Chairman's Report on LMCs conference 2016
When the crack Somerset team got together one evening a few days before this years LMC conference to discuss who was going to speak to our various motions, there were already a few pointers that we were heading into uncharted territory. This year's conference agenda suggested that this was going to be a very different style of LMC conference.
The Special Conference in January, the subsequent Urgent Prescription for General Practice produced by the BMA, and the recently published GP Forward View (GPFV) from NHS England were all testament to the parlous state of General Practice across the country. The Agenda Committee, clearly mindful of criticism that the format of debates, which all too often in the past focussed on technicalities of procedure and the precise wording of motions, recognised that the old-style conference was not fit for purpose, and had certainly done nothing to avert the current crisis in the profession. The usual format of debates had been largely replaced on day 1 with a series of 4 Themed debates:
Funding for General Practice,
Workload
Workforce
Empowering Professionalism.
Longer than usual debates, each was to be introduced by a GPC member, following which LMC delegates would have only 1 minute each to supply a few golden nuggets of information. In theory at least, this would allow many more contributions from the floor. Following each debate, there was an opportunity for the conference to give feedback (via electronic voting) as to what extent they agreed with GPC policy. At the end of the day, delegates would select several chosen motions from the literally hundreds submitted in the above categories for a full traditional debate the following day. There were also 9 discussion groups in the afternoon (of which each delegate could attend 3), and topics arising could also be debated more fully the next day, if chosen by conference. How the Agenda Committee was going to sort it all out was not at all clear, and the main topic of conversation in the hotel bars on Wednesday evening.
The new style of agenda made it virtually impossible to anticipate what topics would actually be discussed. To complicate matters further, your new Chairman didn't appear on the delegate list- a (predicted!) oversight by the BMA secretariat, the traditional venue had failed it's fire certification and so the conference was moved 2 miles closer to the Thames (and 2 miles further from Bloomsbury, where most of the delegates had already booked their hotels). The new venue, The Mermaid Theatre, didn't actually have enough seats to accommodate the whole conference. So in summary, we were heading off to a conference at venue that was too small, nowhere near where we were staying, to discuss an agenda that, initially as least, nobody understood. What could possibly go wrong?
Our train was 20 minutes late at Taunton due to a track fire.
The Somerset contingent of Jill Hellens, your Chairman, Vice-Chair Karen Sylvester, John O'Dowd and Tim Horlock nevertheless arrived in London in good spirits, having sorted out all the ills of the NHS on the way up. An evening curry with Devon LMC set us up nicely for the next 2 days.
The conference starts with a report from the Agenda Committee, usually given by the Deputy Chair. On this occasion, the Chair of conference, Guy Watkins, called himself to the podium, explaining his deputy, the very youthful Mary O'Brien, had had a small stroke after the Special Conference, losing her speech. Although significantly recovered, she wasn't able to fulfil her normal duties, and received a warm ovation from conference. Guy has a keen sense of humour, and gently led the curious throng through the new arrangements.
Chaand Nagpaul gave a predictably bullish keynote address. The GPFV promised extra money, but there was little indication of where it was going to come from, and it would do nothing to help practices that were desperate now. He told us that the GPC would not be constrained by what had been published in the GPFV, and the threat of industrial action remained. The quote of his speech was that "Mass resignation is not a threat- it's an impending reality". He received a standing ovation at the end of his speech- though to this correspondent at least, it felt muted compared to those received by Laurence in his pomp, and even Chaand last year. Many delegates remained seated, and I think this reflected the general mood that action, not words, were needed now.
The contributions in the themed debates that followed were sombre, realistic, and in some cases very emotional. It was striking how many younger speakers said they were leaving partnerships or practices, and there were several speakers on the verge of tears.
The first of our team to speak was Tim, who spoke eloquently in the Workforce debate about the disastrous local registrar recruitment figures. He made his point well, and the story was picked up by Pulse on-line, who for some reason illustrated it with a photo of what looked to me suspiciously like Tuscany, rather than the back end of Bridgwater. I can see their point.
We tried to cover as many of the parallel sessions as possible between us. I listened to a talk by Nigel Watson, one of our colleagues in neighbouring Wessex, about new models of care there, and in particular the situation in Gosport. One practice had been rescued there by a community trust, and 5 other local practices had then decided to follow their lead. GPs would be covered by their Trust indemnity scheme. I asked Nigel later about the issues of VAT, pensions and regulation, and he felt these had been addressed centrally, and was surprised when I indicated that I didn't think that information was available locally. I also spoke with Chaand about the process whereby local practices might be taken over by Foundation Trusts (FTs), and he was clear that he is keen to see funding for local GPs to be able to set up collaboratives, so that the operation of GP practices can stay within Primary Care.
