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....