Chairman's Report of LMCs Conference 21st-22nd May 2015
Chair: Sue Roberts
Vice Chair: Nick Bray
Executive Director (as Observer): Jill Hellens
Members: Karen Sylvester and Will Harris
I sit writing this the day after returning from Conference whilst watching the 60th edition of The Eurovision Song Contest. I hasten to add that there are no similarities between these two – single or (occasionally) groups of people standing up on stage performing sometimes camp, sometimes risqué and sometimes emotional contributions with the odd laugh and usually a round of applause as a result – Eurovision is nothing like that.
My overall impression is that Conference, in line with the mood with the recent LMC Study Day in Somerset, had more of a positive mood, looking forward rather than ‘how we got here and how awful it is’, and was expressing a determination to not go under but take control of the current mess – after all, the Government won’t. The GPC has listened to some of the criticism of Conference construction of recent years – Chaand, our current GPC Chair very much supports this – and changed the format of the Agenda this year (more of this later). It was clear that this was the intention at the beginning since there was a real move towards more REAL debate with speakers for and against alternated and less showboating of the ‘regular’ performers. A significant statistic is that there no fewer than 27 first-time speakers (we are not allowed to call them ‘maiden’ for some reason!) – including our two members attending.
Thursday 21st May
Conference kicked off with the usual standard housekeeping – adopting Minutes and appointing chairs and so forth. Then it was time for Chaand to speak. A transcript of his speech is available on the GPC website for those who want the detail but the main points were as follows:-
Acknowledging the problems that GPs face but looking for solutions
Noting a change in approach towards GPs- both in the Five Year Forward View that put General Practice at the centre of the NHS and in a more positive media reporting of Primary Care recently.
Calling on the Prime Minister to jettison pre-election pipe-dreams and be practical
A call to GPs for inclusivity not competition, co-operation and the strong supporting the weak – all themes we recognise in Somerset.
He got the usual standing ovation.
We then got into the motions and the first hour or so was about workload and the knock on effect on patient safety. Will had a baptism of fire being second speaker on for the second motion related to workload. He had to make some last minute changes because of the need to respond to the initial speaker and managed this very coolly speaking extremely well, getting a laugh when referring to Mr Hunt thinking all we had to do was to stop doing blood tests ourselves and all would be well and even finishing within the time (which your Chairman failed to do in both her speeches!). The motion that the Government has failed to address the rising workload with risks to patients was carried unanimously.
There was an interesting debate about whether there should be a new qualification for Primary Care Doctors akin to the Staff Grade positions in hospitals, for those who don’t achieve MRCGP so that their skills are recognised and services retained but this motion was lost, partly because evidence from Secondary Care is that It provides an unsatisfactory and unfair two-tier system. Other motions in this section related to supporting returners and ‘refreshers’ were all carried.
The LMC Chairman stood up to speak against a limiting list sizes since the Devon motion as written was simplistic and would limit our income, negate the possibility that collaborative working could assist in the problems and tie the negotiators hands unnecessarily if carried. The sentiment however, she agreed with and asked therefore the first, third and fifth parts to be taken as a ’reference’ giving more room for the negotiators to manoeuvre. Devon agreed to do this as regards fixing the number of patients on a list but not the other parts. On voting, the first part was passed as a reference (the sentiment that list sizes should be reduced), the third was narrowly carried and the fifth not passed so your Chairman’s speech may have had some effect.
The rest of the morning covered Education, access, sessional GPs and Premises all of which were fairly straightforward or ‘no-brainers’ as the young things like to say.
In previous years the Scottish, Irish and Welsh LMCs have presented reports on their activity in a given time slot unofficially known as the ‘English tea break’ but this had changed this year to be integrated into the substance of the first afternoons business. This covered new models of care and it is clear that ALL parts of the United Kingdom are thinking along the same lines in this respect. There was a theme that this was a way forward but that it needed investment and groups of Practices should be supported, if they wanted and in the manner they wanted.
This part also focused on contracts and a subject close to your Chairman’s heart – unfunded work.
There was a rejection of the idea of a totally salaried service and also that of suggesting that GPs should be able to charge for and provide ‘top up ‘services for their NHS patients.
Then followed the ‘soapbox’ session. This is when delegates queue up to a microphone and have one minute to present new topics that are not covered elsewhere but that they feel strongly about. These were broad ranging as you can see from the list of subjects below:-
- Enshrine support for LGBT Doctors
- Instalment prescriptions with one charge – safe for patients but saves them money (eg antidepressants)
- Have Mr Hunt come to Conference to account for his policies
- Insist that the Department of Health promotes more positive attitudes to GPs
- Charge CQC whilst they are still learning how to do the inspections
- Protected and funded time for CQC preparation and inspections
- Address the unworkable 10% threshold for QRIsk now set without input from Primary Care Clinicians as regards how practical it is.
