GPC report from 20 November 2014

GPC Report

For East and West Sussex LMCs

Dr Russell Brown

20 November 2014

The GPC held its latest last week.   The latest official GPC news can be found at the BMA Communities web site and for constituents and LMC members is included with this report.  Unlike last month, though the actual conversations are confidential, I am able to be considerably less discrete than last month.  As a result, this report is almost diametrically opposite to last month’s in its length and, of course, its consequent interest value.  No, really.

CQC and “Intelligent Monitoring”

As I am sure you are aware, the CQC published a frighteningly misleading data set about all practices in England, and classified them into 6 bands of concern.  Band 6 practices are apparently least likely to be putting patients at risk, and band 1 practices most likely. Speaking as a partner in a Band 1 practice, which went through a CQC inspection less than 6 months ago where nothing of any meaningful significance was found and which will be going through another inspection in the next few weeks under the new regime, I was extremely angry that CQC had once again deliberately made statements which they must have known the press would leap upon with glee.  My partners and practice manager were understandably upset.  On the other hand, my patients were either totally disinterested in the CQC’s assessment or horrified that their practice was being pilloried in this way.  I have written to my local paper, the Eastbourne Herald, about the matter.  They haven’t published it yet, so it would appear the local press aren’t fussed either.  

The 38 indicators chosen do not seem to reflect on the quality of care provided by practices as well as being out of date.  GPC was consulted by CQC on the use of the indicators and opposed their use as overly simplistic,  but as is normal the genuinely constructive comments made were completely ignored.  CQC has once again proven itself unfit for purpose, even assuming that its purpose is definable, which I am doubtful of.  You will of course recall that fees are increasing by 9%, which is fascinating given the organisation is not providing value for money by any stretch of even the most fevered imagination.  The GPC chairman, Chaand Nagpaul, has written to both Prof Steve Field, that well-known friend to general practice, and the Jeremy Hunt, the Health Secretary, expressing our anger and dismay.   We are actually fortunate locally that the LMC office has managed to establish such a constructive relationship with the local CQC office, meaning that, to a degree, pragmatism and common sense is being applied.  If you are to be inspected, please notify the LMC office as soon as possible and feedback about your experiences.

NHS Five Year Forward View

The full report can be found here.  Interestingly, much of this document seems to suggest a move in a direction which GPs might consider to be right, as it often focusses on many of the areas that GPC has been working on in the last couple of years, particularly the “Your GP Cares” campaign which calls for long term sustained investment in General Practice.  This can be broadly categorised under funding, workforce and workload (where the document agrees we need to expand the workforce including nurses and other primary care staff) and empowering patients, moving towards more self care and support for carers.  Patient access to information is a strong theme and fits with the recently published long term NHS IT strategy and recently concluded contract negotiations, as well as local schemes such as ROCI and the enhanced Summary Care Record.

However, whilst the document recognises the pressure general practice is under as well as the unhelpful focus on hospital care that has existed for the last decade, it does not provide all the solutions, which is perhaps helpful as it recognises that a “one-size-fits-all” approach is inappropriate.  It is worth remembering that funding for hospitals has increased by over 40% in the last 10 years, whilst in general practice that figure is only about 10%, and that consultant numbers have increased at three times the rate of GPs.  The document talks about breaking down barriers between primary and secondary care, between mental health and health and social care.  Services need to be organised to support patients with multiple conditions, with locally delivered services, whilst recognising that specialist centres can produce better outcomes.  The plan recognises that list based general practice is the foundation of the NHS and this will continue. It also recognises the pressure that general practices is currently under and that there needs to be a “new deal” for GPs.  There is a commitment to invest more in primary care over the next 5 years whilst stabilising the core funding for general practice nationally over the next 2 years.

