GPCE report 20 May 2021

 GPCE Report

For East and West Sussex LMCs

Dr Russell Brown

20 May 2021

GPC England met remotely this week.  This was the first meeting after the recent LMC UK conference.

There were verbal reports from the Exec/Policy Leads, Sessionals and Trainees committees and a written report will be sent out to LMCs shortly after the meeting.  There was also a verbal report from Dr Rachel Ali, the GPC’s gender champion. She is assisting SSLMCs in our own development of a similar role for our federation of LMCs.

The main item for discussion was the emergency motion regarding the NHSE letter of last week about face to face appointments, seconded by our own Julius Parker which you may have seen reported in Pulse before the meeting, below:

GPC England is outraged by NHS England and NHS Improvement’s lack of understanding of the pressures facing General Practice and:  

1. Calls for formal BMA action by escalating concerns about NHS England’s apparent lack of knowledge of the applicable contracts and regulations relating to the delivery of General Practice services 
2. Seeks both senior explanation and public action from the Department of Health and Social Care in view of the unacceptable decision to publish letter BO497 on 13 May 2021 
3. Has no confidence in the Executive Directors of NHS England 
4. Calls upon the Chair of BMA U.K. Council to support the Chair of GPC England in demanding an urgent meeting with the Secretary of State for Health & Social Care, to discuss the spiralling crisis in General Practice 

v)   Calls for GPC England’s Executive to immediately cease all formal meetings with NHS England until a motion is brought back to GPC England by the Executive, requesting a vote on their recommendation that sufficient steps have been taken to restore the Committee’s confidence in the Executive Directors of NHS England, to justify the resumption of such meetings.

This is an issue I would describe as probably the most important vote I have contributed to in the time of my GPC service.  The anger in general practice from clinicians and non-clinicians alike has been palpable.  I am delighted to be able to report that the motion was passed in all its parts, with at least an overwhelming majority.  (There were two abstentions for iii and two votes against for v, with 55 GPC members being able to vote on this occasion, the stem and other parts were passed unanimously. It should be noted that voting is anonymous.)

Workload pressures were discussed after the themed debate at the recent LMC conference.  Next steps are being formulated but the new contractual obligation on CCGs and trusts in the NHS Standard contract to develop a meaningful primary-secondary care interface system is promising.

The issue of whether Sessional GPs should be represented as a separate branch of practice to the rest of GPs was discussed. It should be noted that sessional GPs now form the biggest group of GPs, with contractors being the minority.  

A Contract negotiations update was given.  Obviously, future discussions may be delayed after the passing of the motion in the morning session.  Ongoing support for COVID-related matters, an inadequately resourced obesity and overweight enhanced service and updates on the position on new PNC service specs and IIF indicators and an Access offer (the combination of extended hours and access) were discussed.  More details as things get fleshed out.

Issues for Dispensing practices were also discussed.  This includes a relatively small number of practices in Sussex than in other areas but dispensing services are vital to some communities and practices, especially those with a high rurality.  Meetings are being sought at a ministerial level to try and resolve some of the issues, which include reimbursement/EPS, the now defunct Falsified Medicines Directive, deductions after scripts were not signed by dispensers (especially at the start of the pandemic lockdown periods) and the Green agenda (in that the drug tariff will now be available online and not printed each month).

GPC has once again written to NHSE about the parlous Gender Identity Development Services commissioning arrangements or, more accurately, their lack. 

Finally, the recently motions passed at LMC Conference were discussed briefly in terms of how they will fit in to policy group work streams.

After GPC, I attended a meeting of the Representation Policy Group, where we discussed the sessionals branch of practice issue mentioned above,  a survey of LMCs, an update on the GPC UK review, multi member constituencies and standardising standing orders across the GPC committees.

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

Dr Russell Brown

GPC UK and GPC England report 18 March 2021

 

GPC UK and GPC England report

For East and West Sussex LMCs

Dr Russell Brown

 

18 March 2021

 

GPC met in 2 parts today. The morning session was GPC UK meeting in the afternoon session GPC England meeting. Technically, this was the last GPC UK meeting for this session of the BMA year. This would normally be until July but as the BMA ARM has been postponed until September, the session finishes then. However there will be no further GPC UK meetings between now and then. There are 2 more GPC England meetings in the current session.

