Friday, December 20, 2013

GPC report 19 Dec 2013

GPC Report
For East and West Sussex LMCs
Dr Russell Brown

19 December 2013

The GPC held its last meeting of the year today.  

A packed audience witnessed a gripping debate about the minutiae of the Standing Orders at the opening of the meeting.  I was particularly impressed by one members prolific use of commas, parentheses and indeed subclauses, not only within one sentence but in one breath.  Remarkable. 

Thankfully, the meeting then moved to subjects of more relevance to my constituents.  After the contract announcement of last month, where Julius Parker wrote from the LMC office, there was a report as to how work is progressing on the implementation of the changes.  Much work remains to do.  Of particular interest to PMS practices is the news that NHS England has written to Area Teams to inform them that they should pay PMS practices for locum superannuation costs, backdated to April.  It is unfortunate that NHS England has taken nine months to discover that what we were telling them all along, namely that no PMS practice already had this money in their baseline budgets, was correct. With regard to the Equitable funding arrangements that were part of the current year's contract imposition, there may be news imminently on how is is to work for PMS practices.  It should be noted that vigorous discussions are still on going.

The reprehensible and one might say irresponsible media management of CQC last week will no doubt have filled you all with disgust, as it did me.  Apparently a stern letter is to be sent to Prof Steve Field with a meeting afterwards, by both Chaand Nagpaul and Mark Porter.  There was much disappointment and criticism of the lack of an open letter to Prof Field.  It appears that some in the BMA felt it needed tweaking, until such time as it was no longer appropriate to send an open letter.  The Chairman was left in no doubt as to the feelings if the committee on the unacceptable delays to a letter.  Nevertheless, it is being made clear to CQC that such incompetent press releases are not acceptable in future.

A presentation on the work of the BMA's EU policy Manager was given, explaining why it is important for the BMA to lobby in Brussels.  Essentially this is so that we can influence the drafting of EU law, which has a direct bearing on UK law.  After that, we heard about a European professional card, initially designed to be used by mountain guides, plumbers and similar professionals.  There are moves to have it used across the EU by GPs, though training and experience is not equivalent across the EU.  This is being resisted.  Finally, there are moves afoot to get General Practice in the UK, Italy and Austria recognised as a speciality, as it is in much of the rest of the EU.  This requires a ⅔ majority vote in the European Parliament and so will remain a work in progress for some time to come I suspect.

The tariff concept to fund general practice training was discussed.  There are moves afoot to pilot a change in funding arrangements for both undergraduate and postgraduate training.  Various meetings are taking place and reality is being described to those whose plans include charging practices to train.  I predict wholesale withdrawal if that ever happens...

Breakout groups were held during the day to discuss the effectiveness and way of working of GPC, including a discussion of the continuing appropriateness of the negotiating body in its current form.  I suspect there will be changes, but not soon.  When definite plans are made, I will report back.
The next meeting is to be held on 16 January 2014.  I hope you have found this report helpful.  Please feedback so that I can ensure my reports are useful.  Feel free to email me on if you would like to comment or ask me anything.  Comments can also be posted on my blog where this report will also be posted at

And so, finally, I wish you all a Merry Christmas and a prosperous New Year.

Dr Russell Brown

Thursday, October 24, 2013

CSD and GPC reports from 17 October 2013

Sorry for the lateness, I was hoping to have more news on negotiations by now.  Documents replicated below.

CSD Report
For East and West Sussex LMCs
Dr Russell Brown

17 October 2013

The subcommittees of GPC meet three times a year and each have their own email listserver to facilitate discussions.  I was recently elected by the committee to be its Deputy Chair, another step on my progress to a life peerage*.  Information about the roles and functions of the various subcommittees can be found on the new and improved GPC pages of the BMA website at

After considering the committee's business plan, based in large part on relevant Motions from both LMC Conference and BMA ARM, we briefly discussed BMA guidance on Ethical Procurement.

Subsequently we began to discuss new models of service provision.  GPC guidance on collaboration and federation will be coming out soon.  It is a good paper.  However, we agreed that it should be one part of a toolkit and that practices wold need more information on other elements of survival as well.  This is a work in progress but one we hope to prioritise. There are already models in use in various parts of the country, including Birmingham and Hertfordshire.  It is my view that practices will to consider the future with some urgency and begin to plan now for 3-5 years time.