To this end, new models of care are proposed: 

Multispeciality Community Providers (MCP) will offer a new option for groups of GPs to combine with nurses, other community specialists and perhaps mental health and social care to create an integrated out of hospital care organisation. There are some early versions of this around the country but as yet they have not moved to the next stage of employing hospital consultants, having admitting rights to hospital beds, running community hospitals or taking on delegated control of NHS budgets.

Primary and Acute Care Systems (PACS) – this model of vertical integration combines general practice and hospital services, similar to an accountable care organisation now developing in other countries including the USA.  Many would question what would happen to a practice if their contract was held by a hospital. This option could provide a model for some that has something to offer but would need many safeguards to be put in place.  I suspect this may work in urban, under-doctored areas but is going to be of no use at all in the countryside.

Additionally, urgent and emergency care will be redesigned and integrated between A&E Departments, GP out-of-hours services, urgent care centres, NHS 111 and ambulance services.  There has been a great focus on the pressure A&E is under, with an additional £500m being given to hospitals over a 2 year period to help relieve the pressure,  yet A&E sees 21 million patients a year compared to the 340 million seen in general practice (increased from 240 million in 2004 but general practice has not received additional funding for this increased demand).  Urgent Care Centres refers I think to the emerging model of groups of practices working together in partnership with others such as community nurses, paramedics, social workers etc to cover a larger population than an individual practice.  The current model does not work and there are perverse incentives in the system:  if A&E is paid on the basis of each patient seen and critically ill patients are funded at the same level as minor injuries, what is the incentive for them to stop the minor injuries attending the hospital.  This is an important initiative to reducing the workload on general practice as well as A&E.

It is worth considering that many of our younger, often sessional, colleagues are perhaps ambivalent about our independent contractor status.  Succession planning is something that should be thought of early and frequently and the LMC office is happy to provide advice and support.

But change is coming.  Are you and your practice willing and able to embrace this change and move to a more interdependent model with colleagues in other practices as a means to maintain your independence?  I am also concerned that the persistent failure to change the focus of investment from hospitals to out-of-hospital settings will continue.  Without that nettle being grasped firmly, I do not see how this plan can succeed.

Co-commissioning

The NHS England report “Next steps towards primary care co-commissioning” was launched on 10th November 2014 and can be found here.  It outlines three models of co-commissioning, NHS England’s plans for resource allocations for CCGs, plans for developing and delivering a new framework on conflicts of interests and the timeline for approval and implementation.  The LMC is holding events on co-commissioning this week.  This idea should not be dismissed out of hand as, if resourced and used appropriately, co-commissioning may be a mechanism to deliver more resources into primary care.  Of course, the entire concept is only necessary because of a botched major reconfiguration of the NHS which is funded inadequately.  

The key features of the three models are described in the report in this table: 

In my view, model C is a nightmare scenario for general practices.  CCGs are membership organisations of GP practices.  The conflicts of interest evident in model C are unbelievable, with a GP-led (apparently) organisation being responsible for the commissioning of general practice.  How can we hold the board of our respective CCGs to account if they are responsible for decisions on investments into our practices? How is this process going to do anything other than create a wide-ranging postcode lottery of service provision? And that in turn risks significant repetitional damage to GPs, who may well be perceived by the public and the press as commissioning with their own self-interests at the fore-front of their minds.  Disinvestment in and decommissioning of secondary care during service reconfigurations could inflame tensions between primary and secondary care, jeopardising service redesign and integration, with the perception of wide-ranging conflicts of interests paralysing the decision making processes and removing clinical input by devolving more and more decision making powers to lay members of boards.

In summary, I am not a fan and would urge you to consider extremely carefully the various options.  CCGs will, no doubt, be canvassing their member practices for views on a way forward.  It is vital that you engage with those processes.

The next GPC meeting is to be held on 18th December 2014.

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

Dr Russell Brown

GPC Report 16 October 2014

GPC Report

For East and West Sussex LMCs

Dr Russell Brown

16 October 2014

The GPC held its latest last week.   The latest official GPC news can be found at the BMA Communities web site.  The meeting this time was in two parts, with GPC proper held in the morning session and subcommittee meetings in the afternoon.  I was elected for a further year as Deputy Chairman of the Commissioning and Services Development Subcommittee.

