based on list size.
Plans to improve communication with sessional GPs, with a proposal for a ‘national communications strategy to secure adequate communication of guidelines and patient safety communications to locums’ will also be discussed at the conference.
Broader ‘themed debates’ at the conference will discuss issues such as NHS rationing, independent contractor status, working at scale and workload.
One debate will look at whether the NHS can survive given overall underfunding, and whether co-payments for services should be considered. Another will consider whether independent contractor status has reached the end of the road and how it could be protected.
Further debates will look at whether GPs should remain within the NHS – in Northern Ireland GPs have suggested they will quit the NHS en masse if two thirds of practices hand in resignations – and whether there is ‘still a need to consider appropriate forms of action, and would this be effective or counter-productive’.
Another debate will encourage GPs to discuss whether the QOF has reached the end of its useful life – as NHS England chief executive Simon Stevens has suggested.
A motion put forward by Shropshire LMC, meanwhile, suggests ‘the urgent funding of a bioengineering program designed to immediately triple-clone all UK GPs, including the recently retired, in order to facilitate our prime minister’s glorious vision of a truly 24/7 health service’.
It adds: ‘The project should ideally extend to exploration of the resurrection of deceased general practitioners, though conference acknowledges that some health consumers might find zombie GPs unpalatable at first (assuming they even notice the difference.) However, we believe that public fears about human cloning and the walking dead could be swiftly allayed by the persuasive powers of the undisputedly veracious Mr Jeremy Hunt.’
Isabella Laws on 2nd May reports Clare Gerada: GPs’ first priority must be their own health, warns former RCGP chair – GPs must put maintaining their own health above caring for patients and running their practices, former RCGP chair Dr Clare Gerada has warned.
It’s the shape of the GP’s job that needs to change. The pharmacist will see you now: overstretched GPs get help…The fundamental ideology of the Health Services’ provision. Funding of this type admits 30 years’ manpower planning failure
NHS ‘is like a train just before a crash’ (and it is now happennin g in slow motion)