We were joined by Chaand Nagpaul mid morning and discussion turned to the state or negotiations.  I have written as much as I am able in my GPC report on this matter.  The morning's discussions in CSD helped inform the discussion at GPC in the afternoon.

The next meeting is to be held on 14 November.  If LMC members or other constituent GPs would like to raise matters for discussion, please contact me or the LMC office.

I hope you have found this report helpful.  Please feedback so that I can ensure my reports are useful.  Feel free to email me if you would like to comment or ask me anything.  Comments can also be posted on my blog where this report will also be posted at

Dr Russell Brown

*For the absence of doubt, this is a joke.

GPC Report
For East and West Sussex LMCs
Dr Russell Brown

17 October 2013

The GPC held its meeting on 17 October.   This months meeting was in two parts, with the morning being devoted to subcommittee meetings.  Of the three GPC members in the federation of SSLMCs, Julius Parker is the Deputy Chair of Contracts and Regulations, Richard Van Mallaerts is on Clinical and Prescribing and I am Deputy Chair of Commissioning and Service Development. Each of us will be writing short, separate reports on our subcommittee meetings which will be circulated by the office in due course to all the LMCs in the federation.

The afternoon session was dominated by discussions about the state and progress of the negotiating process.  As ever, faces were grim, as we are faced by a government who seem to not wish to understand General Practice and how vital and efficient we are.  Negotiations are at a delicate stage and there may be more news next week that I can share.  At present, GPC is engaged in discussion to help formulate a plan at the suggestion of Jeremy Hunt to both help him and protect us.  Whether anything positive will come of it remains to be seen. If agreement can be reached there is potential for gains on both sides.  If agreement cannot be reached, the government have form on how they behave.

An update on Comms revealed a significant improvement to the GP part of the BMA website with a presentation by the web development team.  You will note the absence of my customary "h" from the words "BMA website".  It is still a work in progress and search for example needs more development but colleagues can view the "new" site at It certainly seems more easy to find relevant information.  A comms group is in existence in electronic form and this is being formalised to try and get communications to be more proactive.  With any luck, we will soon be in a position of leading news rather than reacting days after everyone else.  BMA processes are often glacial in their progress and this work is an effort to make GPC specifically more responsive to events.  A separate update on media work (related to but separate from the comms work) was postponed until November after the afternoon was interrupted by a fire alarm for the best part of an hour.  An investigation into whether Mr Hunt has cameras in the BMA Council chamber is underway, as the timing was interesting.

An update on the ethnicity bias in the CSA was given.  Colleagues will have seen reports of the issue in the national media, with a defensive RCGP and GMC.  A judicial review of the processes is underway.

The next meeting is to be held on 14 November.  If LMC members or other constituent GPs would like to raise matters for discussion, please contact me or the LMC office.

I hope you have found this report helpful.  Please feedback so that I can ensure my reports are useful.  Feel free to email me if you would like to comment or ask me anything.  Comments can also be posted on my blog where this report will also be posted at

Dr Russell Brown

Wednesday, September 25, 2013

GPC report 19 September 2013

GPC Report
For East and West Sussex LMCs
Dr Russell Brown

19 September 2013

The GPC held its meeting on 19 September. The official summary of the meeting is contained within GPC News 2, which can be found at (points to a pdf).  This month’s version is only 8 pages long.  It includes information not discussed at the meeting which it may be helpful for the profession and LMCs to be aware of.  This month’s report is very short as much time was spent discussing and developing the negotiating position.

Prior to the meeting, the results of elections to the various subcommittees were released to committee members by email.  Of the GPC reps from our LMC Confederation, Julius Parker was elected to the Contracts and Regulation Sub-committee (and indeed was elected as that group’s Deputy Chairman), Richard Van Mellaerts was elected to the Clinical and Prescribing Sub-committee and I was elected to the Commissioning and Services Development Sub-committee.  I am waiting to see whether CSD considers me the best candidate (of two) to act as Deputy Chair.

After a short meeting to elect 3 new directors for the General Practitioners Defence Fund, often erroneously labelled as the GPC war chest, the meeting proper began with a confidential report from the negotiating team.  Negotiations are beginning and it is hoped that a co-operative and communicative approach will be employed by NHS Employers.  At this stage it would be inappropriate for me to publish any details of the negotiations but I can say that the GPC is actively considering options and approaches. 