Unfortunately, almost everything we discussed in the morning was confidential.  Consequently, I can’t say very much at all.

However, the new Dementia Identification Scheme was discussed.  I understand the BMA is unable to advise GPs not to do this work as this would be tantamount to inciting improperly formulated industrial action.  My personal viewpoint is that this is work which is verging on unethical in the way the scheme has been devised and that this money, which has been located from the back of a sofa somewhere in the otherwise allegedly financially moribund Department of Health, would have been much better used towards a properly negotiated and structured package of work which might actually made a difference to those families suffering from the effects of a member with dementia.  But that is politicians for you.  I fully expect many practices to sign up to this in an effort to get at least some funding through the door.  I am also fundamentally unsurprised at the press coverage on this, most of which seems focussed on the erroneous impression that a GP will be paid £55 just for making a diagnosis.  

The CSD meeting in the afternoon discussed networks and federations, co-commissioning and integration.  There is much work going on in many places in the country.  Again, much of this discussion is and was confidential.

I hope you have found this report helpful, though given it’s structure and the dearth of information in it this month..…  Please feedback so that I can ensure my reports are useful.  

Dr Russell Brown

GPC report 18 September 2014

GPC Report

For East and West Sussex LMCs

Dr Russell Brown

18 September 2014

The GPC held its latest meeting a couple of weeks ago.   The latest official GPC news can be found at the BMA Communities web site.  The meeting this time was in two parts, with GPC proper held in the morning session which predominantly involved the executive team presenting the details of the proposed contractual changes and breakout groups in the afternoon to discuss them in the afternoon.

This report is, as a result, rather shorter than usual.  Anyone audibly celebrating this fact will be looked at sternly.

As you will no doubt be aware, the negotiations for changes to GPs’ contracts have concluded and been announced.  Chaand Nagpaul has sent out one of his regular updates and the details can be found on the BMA website at http://bma.org.uk/gpcontract2015.  

I know this is usually trotted out, but I have such a grumpy reputation that I hope my reassurance that this is the best deal that could have been achieved is sufficient.  It would be fair to say that, this year, neither side came away from negotiations happy.  Perhaps this reflects a successful process.

However, this is barely the beginning of the work that is needed to protect General Practice and put it on a sound footing.  If you like, the contract negotiations are simply a box that needed to be ticked so we can get on with the more important work.  With this in mind, GPC is already engaging with the DH and has proactively suggested several ways forward.  Details can be found at http://tinyurl.com/mvry8yw but there are 8 suggestions which we hope to base urgent discussions upon.

The next meeting is to be held on 16 October 2014.  It would be very helpful to hear your feedback on the contractual changes before then, if you feel able to.

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

Dr Russell Brown

Dinner time

So my lovely wife is cooking my dinner. We usually do that together. Why am I not with her in the kitchen?

Because, Mr Cameron, after yet another 12 hour day, I am now at home sorting out paperwork, by remotely accessing the surgery computer system. Don't worry, it is all secure and conforms to the NHS Information Governance arrangements. I'm doing that from home so that I could actually see my kids before they went to bed.

If you think that people will be able to see their GP, or a GP (and incidentally I wish you'd make your mind up because you seem to say the first one when you start, then change tack in the middle of each sentence) from 8-8, 7 days a week, you are frankly deluded.

There are not enough GPs. So that means that patients will NOT be seeing GPs, but other health professionals, nurse, physicians assistants or whoever.

I can't see how you are going to train enough GPs, given that takes as an absolute minimum 5 years from graduation from medical school. There is a looming crisis, over and above the one already happening. Did you know that something like 40% of GPs are over 50? How long do you think they will hang around for? And that thousands of young doctors are emigrating rather than staying here to work in the NHS? Can you think why that may be?