 

At the time I write this report, we are in the closing hours of the election for the next 3 years of your GPC rep. I stood again and I was delighted that Dr Andrew Sikorski also stood. This is the first time I’ve had a contested election in a little over a decade so regardless of the result I would like to thank Dr Sikorski for sticking his head above the parapet alongside me.

 

GPC UK

 

There has been much work going on in the background between the GPC Executive and the policy leads. A lot of this is summarised in the latest GPC newsletter which is available on the BMA website at https://www.bma.org.uk/what-we-do/committees/general-practitioners-committee/general-practitioners-committee-uk-overview

 

There was a lengthy and complex item on the changes in the NHS pension scheme after the recent age discrimination decision by the courts against the government. Neither the LMC nor I are regulated financial advisors so any advice we give will be limited to speak to regulated independent financial advisor about your pension! However it would be fair to say that there is ongoing work both in terms of providing guidance to GPs and their accountants or financial advisors and in conversations with government about fairness and Equity with other members of the NHS pension scheme. There are likely to be several levels of support from the BMA, both for non-members and members though as you might expect members are likely to get an enhanced package of support. Given the complexity of GP pensions it may well be that there will be a need for extra expense for advice and at the moment I am not clear whether this will be something that the government pays for, the BMA pays for all that GPs will have to fund themselves. No doubt we will have more pensions information from the BMA in due course, some of it possibly even comprehensible.

 

A working group is being set up involving people within and without GPC to look at the future structure and function of the committee. This will involve a variety of people including some grass roots LMC members.

 

 

 

GPC England

 

The current GPC executive team were reappointed recently. This was advertised in several communications over recent months.

 

There has been significant ongoing meetings with NHSEI to discuss Covid related matters including the vaccination campaign, which has been remarkably successful. I think all of our colleagues involved in the provision of that service should be congratulated. Personally, I remain concerned about the sustainability of the scheme especially given that we are having to move back to something more resembling business as usual (though NHSEI are clear that “BAU” does not mean pre-pandemic BAU) in the next few weeks. For example there will be no protection for QOF this year. Remote reviews however will be an acceptable way to deliver this for most patients.

 

However the GMS contract deal has included minimal changes from April and there will be no further IIF indicators or additional PCN services introduced before October 2021.

 

Vaccination phase 2 planning is proceeding and by the time you read this PCNs will have had to decide whether to move ahead and vaccinate people in cohorts 10-12, the 18-49-year-olds. Colleagues choosing to do so will need to provide assurances to the CCG is that they can continue to deliver clinical services to patients including QOF.

 

There have been discussions about VAT on “services” and staff involved in PCN work. The executive team have written to ministers to see what mitigation on VAT obligations can be put in place, if any. There is still much uncertainty about a variety of issues around ARRS staff and the training needs for example and dialogue continues between the executive team and NHSEI.

 

Colleagues would have seen Julius’s recent communication about appraisals locally. National discussions about this continue.

 

CQC are considering restarting inspection of practices but have revised the position several times already. They appear to be concentrating currently practices who were previously graded as “inadequate” or “requires improvement”.

 

There was an update and discussion about the ICS white paper. It would be safe to say there is still a significant amount of uncertainty and BMA and GPC both continuing to work on making sure that GP representation is adequate and based around our statutory representative bodies, namely the local medical committee.

 

There was also discussion around shared parental leave which received broad support although there are some issues in the SFE. My feeling is that these should be addressed so that shared parental leave becomes the norm rather than a benefit.

 

The GP gender pay gap persists for several reasons. For salaried GPs the gap is 22.3% but even partners have a 7.7% gap. The committee discussed ways in which to develop a negotiating position to attempt to move things forward. Again, although the concept is simple working our way through it appears to be very complex. Again, a personal view is that I find it in comprehensible that anybody would treat colleagues differently based simply on their gender.

 

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

 

Dr Russell Brown

GPC UK report 1 October 2020

 GPC UK Report

For East and West Sussex LMCs

Dr Russell Brown

1 October 2020

The GPC met remotely this week.  I managed to actually attend this one, the previous two meetings being held while I was on leave.  I don’t think this was deliberate on the part of the GPC Executive team and would like to thank Julius for sharing his last two reports with Sussex GPs.