Colleagues have probably seen details of the Contract Imposition Survey undertaken by GPC after the profession was emailed by Chaand Nagpaul.  The results were disappointingly predictable but also tremendously helpful in bolstering the position of our negotiating team.  In brief, we are overworked and have little or no capacity to do more, coupled with an expectation of diminishing resources.

The NHS England Call to action, a bid to “improve” General Practice, focuses on encouraging local discussions and feedback.  I feel this is telling and am concerned by an apparent wish to see swingeing changes and introduce more competition into an area of the NHS which is efficient and well regarded.  The consultation closes on 10 November and details can be found at  I would encourage you to consider responding.

The matter of the poor pass rate of the CSA by international medical graduates was discussed, following a leaked draft version of a report for the GMC made its way round the internet.  When it is eventually published, the Trainees Sub-committee will be taking the lead for GPC.

The next meeting is to be held on 17 October.  If LMC members or other constituent GPs would like to raise matters for discussion, please contact me or the LMC office.

I hope you have found this report helpful.  Please feedback so that I can ensure my reports are useful.  

Dr Russell Brown

Monday, July 22, 2013

GPC Report 18 July 2013

GPC Report
For East and West Sussex LMCs
Dr Russell Brown

18 July 2013

The GPC held its meeting on 18 July. 

An exciting morning was had, with elections for a new Chairman (Chaand Nagpaul) and for three negotiator posts (Richard Vautrey, Beth McCarron-Nash and Peter Holden). With the election of Charlotte Jones to the position of Chair of GPC Wales, our negotiating body is 25% female.  There is significant challenge ahead.  All were elected on the promise of change. We will see but in my view we have a good team to move forward with.

Negotiations may start soon, with some clarity developing as the mandate of NHSE matures.  There is little I can report as yet as far as negotiations are concerned but there have been meetings about some of the many problems encountered in the new world of the NHS, such as payment irregularities, money for appraisals and IT.  NHSE have apparently gone away to consider how to resolve the issues.  I am not expecting rapid resolution on a national level.

By the time I publish this report, a position paper on Out of Hours provision will be in the public domain.  I have asked the LMC office to send a copy with this report. No doubt it will be somewhere on the BMA website. Good luck finding it. 

UEMO, the European Union of medical organisations, wishes to see general practice (or Family Medicine as it is called in some countries) recognised across Europe as a speciality in it's own right. As you might expect, GPC supports this and will try and facilitate the process. 

There has been further work on the Future of General Practice.  A document should be forthcoming soon, likely in the form of a position statement.  More when I have it.

There was discussion around the recently reported consultations about eligibility for access to NHS services for immigrant populations of one sort or another.  The consultation documents make suggestions which are unworkable and LMC conference policy is that we will NOT become de facto agents for the Borders Agency.  Many of the suggestions are not only unworkable but would cost more than they would save (given reliable figures suggest that this costs the NHS about £6M per year, not the £200M Hunt has been spouting) and are probably unethical and contravene Human Rights legislation to boot.  Still, makes for a good soundbite. 

Monitor are examining General Practice, overtly asking where current commissioning arrangements work against the interests of patients, which is double-speak for "how can we introduce competition?"  This is a very worrying piece of work and will be responded to robustly by the BMA. GPC has been the main player in composing the response which will be published soon.  

A presentation by the Association of Medical Research Charities went on rather, as they are keen to enthuse GPs and get them engaged in research.  Which is all very well, but when we are all overloaded already and they failed to address the issue of how is that time funded, I am not sure there is an easy answer.  The obvious solution is to invest more in General Practice, perhaps by generating an extra 22,000 whole-time equivalent GPs, so we can resource to time needed to engage. There was no disagreement with the position that research is important but no obvious, realistic way forward.  The matter will be examined by the Clinical and Prescribing subcommittee in due course.

The subcommittees will be elected electronically in the next month or so.  I am standing again for the Commissioning and Service Development Subcommittee. Fingers crossed, eight spaces, a least a dozen candidates....