340 MILLION consultations a year in General Practice. Compare that to 40 million in A&E and it kind of puts it in perspective. You want us to do more and more. Fine we can do it, or at least arrange for it to be done, but not without resourcing. The proportion of the NHS budget going into Primary Care has gone from about 10% to less than 8.5% in the last four years. That 1.5% reduction is the equivalent of about £1.5 BILLION quid, very roughly. So how are we to pay for all of this extra stuff? It is certainly doable. But it doesn't come cheap.

And what about premises? If you want us to do these things, provide a new model of out of hospital care, closer to peoples' homes, what are we going to do it in? There has been a de facto moratorium on the revenue needed to fund the extra space that General Practice needs, never mind all this extra stuff. So where are you going to fund that from?

And as for GPs now being in charge of the NHS, local groups making decisions for local health economies... Have you actually seen what is going on? There are so many financial constraints that there is very little flexibility in the system almost everywhere to allow for sensible redesign of systems and services. Yes, yes, I know there are places doing bits and pieces but, and I appreciate you are not of a scientific bent like me, anecdote does not make evidence.

The Commonwealth fund report this year showed we had not only the most efficient but THE BEST health service in the world. About the only thing we could do better is speed up access. Guess what? That requires resources.

Demand is going up and up, inexorably. You can't blame the patients, they expect what you promise them. The problem is, you keep talking about an NHS based on wants, but you then barely fund it enough to cater for the populations needs.

We need as a nation to decide what we want from the NHS. That may be the status quo, which is still going to need more resources given the ageing population etc. It may be that it provides less. Or it may need wholesale change of models of provision but that takes resources and is not without risk.

You need to start engaging with the issues honestly. Except I have no expectation that you or any of your political allies or enemies will do so, as there is an election in a few months and unless you are elected, your promises mean nothing at all.

My dinner is ready now. When I've eaten, I'm going to come back and finish off my paperwork.

Have a pleasant evening.

Russell Brown
GP, Polegate, East Sussex

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GPC report 19 June 2014

GPC Report

For East and West Sussex LMCs

Dr Russell Brown

19 June 2014

The GPC held its latest meeting today.   The latest official GPC news can be found at the BMA Communities web site.  The meeting this time was in two parts, with GPC proper held in the morning session and subcommittee meetings in the afternoon.

Negotiation report

There is much going on in the background, developing and assisting idea formation within the DH.  As usual, much is confidential.  However, PMS reviews guidance and a checklist for LMCs has been published.  The LMC in our area has already had extensive experience in assisting practices during the review process.  I would recommend practices affected by reviews approach the LMC office at the earliest stages.  A letter has ben sent to once again ask what support the outlying practices affected by the phasing out of MPIG has yet to be replied to.  I am not aware of any outliers in our area but of more concern is those practices outside of the 98 identified by NHSE as outliers, as many other practices are going to find the situation uncomfortable if not ruinous.  Again, please contact the LMC office as early as you can if you have any concerns about your practice.  Care.data was not a big feature of the agenda today, a welcome break.  Pilots are however to be held later this year, involving 100-500 practices, to look at the mechanism for data extraction.  There is no date set for the national roll out of the scheme.  A GPC CCG involvement survey has taken place, the results of which will be published soon.  I hope it will make some CCGs around the country take note.  The local Somerset QOF replacement scheme was discussed at length.  It is causing much consternation and concern.  Though practices will not be performance managed, they will still need to do the work (and so will be collecting the data anyway).  I am concerned that this is a short term view which will have implications for a nationally negotiated contract in future.  NHSE has been clear that this is a one off pilot and we are pressing to ensure that a proper and full evaluation takes place, given the DH’s past definition of the word “pilot” in various other schemes.