Much of the discussions were confidential unfortunately, so I can’t share many details. However the latest GPC newsletter is available from the GPC pages of the BMA website. There is usually an update every week or two.  Julius’s updates from the LMC office are also an excellent source of information and I would recommend you read them.

Colleagues will have seen the BMA/GPC proposal on urgent measures needed to support general practice but if you haven’t it is available at https://www.bma.org.uk/advice-and-support/covid-19/gp-practices/covid-19-general-practice-during-the-second-wave. You may be aware of the BMA GP COVID resource centre and toolkit but if not, it’s worth a look. 

At the time of writing, no apology has been received from Sir Simon Stevens about the outrageous letter sent by NHSEI on the 14^th September, telling us to go back to routine face to face work if patients wanted it, in direct contrast to the SOP published by (wait for it) NHSEI.  Apparently one is coming. Not altogether sure why it hasn’t been sent already to be honest.  

Much of the morning was taken up with reports from the five “national” GPCs in the UK, essentially on how the other four areas’ governments have supported GP much better than NHSEI. Plus ça change...

The afternoon saw a seminar on unconscious bias followed by policy group meetings.  I am on the Representation policy group.  We discussed: possible changes to changes to constituencies for GPC elections (moving to multi-member constituencies); the continued work of the Gender Balance task and finish group and the election of a Gender Diversity Champion; and a proposed altered branch of practice definition for GPC (so a committee member definition, or who would be eligible to stand for election to GPC).

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

Dr Russell Brown

GPC report 6 Feb 2020

GPC England Report

For East and West Sussex LMCs

Dr Russell Brown

6 February 2020

The GPC England met again this week.  I managed to actually attend in person, a fact which took many of my fellow committee members by surprise.  More than one asked “Who are you, are you new?”

This meeting was an extra meeting to discuss contract negotiations, after we voted to reject the offer at the previous meeting in January.  There were no other items for discussion.  No doubt you will already have seen the official press release from the GPC executive.  The deal on offer was definitively the final result of negotiations, with the deal having been signed off by all government departments including the Prime Minister’s office before coming to GPC.  This differs significantly to “business as usual” in these matters.

 The most recent offer is a significant improvement on the previous iteration.  It would be fair to say that NHSEI took the feedback they sought and received before Christmas very seriously. 

I think that this offer is the best deal that could have been negotiated at this time.

There are some QOF changes, which increase the amount of resourcing in QOF, with an extra 8 points, as well as an increase in the pounds per point as well as a 4% increase in global sum.

Funding has been retained in global sum for vaccinations and immunisation but there will be an additional item of service element to this service.  Details are in the official GPC information.

Service Specifcations: That said, there are still issues and concerns with it and much will depend on the details in the guidance support in the service specifications, which is still to be agreed and written.  The service specifications have been significantly reduced in detail, with all targets removed.  

Additional Roles Reimbursement Scheme: Some of the benefits include a change from 70% to 100% reimbursement for the new staff recruited under the  ARRS.  While I suspect the word “savings” will be used, this is still a significantly reduced expenditure for practices.   Additionally, the number of people recruited to these roles is now up to 27000, from 20000.  And not only that but these staff will continue to be funded beyond the end of the current contract term, so after 2023/24.  There will be a requirement for CCGs to assist with recruitment to these positions.

Other agreements reached: There are measures which actively support partnership as a means to deliver general practice, especially the £20000 Partnership Accession Payment for new partners.  Whereas before there was a limited pot of money for this, this restriction has been removed, so no matter how many more partners can be recruited,  ALL of them will be eligible for this scheme.  It should be noted that GPC exec and NHSEI are still discussing the full details of the eligibility criteria for this scheme.  There will be further work on the occupational health services available to practices and PCNs, as well as arrangements for Enhanced Shared Parental Leave for salaried GPs as soon as possible.  There will be amendments to the NHS pension scheme to ensure PCNs are covered.  There will also be a new and transparent measure of patient experience of access to general practice piloted, for nationwide introduction by April 2021.

It is worth noting that the involvement of LMCs, for once, appears throughout the documentation.

So what does this mean for practices?

Practices can choose to sign up to the DES or not.  