For further news, colleagues can access the most recent GPC News on the BMA website.  For some reason it is under "About the BMA" rather than clearly signposted.  A direct link to this month's offering is at  It may interest you to know that there is a work stream on improving communications going on within GPC separate from BMA. Watch this space...

I hope you have found this report useful.  Please feedback so that I can ensure my reports are useful. 

Dr Russell Brown

Monday, June 24, 2013

GPC report 20 June 2013

GPC Report
For East and West Sussex LMCs
Dr Russell Brown

20 June2013

The GPC held its meeting on 20 June.  Given my previous reports seem to have been superseded fairly rapidly by GPC News, rather than be indiscreet, I have waited until this month’s edition is available.  It is lengthy, and though I avoided somnolence for the majority of the session, it contains much that I have no recollection of discussing during the meeting.  Of course, it is also an opportunity for the GPC Secretariat to publish information which has arisen since the previous GPC meeting for LMCs.  It is available for downloading, should you wish to read it, at the bottom of the page here:

The morning session was devoted to various subcommittee meetings.  I currently sit on the Commissioning and Services Development subcommittee, which has a wide remit.  Various matters were considered, including some draft BMA responses to consultations Monitor are running and consideration of those motions from LMC Conference which would fall under the remit of the subcommittee.  Of particular interest to me was a report about a roundtable event held by GPC to engage with GPs who are board members of their Clinical Commissioning Groups.  As a forum for sharing of ideas between those running our CCGs and those representing us as providers, this seems to be a Good Thing.  More events are planned and I would encourage colleagues with such Commissioning roles to consider engaging in the future.

After a brief lunch, the main meeting started.  Laurence Buckman was Chairing his final meeting.  He advised he will be returning to full-time practice, but will remain as an ex-officio member of the GPC for the next year.  After a long discussion about electoral processes, it became clear that, should the standing orders which state how elections take place need changing, it would have to be after the elections coming up next month!

There are currently no negotiations taking place regarding next year.  As yet, NHS Employers have not been given a mandate by the Department of Health to negotiate on its behalf.  Hopefully this will change soon and thus allowing some kind of discussion to begin.

Future of General Practice
A major item discussed was the Future of General Practice.  Work and discussions are ongoing to develop a vision of what we may wish to see in the future.  It is too early to report any details, but any thoughts you may have would be welcomed.

A lengthy and detailed debate on the thorny issue of Out Of Hours care was had.  This followed a lengthy and detailed debate on the GPC listserver.  I contributed to both, emphasising the wishes expressed both in the local survey so many of you were kind enough to complete (512 of you in the end) and by LMC Conference.  Consideration is being given to what will happen next.  This does not imply navel-gazing.  I suspect I will have news for you quite soon but at the moment this is genuinely one of those occasions when I have no wish to potentially compromise our negotiating position, especially given the ongoing pressure on services in-hours.

The Monitor consultations were discussed again in the afternoon.  Regarding walk-in centres, it is important to consider that the review is about the CLOSURE of some or all of them and NOT the procurement.  The procurement was a politically-driven centralist process.  My own view is that the closing of centres should be considered according to local circumstances - there never was a one-size-fits-all solution to the “problem” (that wasn’t, in many areas) and it would be unwise to follow the same blanket approach to closure.
A brief update on appraisal and revalidation was delivered.  Particularly invidious is the policy of ceasing payments to locum GPs for their appraisals.  It is illogical to inflict this on locums as a group, given the time for preparation and the appraisal itself means time not working and thus loss of income.

The issue of communications was discussed.  There is already some patient facing information on the pressures facing General Practice at  Discussions and work are ongoing as to next steps in a comms strategy.

Standing Orders for GPC mandate that the meeting cannot run past 1800, which is when we finished.  I then managed a new personal best, getting from the Council Chamber in BMA House to a train at Victoria inside of 16 minutes.  Sharp elbows.

This was the last meeting of the current session.  Next month’s meeting will see the election of a new Chairman and several negotiators, as well as elections to the subcommittees again, including elections of Chairmen of five of the subcommittees.  I am aware of several candidates for the negotiators’ election already.  I suspect there will be a fierce contest.

I hope you have found this report useful.  Please feedback so that I can ensure my reports are useful.