The traditional debates later in the afternoon resulted in a call for paper records to be digitised and then destroyed, and a motion for urgent calls coming in to a practice after 6pm to be directed to the OOH service was defeated. There was a section on the Junior Doctors Dispute, the wording of several motions having to be changed, as it appeared that the dispute had been settled recently, subject to acceptance by the BMA junior doctors membership. There was widespread admiration for the clout that a 98% vote in favour of strike action had given them, several speakers made that the point that far from "destroying" junior doctor's morale, as the motion had said, it had actually boosted morale and improved unity across the profession.
The Conference Dinner on Thursday evening is something that Somerset usually avoids, preferring instead to strike out on our own to somewhere interesting, so we can chat about what we've heard, and plan what we'll do the next day. As a new chairman, it was a great opportunity to get to know my colleagues just that little bit better. Who would have thought that the Vice-Chair's side dish of choice with shellfish would be macaroni-cheese, for example?
We arrived at the venue on Friday morning to discover that the Somerset motion on workload was the only one to be selected from that section for formal debate (thereby instantly dispelling any hopes your Chairman might have had of a relaxed morning), along with 5 or 6 others related to funding and workforce. Devon had also managed to overturn an Agenda Committee decision that the Firearms Certification debacle should not be debated, and they secured a spot later in the Chosen Motion section.
The main business of the day was the first section- Response of the Profession. This was to gauge the view of conference as to how well it felt the GPFV had answered calls in January at the Special Conference for a rescue package to be produced in 6 months, with the threat of undated resignations if this didn't happen. The Agenda Committee had met with lawyers, and produced a motion (S20) that they felt would be legal, and allow the conference "to have the debate it wants to have". For information, S20 was as follows:
S-20 AGENDA COMMITTEE to be proposed by Tower Hamlets: That conference does not accept the General Practice Forward View is an adequate response to the GPCs statement of need within the BMAs Urgent Prescription for General Practice, and considering this to be sufficient grounds for a trade dispute, unless the government agrees to accept the Urgent Prescription within 3 months of this conference, the GPC should ask the BMA to:
1. ballot the profession on their willingness to sign undated resignations
2. ballot the profession on their willingness to take industrial action
3. ballot the profession as to what forms of industrial action they are prepared to take
4. produce a report to practices on the options for taking industrial action that doesn’t breach their
contracts
The overwhelming view was that there was simply not enough urgency- that jam tomorrow was irrelevant if the need was for bread today. There were too many hoops and hurdles for practices to jump through. GPs knew how best to manage their funding and what was likely to work best for them and their patients, so why not just increase the global sum and get on with it. Several GPC members spoke against the motion, warning that failure to secure the sort of extraordinary 98% figure achieved by the Juniors would be seen as a sign of disunity, and that it would be much harder to get public support. Chaand reminded delegates that they were the democratically elected representatives of the 40,000 GPs unable to be there. What would they want the conference to decide? He said that was worried about what was happening back in his practice when he wasn't there- were they coping?
After a meaty discussion it was agreed that GPs will be balloted on their willingness to sign undated resignations, their willingness to take industrial action and also what forms of action they would be prepared to take. As in (4) above- they will also help practices by producing information about what they are able to do, whilst avoiding breaching their contracts. The 64 million dollar question is what the GPC does with this next.......
Karen spoke next for Somerset, in one of the selected motions in favour of seeking a suspension of PMS redistribution and MPIG erosion. Perhaps wary that she didn't have her most sparkly conference shoes on (quite an intricate leather design this year, since you ask), she nevertheless gave a strong performance and made her points well, turning to address the leaders of the GPC and the Chairman directly. The motion was passed.
Your Chairman proposed the chosen motion on workload, arguing that there was an urgent need for clarity as to what actually constituted the core contract, so that sinking practices could decide what they could throw overboard to help survival. He (me) also demanded that additional work needed additional resources, and that the government should be pushed on how to control public demand. That motion was also passed overwhelmingly.
Devon's motion on Firearm Certification, calling on the BMA Professional Fees Committee to sort the situation out, and for the GPC to support GPs not participating in the process was carried in all it's parts. GPs from the leafier shires were all vociferous in condemning this unfounded and potentially lethal scheme. The fact that the motion was up for debate at all was a triumph for democracy, and Dr Anthony O'Brien (Devon) in particular, who had previously been glimpsed remonstrating with the agenda committee on several occasions.
The last of our team to speak was John- who was very eloquent in making the point that the GPC reform is desperately needed, particularly in respect of its presence on social media, and the need for a website.
It is quite something to stand up at the Conference, in front of 360 of your more vocal and outspoken peers, the great and the good of the GPC and BMA, the medical press and other observers, and hold forth on topics that may or may not be the closest to your heart, but rest assured that your Somerset colleagues did you (and your Chairman) proud. More importantly I think we all had a lot of fun in the process, and fully deserved that "sharpener" to settle our excitement at a job well done as we enjoyed the trip back to Somerset. Thanks as ever to Jill for all her organisation, encouragement, support, and Tweets!
This felt a significantly more important and relevant conference than any I have attended in the past. Quite what the state of the profession, locally or nationally, is by the time the next one comes round will probably determine how successful it turns out to have been.
Dr Nick Bray
May 2016