If they do, they will have access to the benefits described above, with the additional funding described.  For that, there will be more work, even though the PCNs should be recruiting these staff to do much of it.  It is unclear to me currently how CQC for example will view these new staff and their relationships to practices (as this is of course a DES).  These new team members will need to be managed, supported and supervised, to varying degrees.

If they do not, they will not have to partake with this extra work, though there will remain a contractual obligation to engage with the activities of a PCN, in terms of data sharing at the very least.  Global sum will still go up, though overall funding increases will be lower than for practices that sign up to the DES.

GPC England were asked to vote on whether to agree the package on offer for 2020/2021 and the result was conclusively in favour though not unanimous.

Links to the BMA news and info are below:

Richard Vautrey’s statement: https://www.bma.org.uk/news/media-centre/press-releases/2020/february/bma-gp-england-committee-agrees-gp-contract-package

The BMA/GPC info pages: https://www.bma.org.uk/collective-voice/committees/general-practitioners-committee/gpc-england/gp-contract-agreement-england-2020-2021

The next meeting GPC in on 19 March and is a GPC UK meeting, to be held in Cardiff. 

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

Dr Russell Brown

Report of GPC England 18 July 2019

GPC England Report

For East and West Sussex LMCs

Dr Russell Brown

18 July 2019

The GPC met this week. I was unable to attend in person as we were short-staffed and so Skyped in.  This was a novel experience for me but enabled me to contribute to the meeting while also managing work flows such as phone calls, visit requests and clinical admin in the practice.  I even saw a couple of patients during the day...

A variety of matters were discussed and I will ask the office to send out the “official” news with this report.

Capita have made known yet another error on their part, having discovered over four thousand unactioned emails in an inbox somewhere, though presumably not in the same draw as the previously reported missing notes.  These date back to 2017 and 71 practices are affected, predominantly in Leicestershire and Lincolnshire.

There are widespread CCG Merger plans going on across the country.  I am aware of it happening in East Sussex.  Please remember that CCGs are membership organisations and that CCG executive bodies should be ASKING you for your views, rather than telling you what they want you to do.  This doesn’t stop them suggesting a course of action but do not feel forced into anything you don’t feel comfortable with.

There were updates on sessional matters from the new Chair of the committee, Ben Molyneaux.   I have known Ben for several years through GPC and he is excellent at making sure GPC does not simply take the contractor view all the time.  I think his election, after his predecessor stood down to concentrate on her role as an LMC secretary, is a very positive thing for our craft generally and sessional colleagues in particular.

There was a Contract item, in which we discussed the implementation of the current year’s contract (essentially confirmation that the necessary changes to Regulations are being placed before Parliament so that they can come into effect from October).

PCNs are now with us and apparently 99.7% of practices are signed up to the DES, with about 25 practices throughout England electing not to sign up.  There have been some concerns aired about the long term affordability of the 30% staff costs which practices will be responsible for going forward, though of course there is much new money coming into the pot to support this new contract over the next five years.  The BMA hosted a PCN Directors’ Conference, which was apparently well-received by attendees.  There are more supportive events planned for the future, though details are currently lacking.  There is a webcast of the plenary talk and summaries available here.  The five service specifications detailed in the contract documents previously circulated are being developed by NHSE and the GPC Exec team over the summer and will be looked at by GPC in the Autumn, I understand.   Additionally, the Investment and Impact fund is in the process of being designed.  Separately, there have been reports from around the country of various management structures viewing PCNs as the answer to a wide variety of system issues.  It is very important that expectations are managed: the new staff in PCNs are to support and address CURRENT pressures IN PRACTICES, not necessarily to be a repository of new work.  That may come in time but we must build capacity and sustainability first.  Once PCNs are properly established and are confident that they are both willing and able to take on new work, negotiations could begin to discuss that.  The LMC is of course able to assist all parties in discussions of that nature.

The OOA (out of area) regulations are being looked at by NHSE.  GPC remains concerned about the effect of cherry-picking and disruption caused by providers such as GP@Hand and Babylon.  That said, the technology of Digital first itself and the issues it may raise, positive and negative, are recognised as something we must get to grips with for the benefit of our constituents, who of course include those GPs who choose to work in and for companies such as Babylon.  In my view, their products are a potential solution to a poorly defined question.  I think NHSE would do well to define the question they are trying to answer then resource practices, or perhaps PCNS, properly to come up with innovative solutions.  Those may include companies such as Babylon.  Many of us in GP would welcome the ability to utilise tools like these, provided they are properly resourced, both financially and in terms of time. But there must be a level playing field.  Digital first providers should be obliged to register ANYONE who presents to them, as we are.