Dr Russell Brown

Friday, May 24, 2013

LMC Conference 2013 - Day 2

Here is a brief summary of my version of events. As yesterday, its intended audience is my constituent GPs in Sussex and it is not intended to be a detailed account of proceedings.


An hour of networking again to start with resulted in a read-through of the Hunt speech - which says not very much at all. Even the announcement of a Chief Inspector fails to be specific. This could be an opportunity for us to seize the initiative and put forward our vision of General Practice. There is a work stream going on at GPC but it would be most useful to hear from constituents if you have a wish list. I have one, but you may modify it! I hope to have news of sorts after June's GPC meeting.


Conference deplores the destabilising effect of MPIG changes, though the situation is complex. This is something that GPC is already keeping an eye on. Hopefully outliers who are heavily dependent on MPIG will be looked at by NHS England, which as far as I know does not include many or possibly any practices in the Confederation do SSLMCs. I understand the office is in the process of finding that info out.


A fairer funding formula is coming, Conference feels its introduction should be accelerated but made the point that any resources redirected from practices must stay within the envelope of GP funding. The cost effective nature of General Practice was emphasised, a Motion very popular with Conference. The Governments persistent failure to walk the walk and fund General Practice such that we can deliver everything they wish us to, which we could (though not "us" but we could organise it), is persistently and consistently disappointing.


A UK-wide contract is the only way to ensure equity of health provision, a reiteration of past statements but now it is also Conference policy. This will be helpful in the future during negotiations, though it is already emphasised by our negotiators. However, given we essentially have four Departments of Health, each with slightly individual plans, is this sustainable? We will see, I hope it is.


A disappointing 10 minutes was allocated to the vexing issue of Premises and the transfer of leases etc to PropCo (more properly NHS Property Services Ltd). There was brief discussion about the effect on practices and Conference agreed that there is still much to be concerned about. Personally, I was disappointed there were no motions on General Practice premises INVESTMENT.


A proposal to tightly define core services was popular though ultimately lost and in my view core services are already adequately defined in our contracts. Defining specific things we do risks allowing more salami slicing and farming off of work to others. Have a look at your contract under Essential or Additional services, which will tell you what you must do. Anything else should be adequately resourced. On the other hand, the ability to place sanctions (fines in other words) on persistent DNAers was less popular and also lost (thank goodness). The are other ways to deal with this problem. Occupational health issues are of concern and Conference decided to push for more consistency.

A half hour session for Q&A for the negotiating team from the floor covered a wide range of issues. As I alluded to yesterday, there will be an election for the neg team in July. Whether this will result in a change of nuance remains to be seen.

On day 2 there is a half hour "Soapbox" session, where speakers can speak for 1 minute on any matter they like. The topics are always many and varied.

Motions about GPC are always fiery. Despite criticism of communications, which have and are improving, the only demand that was made was that GPC should have its own website. Much was made of the frankly bizarre situation of lack of female representation on GPC. It is difficult to know how this could change given that, arguably, the electoral processes are already on a merit basis. However the motion called for an examination of ways to change matters and was passed. Unfortunately, this work is already ongoing but is being led, inevitably, by the BMA and so is likely to result in changes around the time I am currently planning on retiring in 2030. I just wish more women would actually stand. Finally a motion was passed to set up a training program for younger doctors to facilitate the development of future medical politicians.

After lunch, we discovered one of our colleagues from K&R, Richard van Mallaerts, had been elected as a newbie to GPC from Conference. Having spoken to him at length in the last two days, he will be an asset to the whole profession, at least for the next 12 months...

IM&T issues which were raised included concerns abut the risks of online accessible medical records, data extraction from records and data sharing.

The is a bit of a gap in my awareness of proceedings in the period after IM&T as I was busy trying to figure out the best way to respond to the major debate items. This involved discussion with several colleagues from a variety of LMCs as well as some GPC colleagues. A strategy was agreed upon....

The Major Debate covering mainly the return of OOH was noisy but the message was clear: that our constituents do not want it back. The motion suggesting we take back responsibility fell, so existing policy stands: that we do not take it back. Another motion expressing no confidence in Jeremy Hunt, which in my view is pointless posturing that actually might make it difficult for our negotiating team to engage with the other side, was lost. The other motion in the major debate agreed that GPs are working so hard on guff that it is all getting in the way of "the patient's agenda", which passed.