- Increase medical school places
- Address the fact that defence organisations do not cover media doctors
- Take up the matter of a GP locality where they declined to engage with Shared Care Agreements and the CCG threatened to report them to the GMC
- negotiate or prevent the need for GPs to do unfunded letters for DWP appeals
- Out of stock drugs
Shortly after soapbox, your Chairman spoke about NHS 111 and proposed that it should be scrapped explaining the reasons why. After an amusing intervention from a past chair of Conference, standing orders were completely overturned and the motion amended to stop at just the bald statement – ‘NHS 111 should be scrapped’. Motion carried unanimously. No-one was really sure what happened there but it was fun.
Friday 22nd May
The first section on the next day was about Regulation, Monitoring and Performance Management. There were motions regarding the GMC and how the tone of their communications suggest that Doctors under investigation are guilty until proven innocent and a call for action on this was carried. We voted to decommission CQC (so that is going the way of NHS 111 then!) and get appraisals back to being of more benefit to the appraisees needs than for performance monitoring.
Nick then stepped up to the microphone to speak on category M drugs and price manipulation by pharmaceutical companies. No-one would have known that he had had a very stressful previous day after being accosted by the Chair of the Dispensing Doctors Union to say that our motion was factually wrong. After to-ing and fro-ing between various parties he presented the motion as a reference and it was carried. . Importantly, there was one part passed without reference which was condemning the guidance to prescribe pregabalin as lyrica for neuropathic pain which made PULSE the next day. Well done Nick and I hope you have a less fraught Conference experience next year.
Karen was up to the podium in her sparkly shoes shortly afterwards to support a motion to change the unscheduled admissions enhanced service. She cunningly and amusingly likened it to building a bookcase from IKEA only to have to ask someone else to do it who didn’t use the instructions anyway. The motion was passed. Well done sparkly shoes ( and Karen). Clearly the crystal that One of Karen’s patients gave her (she works in Glastonbury) had a positive effect.
In a further new initiative for Conference we then went into ‘break out’ groups to answer specific questions about the role of the GPC, LMCs and what we want from Conference. It was pleasing that the GPC also consulted with the observers because they make such a huge contribution to LMC work but have no voting rights at Conference. It was useful finding out what is going on in other areas and it is clear that Somerset already fulfils many of the roles that GPs expect of them. However, we are clearly ahead as regards Pastoral matters and this is largely due to the fact that we have the Benevolent Fund that most LMCs do not and of course, the dedication of Harry and our Pastoral Officers in doing this work.
The next section was on funding and covered the areas of MPIG, Seniority and also calls for a new contract the suggestion being that this be based on activity not on list size. This was passed narrowly. We then went on to debate IT and adequate funding for co-commissioning involvement. All the motions were passed in the manner that one would expect.
There was then a further ‘queue up and speak’ microphone session where the GPC executive team (including the negotiators) were firmly quizzed about their success or otherwise and came away with a clear idea of what was expected from them. There was a question as to what the GPC would do if 7 day a week 8-8 working was imposed. This was sidestepped and we were told that it wouldn’t happen, so we will need to watch this space. There was also questions about what had happened to the ‘your GP Cares’ campaign but Beth Macarron- Nash was unable to comment – this is because the progress of this is related to internal BMA politics but Richard Vautrey, who had spoken at Somerset LMC Study Day the week before, said that General Practice was for the first time central to the recent Election campaign and that it has highlighted in Politicians minds the importance of what we do. He also noted that it is all very well the GPC calling on GPs to take ‘definitive’ action but Chaand would need to know that he would not need to ‘look over his back’ to see if he was indeed being followed. I would reflect that this is sometimes a problem for LMCs also.
In yet another new initiative, we then had a series of slides with questions on which we could reply to anonymously with our electric button sets, asking for further feedback regarding the GPC. The results were interesting. The jury was out about whether the GPC truly represented the voice of GPs, that it does not meet the needs of LMCs really, that we have no idea what the GP Defence Fund does and that Conference needs reforming. There was very strong support to remain as a UK Conference rather than to devolve into 4 parts which was pleasing and undermines the unifying effect of Conference, despite its flaws.
So it seems that the GPC has some thinking to do if it is to truly represent grass roots GPs and must follow these up with actions. It is fair to say that within the GPC there are those who want to stay where they are as well as those who wish to move forward and the initiatives at Conference were a start at supporting the latter but need to be developed further.
I am nearing the end of my report and I wish to say a few thanks. Firstly to all Practices for your continued support of the LMC and specifically to those who indulged our speakers this year gave us the time to attend. I thank Karen for her jokes, Nick for his patience and Will for his timekeeping. Last but not least a huge thanks to Jill who once again organised everything, contributed and supported us significantly and taught me what an UBER taxi is.