QOF and QI work has begun, with the models in the seven areas being developed with a view to being negotiated on and agreed in the autumn.  The areas are replacing the current two modules from April 2020 and practices will be expected to work on two of them.  They are:

• early cancer diagnosis
• CVD prevention and detection
• supporting people with learning disabilities
• shared decision making
• anxiety and depression
• anti-microbial resistance including antibiotic prescribing
• wider primary healthcare prevention

The promised Vaccinations and immunisation review has started.  I won’t bore you with details of it yet but this is a Good Thing™ for general practice.  The review should conclude in the Autumn and the results of the review should feed in to the negotiation process in due course.

GPC also continues to engage with NHSE’s Access review, in which we have expressed considerable concern about some of their suggested aims.  Essentially, they wish to reduce waiting times, develop a comprehensive offer for out-of-hospital care including times when practices are not open and look at workforce to ensure resources are used sensibly and thus reduce pressure on and improve services.  Forgive my cynicism, but the word “hospital” seems to loom large by its absence in several of those aims...

Pensions were discussed, with the current pressures being faced by a variety of GPs as well as other members of several branches of public service.  It can be summarised thusly:  the situation is absolutely ludicrous and Government thinks we should just suck it up.  If you haven’t had professional advice, can I suggest you get some sooner rather than later, as an annual additional 5-figure tax bill is rather unpleasant to receive.

Finally, there was a brief item about the NHS Campaigns that you will recall we are now contractually obliged to advertise.  They are basically mostly the patient-facing bits of the items above.  I am sure there is a notice board somewhere in your practice just begging for a new poster.  When they are sent out, obviously.

finally, a plug for the LMC’s annual conference, “General Pratcice: Powerhouse of our NHS”, to be held on Wednesday 2 October at the Aurora Hotel in Crawley.  The speaker list is impressive and you will no doubt be delighted to hear it does not include me.  To sign up, please go to the LMC website at this link.

The next meeting GPCUK in September. 

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

Dr Russell Brown

Report of GPC England meeting 16 May 2019

GPC Report

For East and West Sussex LMCs

Dr Russell Brown

16 May 2018

The GPC met this week. This was a GPC England meeting.

I was not terribly happy with this meeting.  Though the Speaker managed our time well and kept us on track, I did not feel that we were given enough opportunity to discuss matters.  Many items were essentially “receive” items with a small opportunity to ask questions (and no chance to respond to answers).  We also spent more time on a presentation by Dr Masood Nazir of NHSE on IT aspirations and plans than we did on the executive and policy leads’ reports.  My own feeling is that should be the other way round.  On the upside though, for the first time we have been asked for feedback, almost in the style of evaluation forms after a CPD activity.  I have done so.  At considerable length.

With regard to the Independent Enquiry that the BMA has organised after the sexism/misogyny scandal, it does appear that it will be properly independent, which provides some hope.  It should be starting soon, with a plan to report back in only a few months time.

New intercollegiate Safeguarding guidance has been released and as is often the case is onerous and far too time consuming for the reality of life.  As things stand, we will be spending more time on safeguarding training and reviews/reflection than we will on PCNs...

Honoraria issues continue to grumble along.  The Meldrum reforms which changed how things work with regard to resourcing your representation have not, in my view, been helpful.  for example, I attended the LMC conference in Belfast on your behalf (rather than as an LMC rep).  I did not receive any honorarium for either of the two days I attended.  I was able to claim for a locum cost on the Tuesday.  Wednesday is my day off so I was there in my own time.  However, I was fortunate that I am a partner in a practice.  If I had been a locum, I could not have claimed any money for the Tuesday to offset earnings lost by attending.  BMA rules don’t pay any honorarium until 12 meetings in a year have been attended.  This is partly because employed members (such as consultants) are entitled to up to 12 days of trade union time.  GPs, often being self-employed, are not able to make use of this of course.  For GPC reps, the GPDF pays an honorarium for attendance at GPC meetings.  For some reason, that has not been continued for LMC Conference, which to my mind is ridiculous.  If you want decent representation, you need to resource it.  It’s not a gravy train but if I can’t fund a locum (or afford to take the hit myself) I can’t go and represent you.  I also have considerable concern that the arrangements as they stand run the risk of reducing an appropriate diversity of representation: we might end up with a larger than appropriate number or ratio of straight, white, male, semi-retired people on the committee.  Oh, wait... (I only conform to some of those categories.) In my view, the only people who can decide whether a person or body represents them is the group of people concerned.  I *think* I do a decent job of representing all of you, but please keep the feedback coming.