The end of the second day is always slow, especially after an exciting major debate. I missed most of the last half hour as I was grabbed by Pulse regarding the survey I had sent out to constituents on the OOH issue.

Next year's conference is to be held in York I understand. Next GPC is on 20 June, so more from me then.

Thursday, May 23, 2013

LMC Conference 2013 - Day 1

This report is not a detailed report of the outcomes of the first day. As a GPC rep, I have no vote and so am not always in the auditorium for every motion. It is more of a narrative for my constituents in East and West Sussex.... Your LMC reps will not doubt report back in some detail in due course and of course the BMA and GPC will publish detailed information about Conference in the next few days.
Arriving slightly late because of problems on the underground, I discovered a lack of both wifi and phone signal. A quick petition to the Agenda committee got them to at least look in to it! Apparently the bandwidth available was inadequate. This will be considered in future years. I was not alone in being unhappy with this, especially given the other meeting going on in the afternoon at the King's Fund which we could not rapidly respond to as a result.
A less rousing than expected speech from Laurence Buckman, his last as GPC Chairman, met with a long standing ovation, to his obvious embarrassment. As a State of the Nation address, we are in a very difficult position. His speech this evening will probably be less politically correct and more humorous.
That so many GPs were speaking so critically of the direction of travel speaks volumes about the professions' feelings on what is happening to our NHS and General Practice. Motion after motion on the enormous problems with resources (reducing) and pressures (increasing) has been passed, many unanimously.
NHS111 needs an enquiry, independent and external, incorporating an examination of the use of the most inexperienced people for triage, contrary to all the evidence about effective triage. Revalidation and appraisal need consistency and a national approach. None of this is news but now it is Conference Policy.
The Primary Care Workforce issues were discussed at length, with so many wishing to speak that timing had to be restricted. The ongoing theme of lack of goodwill, feeling worn down and that enough is enough continued. My own perception is that calling on the Government to take measures is a bit like asking King Canute to put his wellies on. We need to be more proactive and come up with solutions rather than react to the latest mad idea. The problem is to get them to listen. Communication with members also needs to improve, a matter raised by more than one speaker. Recruitment is a major problem all over the country with low numbers of applicants.

That GPC and its negotiators have lost the faith of the profession is a matter which generated enormously strong feelings on both sides of the debate, though debate was short. A stern, indeed ill-tempered, rebuttal from Laurence Buckman swung the day, the Motion being lost comprehensively.
I spent some time after lunch networking with GPC and LMC colleagues before returning to the auditorium. It is both useful and pleasant to put faces to names and meet people who otherwise I may only interact with electronically. Sharing ideas is a useful way to influence opinion, or indeed be influenced.
GP education and training caused much interest, covering extending training, international medical graduates' difficulties attaining similar grades to UK-trained graduates. CQC is not an organisation we have much confidence in and OFSTED style ratings will be unhelpful.
The day was characterised by irritation, anger, frustration. There is an obvious feeling of dissatisfaction in how matters have been progressed or not, in what achievements have been made or not. It will be interesting to see what happens in July, when a new Chair of GPC and negotiating team are elected by GPC.
More tomorrow....

Thursday, April 25, 2013

Strain on A&E...

Just heard Hunt on Today program, trying very hard to back-pedal and say that it isn't actually GPs' fault that A&E can't cope with the extra 4 million visits per year but the previous governement for allowing us to opt out. And to put that 4 million extra consultations into context, UK GP see 300 million consulations per year. Yes, 2 whole orders of magnitude more...

Well, for one thing, my "part-time" week (read the comments on the Telegraph website) is already 47.5 hours, and that's without the extra I put in. For another, the reason I am tapping away on the computer is two-fold: most important is I'm keeping records so I can remember what happened to you years ago; but the way GP is resourced (NOT how I get paid but how the services in YOUR surgery are funded) means that if I don't tick an increasing number of boxes (many of which will do nothing to improve either your health or well-being), the resources don't come in to pay for the nurses, reception staff, equipment etc.

So rather than blame ME for poor OOH provision, fund the bloody service properly in the first place, rather than engage in a race to the bottom with cheapest wins the tender, set proper standards that must be adhered to. How about a national strategy, given it's the National Health Service? Rather than arms-length "oh that's the fault of local commissioners", who you haven't given the resources to in the first place. And make sure that A&E departments are empowered to tell people to go to the appropriate place rather than have to see and sort them (inadequately, which is not incidentally their fault).