Communications

The “Your GP cares” campaign was launched at LMC Conference.  Although separate, the RCGP have also launched a campaign and the two organisations are now, finally, collaborating on the development of both and planning to work much more closely in the future.  Given the different nuances of the two bodies, this can only be a good thing.  Practices should expect to receive patient materials from the comms team very soon.  I would encourage all practices to engage with the campaign.  As a part of the campaign, there is an e-petition at http://epetitions.direct.gov.uk/petitions/65093.  I urge you to read it and sign it and share it with your professional and personal networks such as patient groups and friends on Facebook or Twitter.  It has already drawn almost 5000 people to sign it in its first few weeks.  It’s closing date is next year, just before the General Election.  Additionally, an early day motion, sponsored by several past health ministers including Frank Dobson is being placed before the Commons.  Please consider emailing your GP, which can be done easily by clicking on the following link and following the prompts.  It takes about 2 minutes and could have a real impact.  The link is http://bma.org.uk/working-for-change/your-gp-cares/email-your-local-politician. 

Recruitment and the future

Figures soon to be published have revealed an absolutely dire situation in GP training, with many places north of London desperately short of candidate for training places.  Worse, HEE is shifting funding around and planning on spending money meant to train GPs on other projects, given they have been unable to fill places.  The only solution is to make General Practice a more attractive carer choice and that is in the gift of others, which of course is where the negotiations we go through each year come in.

The next meeting is to be held on 17 July 2014, but I will be on annual leave that week.  There will be an election for the negotiating Executive team taking place.  I will be voting by proxy,, an arrangement which allows a more democratic process.  Until recently, on those actually present at the relevant meeting could vote.  There is a hiatus in August so expect my next report in September.

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 April 2014

GPC Report

For East and West Sussex LMCs

Dr Russell Brown

17 April 2014

The GPC held its latest meeting today.   The latest official GPC news can be found at the BMA Communities web site.

Collaborative fees: In some areas of the country, there have been issues with getting these fees paid.  I am not aware of any particular issues in Sussex, but if there are any, please let the LMC office know.  It has been acknowledged this is an NHS responsibility and the system that existed for payments prior to the changes last year should still be functional.

Negotiation report

As ever, much of this is confidential, but as discretion is my watchword, I can reveal that we appear to have someone in a position of influence who wants to see lots of money come into primary care (which as you may recall includes general practice).  Treasury however is apparently concerned that hospital waiting times will go up, which demonstrates nicely the difficulties we have in perception of the problem and potential solutions to it within the NHS, as well as the apparent mismatch in viewpoints, not to mention priorities, in different places in Government..

Contract implementation

Admission avoidance DES read codes should be available by the end of April.  I am unclear which April but I assume the aim is this year.  Hopefully, there will very soon be some short and snappy GPC guidance on implementation to compliment the official joint guidance.

Transforming Primary Care, aka the £5 per head.  

A document sent out by NHS England has made it clear that this money should be used to support the work of practices.  Local plans are developing and I anticipate the usual proactive and productive discussions will take place between the LMC and CCGs in the two Sussexes.

Prime Minister’s Challenge Fund

The eagle-eyed amongst you will have seen that Brighton and Hove have bid successfully for some of this money.  I heard that all these schemes will be independently evaluated in due course.

QOF 13-14 payments

There was an error in calculating the achievement scores of some practices, who will have been contacted by HSCIC already.  It is not yet clear, however, whether PMS deductions have been similarly affected.

QOF 14-15

There is an issue affecting the value of the average QOF point as the average list size changes.  This is being actively addressed by the negotiating team as it has a small but significant effect on funding for General Practice and will continue to do so in future if not sorted.

PMS reviews

Guidance for LMCs will be issued shortly.  In my personal view, PMS practices might be sensible to ask the LMC for assistance at an early stage as there is unlikely to be anything other than a single model approach, perhaps even on a national basis, adopted for these locally negotiated contracts. GPC is prevented from negotiating directly on matters relating to PMS contracts.

