Friday, December 20, 2013
Thursday, October 24, 2013
Wednesday, September 25, 2013
Monday, July 22, 2013
Monday, June 24, 2013
Friday, May 24, 2013
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
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.
Thursday, April 25, 2013
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
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,
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
It isn't bloody rocket science.
Friday, April 19, 2013
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.
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 tinyurl.com/cuea2rg, as I was under the impression much of the conversation was confidential. Perhaps I should be less discrete...
Wednesday, April 03, 2013
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: http://bma.org.uk/practical-support-at-work/contracts/gp-contract-survival-guideThis 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
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
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
BMA.org.uk/working-for-change/negotiating-for-the-profession/general-practitioners-committee/contract-negotiations The BMA are running a survey until 13 February to gauge opinion from the profession. It can be found at http://www.demographix.com/surveys/6VQM-4EGE/72LVTJPV/
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 www.thebrownstuff.blogspot.com 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