It isn't bloody rocket science.

Friday, April 19, 2013

GPC report 18 April 2013

GPC Report

For East and West Sussex LMCs

Dr Russell Brown


18 April 2013


The GPC held its meeting on 18 March.


This months report will be brief as, for a change, much of the discussion was confidential.


Equitable funding, locum superannuation and PMS practices news

Discussions are ongoing. A letter to the profession has been sent by Laurence Buckman on 17 April and its contents are about all I can divulge on how the plans for equitable funding are likely to impact on PMS practices. Discussions about the new obligation on practices to pay locum superannuation are still ongoing but are no further forward at this time.


Additionally, there have been discussions about arrangements for collaborative fees and occupational health services for practice staff. But no news.



There will be an announcement shortly on a policy that is to be implemented very soon. You will have to wait for the announcement but expect some of previously aired concerns by LMC members to be addressed. It should also be noted that it will be an ongoing and developing piece of work, with involvement from the profession and patients being encouraged.



Work is continuing on nailing down the details for leases and the like. Legal advice is being taken by both sides in an effort to get an agreed and sensible model. However, it will still be necessary for practices to instruct their own advisors to ensure they will be well served by any lease arrangements.



I was asked to give an interview to BBC South East Today about NHS111 during this months meeting. Fortunately, I managed to get back to the meeting without missing much about NHS111. In brief, it is still a mess, the tendering process has demonstrably failed, response times are still unacceptable. What we need is a reintegration on the triage service with the face-to-face service. Will it happen? As we already know, there is a political imperative on this. I just hope no one gets hurt.


Commissioning update

There was an update on the recently published conflicts of interest guidance from NHS England, the Monitor document on fair playing fields and an oral update on engagement with the process the Labour Party is going through to try and determine its health policies.


A motion was proposed and passed in all parts. I reproduce it below:


That GPC believes that compulsory practice membership of CCGs with statutory duties as defined by the Health and Social Care Act:


1. risks placing GP partners in a position of untenable conflict between their professional obligations to their patients and the statutory obligations of their practices as CCG members;

2. fundamentally changes the role and nature of general practices, and, in view of recent regulatory changes, risks forcing them to be integral agents of state rationing, cost control and privatisation, seriously threatening the trust between GPs and their patients and therefore posing a risk to the very integrity of NHS general practice;


3. places significant obstacles in the way of GPs and practices acting in accordance with the recommendations of the Francis report as they will be under inevitable pressure to comply with their CCGs' statutory obligations to stay within budgets and to achieve financially and managerially-driven targets which conflict with the needs of their patients;


4. adds to competing pressures on general practice, particularly following the recent contract imposition, and GPC recognises that practices must and will prioritise providing safe essential services to their patients and are therefore very likely to consider limiting their engagement with their CCG and its activities to their contractual obligations;


5. leads it to call upon the BMA , local medical committees to robustly support doctors who are placing the interests of their patients as their first concern and who may be unable to comply with obligations placed upon them by the constitution of their CCG where there is evidence that patient safety may be compromised by the requirements of CCG policy.


Words mean what words say and I will not embellish them by attempting to interpret the beyond repeating them.


I understand there are similar motions going to the Conference of LMCs next month. The next GPC meeting is in June because of this. There will be a report from there as well though.


I hope you have found this helpful. As ever, feedback on my report is encouraged.


Dr Russell Brown


PS It is interesting to see how much more detail is contained in this month's GPC News, which will be on the BMA website soon at, as I was under the impression much of the conversation was confidential. Perhaps I should be less discrete...