Care.data

There was yet another presentation on this.  There is now an independent advisory group, which has an interesting combination of members.  I am not sure if the membership is currently in the public domain.  However, this is highly likely to be discussed at length at LMC Conference, where GPC policy on the matter will be set.

Communications

I may actually have news I can share on something which may actually be quite promising soon.  As things stand, I can’t/haven’t.

Recruitment and the future

An excellent paper was presented by some younger members of the committee, which is included as an attachment to this report.  Please, read it, forward it on, give feedback and encourage others to do so to, either to me or to the GPC secretariat.

Link to recruitment document in my google drive.

The next meeting is to be held on 19 June 2014, as the annual Conference of Local Medical Committees, the annual “policy setting” conference, is taking place on 23/24 May in York.  I hope to be tweeting/updating from there as we go along (@drbrown1970), broadband and batteries allowing.  

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 www.thebrownstuff.blogspot.com

Dr Russell Brown

GPC report 20 March 2014

GPC Report

For East and West Sussex LMCs

Dr Russell Brown

20 March 2014

The GPC held its latest meeting today. 

Negotiation report

As usual, much of this part of the meeting was confidential.  

Contract 2014-15 Under sustained pressure from our negotiators, guidance on the contract changes for the next financial year should be out soon, after various last minute changes were rejected.  Likewise, guidance for the Unplanned Admission avoidance DES has been delayed as certain changes were proposed and rejected.  I understand the guidance will reflect the agreed position of some months ago. The GPC guidance documents have been ready for some time but need to be published after the "official" joint guidance documents that are published. Jeremy Hunt has said that there will be £5 per patient made available to further support the work around the Unplanned admissions DES.  However, it is likely that this money already resides within CCG budgets, albeit unbadged. LMCs will need to work with CCGs to ensure practices can access this money for their patients' benefit. Locally, I suspect there will be positive, proactive discussions.  Nationally, the picture is distinctly patchy. 

DDRB announcement We will be getting a 0.28% uplift, which is supposed to deliver a 1% rise in income for GPs. This figure has been arrived at because expenses have apparently fallen, a situation I do not recognise.  What this means is that the system for calculating expenses is flawed.  We are pressing for a review of the process to ensure the formulaic approach reflects reality in future.  The negotiating team are continuing to press hard on this.

MPIG/PMS reviews This is still chaotic, we continue to express dismay and anger that it is not sorted out.  There is a ready reckoner produced by NHS England to help practices get some idea how they will be affected.  I am not sure how accurate it is given the assumptions it makes.  However, my own non-MPIG practice would appear, on the face of it, to LOSE £6k per year, which seems odd.  NHS England persists with the fiction of local resolution of the PMS review process, given they are locally negotiated contracts, albeit with a de facto national "solution" to the differential funding “problem” between PMS and GMS practices.  Work is ongoing to ensure the £235M identified as NOT being mappable to additional work remains within General Practice.

Premises Work is ongoing, with discussions with health ministers.  They are aware their wishes for service changes will not work without some kind of premises strategy. Expect news at some point before the next general election...

Structure and function of GPC

Changes to nomenclature and processes were debated.  An attempt was mounted at the outset to have all the suggestions adopted en mass, facilitating an early lunch.  Sadly, my suggestion fell on deaf ears and lunch took place two hours later.

Care.data

After last month's discussion with Tim Kelsey, Tony Calland, the chair of the BMA's Ethics Committee, presented further information on care.data and it's implications.  There was a broad-ranging and lengthy debate.  The delay on extractions provides an opportunity to influence how this works.  It should be allowed to work, as it is potentially a valuable research tool.  Negotiations about potential changes are ongoing.

ICM perceptions survey

HPERU presented a summary of th results of a BMA perceptions survey, covering public perceptions of the NHS and GPs in particular,  As usual, we do well.