Anyway, moving on from my own bugbears...

EMIS Amazon Web Services is a work in progress, with EMIS intending to move patient data on to AWS.  This is something which we support for reasons of service resilience, delivery and sustainability.  There is much work ongoing to tie down the details of any Data Controller liability issues.  Practices in due course will need to update their Privacy Notices and inform their patients about changes, which will involve things such as automated text messages and emailing.  EMIS will be writing to practices at the appropriate time.  One for your radar rather than any action at the moment.

There is a review of the GP trainee contract arrangements as part of wider junior doctors’ contract negotiations.  This is currently confidential but I understand there will be more Comms very soon from the relevant committees and subcommittees of the BMA.

As I mentioned above, Dr Nazir presented on IT aspirations and plans from NHSE.  While interesting, I feel it would have been better to have that item away from the main committee meeting.  

We briefly discussed PCNs, negotiations on the details of the staff groups from year two are beginning and the support that has been put in place this year for ACDs will continue, as there is a recognition that ACDs may well change often.

There was an oral update from Dr Zoe Norris, the outgoing sessional subcommittee chair, who is also leaving the GPC.  She has been remarkable in her vigour and tenacity in her relatively brief time on the committee, representing sessionals’ interests consistently and comprehensively.  She leaves a legacy of a much more visible part of our profession, one which has historically been somewhat neglected by the GPC and BMA.  I will not be alone in missing her contributions.

There were other items in the exec team’s report that were not discussed.  A version of that report will be provided by the GPC secretariat soon (usually the Monday after the meeting) and I will ask the LMC office to forward it on when it is available.

The next meeting is Thursday 18 July, another GPC England meeting.  After that, we have GPCUK in September.  You may recall there are fewer meetings now.  I am still unsure whether this is a good thing or not, to be honest and have suggested this is reviewed as I am concerned about the adequacy of representation at a national level.  But now I’m at risk of repeating myself.

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

Dr Russell Brown

GPC report 17 January 2019

GPC Report

For East and West Sussex LMCs

Dr Russell Brown

17 January 2019

The GPCE met today in London.  

It was a full day, with the majority of the time being taken up by discussions around a proposed contract deal.  Details of that are currently confidential but there will be an announcement in the next couple of weeks.  Many elements such as indemnity changes, if not details, have already been announced and I hope the package as a whole will become clear to you all soon.  The GPC will share this as soon as possible and there will be a series of contract roadshows in forthcoming months.

There were also two question and answer sessions.  

The first was with Nigel Watson, regarding his reported GP Partnership Review, which was published on 8 January and can be found here.    I think this is a good piece of work with much to commend in its pages.  However, delivery of the recommendations is a concern, given previous actions by DHSC.  That said, if the Secretary of State accepts any or all of them, the DHSC will have to find some way to implement them. There are also a number if YouTube videos on the different sections of the report:

• Summary of the review here
• Introduction Vblog here
• Workforce part 1 here
• Workforce part 2 here
• Risk here

Dovetailing nicely with that session, Nikki Kanani and Dominic Hardy of NHSE visited GPC to discuss the 10 year Long Term Plan which was recently announced.  Details of that can be found here, with a links to the full document, an on line version and a summary document.  The summary is worth looking at for all my constituents, being only a couple of pages long.

There seems to be a welcome meeting of minds and, to a degree, vision between NHSE and GPC.  Relationships this year have been more productive than of late.  There seems to be much more recognition of the vital importance of Primary care, and general practice within that, than before.  There is also a commitment to support and develop our part of the NHS after a drought of any real investment in the last decade.

The next event is the annual LMC Conference in Belfast on 19-20 March, which I shall be attending in my GPC capacity, with GPC UK meeting the following day.  The next GPC England meeting is in May.

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

Dr Russell Brown