Wednesday, April 03, 2013

Text of my GPC report 21 March 2013

GPC Report
For East and West Sussex LMCs
Dr Russell Brown
21 March 2013
The GPC held its meeting on 21 March. Much of the agenda and discussions were confidential,
unfortunately. We are now in the new world of CCGs and post-Francis, not that I expect either of
those to make any difference to the direction of travel.
Contract and QOF
Though I cannot report on discussions which took place, details of the imposition and DES
specifications are gradually becoming clearer. It is not pretty and I suspect that at least some
practices will consider carefully whether the new work is affordable. I suppose it may be that
some of the less attractive bits may be possible to do in collaboration with other practices.
Whether that is desirable is for practices to consider. There has already been much comment and
guidance on this so I will not add to it except by pointing to some of it: is a work in progress and will be added
to over time.
The Francis Report
This said nothing terribly unexpected. The BMA welcomed it in the main. I have some concerns
about how it may affect GPs. However, with the rollout of 111 steaming ahead in many places
despite concerns being expressed by many, it appears that HMG and DH are still considering how
to implement some of the suggestions made in the report.
The future of General Practice
Not a GPC piece of work, but a response to a request from the Labour Party to consider how
they should develop their policies on this matter in the future. I can see arguments about being
inside a tent, but I am uncomfortable with this. I am generally cynical about the motives of
Commissioning matters
An oral report from the negotiating team generated much discussion and, unusually, a motion
which was passed: "that GPC opposes and calls for the withdrawal of Statutory Instrument
2013/500." This referred to the competition concerns expressed elsewhere. Despite governmental
assurances, I suspect that CCGs will in effect have no choice but to tender services. If we can help
them see how and where they might avoid doing so I am sure they might be inclined to maintain
Work on premises cost directions is almost complete and there will be a common single set of
documents. The regulations themselves have been signed in to force in the last week. For the first
time there will be a uniform set of guidance notes, available by the end of April. One outstanding
area is the issue of waste of various types but I understand this will be resolved soon. Leases are
coming but still a work in progress.
NHS111 & NHSCB (now NHS England) Single Operating Model
Unfortunately I had to leave the meeting early so Julius will update us on theses items.
The next meeting is on 18 April. As ever, feedback on my report is encouraged.
Dr Russell Brown

Thursday, January 17, 2013

GPC report 17 Jan 2013

GPC Report
For East and West Sussex LMCs
Dr Russell Brown

17 January 2013

The GPC held its meeting on 17 January. The day was in two parts, the morning being GPC-proper, the afternoon being devoted to a strategy session with thought-provoking (no, really) external speakers held under Chatham House rules. I expect to be able to share some of the issues raised in the afternoon with you in the months to come but as it is still a work in progress, now is not the time.

Contract negotiations update:
All of the details that can be shared can be found on the BMA website at The BMA are running a survey until 13 February to gauge opinion from the profession. It can be found at
I urge you all to complete it before the deadline though it may be sensible to wait until you have attended the Negotiators Roadshow if you are unsure about the extent of the damage that is about to be inflicted on us. This is also true for our constituents and I would ask that you remind them about the survey repeatedly. The negotiators roadshow on Thursday, 31 January has been confirmed. This will be held in the Aurora hotel in Crawley though I am unsure which negotiator is attending. Julius maybe able to advise. This meeting technically covers Surrey and Sussex. As last month, I would encourage all of you to attend and I would ask that you encourage as many of our non-politically minded colleagues to attend as well. For those unable to attend, I understand that the intention is to webcast the Avon meeting which I believe is on 7 February. Either the LMC office or I will forward details of that when we have confirmation.

Public Sector Pensions update:
A useful presentation from Andy Blake, the head of the BMA Pensions department, updated the committee on where we are. The Bill is currently at the Lords Committee stage, about a month ahead of schedule. This implies a degree of "rush". The Government has conceded that the so-called "Henry VIII" clauses, allowing retrospective changes to Primary legislation using Secondary legislation, are inappropriate and has removed them from the Bill. This is good news though of course in a context of a dire inevitability.

GP workforce issues:
A paper was presented for discussion, to advise and inform strategy for dealing with and helping other bodies involved in issues such as workforce planning, a contradiction in terms as no one knows what the NHS will look like in five years, never mind fifteen to twenty. A learning point for me was that the UK has the lowest number of GPs per head of population of any European country. I already knew about the recent report showing we were also the most efficient in Europe. One can't help thinking those two facts must mean something significant.

The next GPC meeting is on Thursday, 21 February and I will be absent as I am on leave that day. Any feedback or questions are welcomed. I have also started publishing these reports at a blog I used to keep at so that people can get to it easily. I am not using the blog for anything else these days.

Dr Russell Brown.
GPC Rep East and West Sussex