The latest edition of GPC news will be on the BMA website at https://communities.bma.org.uk/the_practice/default.aspx soon.  I suggest bookmarking the URL as in future GPC news will be published there, often on a more frequent basis than in the past.

The next meeting is to be held on 17 April 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 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 www.thebrownstuff.blogspot.com

Dr Russell Brown

GPC report 20 Feb 2014

GPC Report

For East and West Sussex LMCs

Dr Russell Brown

20 February 2014

The GPC held its first meeting of the year today. 

The meeting in January was an "extra" with external speakers to help stimulate debate and thus assist with strategy formation for the longer term. Held under Chatham House rules, there is little to report directly, but it was useful in my view.

This month's meeting was back to the usual format, though was shortened by subcommittee meetings in the afternoon.  The official GPC News 10 appears not to be on the BMA website as yet.  I will see if I can upload a copy to the blog entry for this report so constituents can see it if they wish. (Available here )

Negotiation report

Work continues on the implementation of the contract agreement for 2014/15.  Though confidential in the main, I was interested to note that negotiations and discussions are not following the traditional format.  I will say more on that if and when able but it is likely to be a positive step forward.  Guidance notes will be published in due course on the contract changes and  enhanced services.  The King's Fund published a paper called "Commissioning and funding general practice". It is an interesting perspective and I suggest you at least glance at it.  It can be found here

Future of general practice 

A motion was passed at the September meeting directing the negotiators and GPDF to work towards establishing a view of the the opinion of the profession. Work is ongoing and colleagues should expect a survey in due course, of all GPs.  It is likely to be a lengthy and detailed survey.  I have no more details at present.

Care.data

Tim Kelsey and two of his team visited GPC to answer questions.  This occurred the day before the announced pause and the week before the grilling by the Health Select Committee in Parliament. Colleagues will no doubt have seen the email from Chaand Nagpaul on is matter, so I will bore a you no further.  GPC is however continuing to apply significant and persistent pressure.

Funding redistribution

Area teams have two years to undertake reviews of PMS practices, with NHS England telling them that matters need to be sorted out locally. It is a right mess.  There are 35 practices I the LMC area (including Surrey) who will be affected by this.  As well as this, the MPIG transition process by NHS England has identified 98 practices who are outliers, using an arbitrary cut off of £3/patient/year.  I am very concerned that there will be other practices in Sussex who are not technically outliers who will nevertheless find it extremely difficult. Please contact the LMC office if you are concerned about the impact this may have on your practice. 

The afternoon session was taken up with subcommittee meetings.  Colleagues may recall I am the Deputy Chair of the Commissioning and Services Development subcommittee.  Much of this meeting was taken up with discussions based around the King's Fund document mentioned above.  Together with members of the negotiating team and Simon Poole, the Chairman of CSD, I will be meeting to further develop matters in a couple of weeks time.  Additionally Simon and I will be attended a meeting at the King's Fund on behalf of GPC/CSD on this matter.  We will endeavour to ensure your interests are represented, given all the other non-elected and non-representative "stakeholders" who tend to be at these things.

The next meeting is to be held on 20 March 2014.  I hope you have found this report helpful.  Please feedback so that I can ensure my reports are useful. 

Dr Russell Brown

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 drbrown1970@gmail.com 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 www.thebrownstuff.blogspot.com

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

Dr Russell Brown

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 www.bma.org.uk/gpc.

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 www.thebrownstuff.blogspot.com

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 www.bma.org.uk/GPC. 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 www.thebrownstuff.blogspot.com

Dr Russell Brown

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 http://tinyurl.com/pl9wyww (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 http://www.england.nhs.uk/ourwork/com-dev/igp-cta/  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

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 http://tinyurl.com/m2d7dnw.  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

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: http://tinyurl.com/cuea2rg

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!

Negotiations

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.

OOH

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.

Monitor

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.

Comms

The issue of communications was discussed.  There is already some patient facing information on the pressures facing General Practice at changingnhs.com.  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

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.

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....