LMC Conference GPC Chair - Richard Vautrey started by thanking the chairs of the devolved nations for their support. He pointed out that they have worked with the UK GPC to support the national agenda. - He talked about the dedication & commitment of doctors, but warned that those qualities should not be exploited. Tired doctors are not safe, but the system continues to be unsafe. Lessons are not learned from mistakes, he referred to the recent actions of the GMC. He called for the system to change to reduce the risks doctors face, referring to the new contract in Scotland and suspension of QOF in Wales. Pharmacists have been recruited to practices in Northern Ireland. - The GP forward review scheme remains underfunded. - Every practice should have a linked pharmacist. - The is an ongoing increase in mental health problems, but there is insufficient resource with waiting times going up. Therapists should be linked to practices as part of rebuilding the primary care team. - GPs are almost unique in having to pay their own indemnity. The winter indemnity scheme is due to finish despite pressures not going down. There should be equity with hospital colleagues. There should be a comprehensive scheme covering all GPs and staff. - Premises costs are making practices unviable, particularly with NHS Property Services. The costs are stopping new doctors applying for partnerships. The new Scottish contract addresses some of these issues. Commissioners are burying their heads in the sand. - It is resilient practice partnerships which are the foundations on which the NHS is built. - He condemned the performance of Capita. - The registered list may be under threat, he referred to services in London cherrypicking healthy patients arguing that that is not what the NHS should be doing. - The government has launched a project to re-invigorate the partnership model, but GPs are still starved of funding. This underinvestment has been the cause of the fall in GP satisfaction ratings. 1
- The government has used any excuse to avoid proper investment (banking crisis, Brexit etc). There needs to be an end to the attrition in GP pay. - The service needs to funded properly to meet the increasing needs of patients. The funding needs to be recurrent. - The majority of increased NHS funding is swallowed up by hospitals, leaving General Practice starved. If practices fail, so will the NHS. - GPs are stronger together and that is the only way to make things better. Motions MOTION 7 - AGENDA COMMITTEE TO BE PROPOSED BY HAMPSHIRE AND ISLE OF WIGHT: That conference believes the partnership model to be the most efficient and cost-effective way of delivering general practice and demands that government: - (i) does everything possible to support and sustain this model - (ii) invest in an incentive scheme to encourage GPs into permanent roles - (iii) needs to explore all avenues to encourage older GPs to remain in practice - (iv) encourage non-gp staff to become partners to further increase the sustainability of the partnership model. The proposer pointed out that the partnership model was flexible and resilient. A speaker against felt that the section caller for incentives to encourage people into permanent roles undervalued locum & sessional GPs. A speaker in favour referred to the loss of senior GPs and the disincentives to continuing. Another speaker against questioned the wisdom of encouraging non-gp staff to become partners. It is investment in GPs which is needed now. Another speaker said that she has not noticed any tangible change from recent initiatives. The first three parts of the motion were carried, the fourth part was rejected. 2
MOTION 8 - AGENDA COMMITTEE TO BE PROPOSED BY NORFOLK AND WAVENEY. That conference acknowledges the increased role played by allied health care professionals within the practice team, as a result of the GP workforce crisis, and calls upon the GPC to demand: - (i) full, recurring and direct reimbursement for their employment costs - (ii) an extension to the sickness reimbursement scheme for key practice staff - (iii) that GP practices are funded to provide a formal support structure for them The proposer listed the parts of the motion. An opposer felt that the benefits of allied health professionals were overstated and that it was core General Practice which need to be supported. A speaker in favour described the benefits his practice had seen from using a paramedic to manage house calls. Another opposing speaker saw a risk to the independent contractor status in this motion which would reduce the scope to recruit flexibly to meet their needs. He also felt that practices did not have the resources to support several different AHPs. as a reference (meaning the spirit is supported, but it does not form policy). MOTION 9 - AGENDA COMMITTEE TO BE PROPOSED BY AVON: That conference is concerned about the number of recent practice closures and - (i) believes that unmanaged dispersals lead to patient safety issues - (ii) believes that more needs to be done to make the public aware of the mounting threat to the system of general practice 3
- (iii) demands details of the contractual arrangements to provide ongoing primary care a er a practice closure, are made public - (iv) instructs GPC to take urgent action to ensure the protection of last man standing GPs from any additional costs of resignation or retirement resulting from practice closure The proposer talked about the threats to practices and increasing closures. Another speaker referred to the difficulties in Plymouth where 15% of the population does not have a regular GP. unanimously MOTION 10 - Report on Scottish GMS contract Alan McDevitt talked about the importance of trust. QOF has been abolished. Clusters have been encouraged, but are not contractual. MoUs were agreed between parties. Care at home is a key principle, and GP investment has been agreed. There was a major engagement process. The contract framework was sent to doctors and widely supported. The contract is due to come into effect on 1st April, and be fully implemented by 2021. There will be a 250m increased investment annually by 2021. The GP is to become an expert generalist, concentrating on undifferentiated presentations, complex problems and leading the primary care team. There will be no loss of income to GPs, despite some services (e.g. vaccination) being moved to a national service. Practitioners will be protected from last person standing liabilities and health boards will be able to take on premise leases. There will be protections against data protection liabilities. He likened the scheme to Don Berwick s third era of medicine. 4
MOTION 11 - CUMBRIA: That conference believes that there is much to be gained by examining the Scottish Contract offer and how elements of it could be incorporated into the English contract negotiations. The proposer called for examination of the Scottish offer, referring to the winter problems recently experienced in his practice in Alston. Another speaker felt that the promises of the GP forward view have not materialised. MOTION 12 - NORTHAMPTONSHIRE: This conference demands that GP premises are fully resourced to meet the demands and needs of the population of the UK. The proposer described the continuing failure of the government to make good on its premises investment promises. Meanwhile the standards of premises continue to deteriorate and cannot support new ways of working or the increase in population. Another speaker called for stamp duty land tax reimbursement to be made available to those not in NHS Property Services premises. A further speaker condemned the NHS Property Services service charges. MOTION 13 - Report from GPC Wales Charlotte Jones talked about the move to developing cluster-led services in Wales. The GP contract for 2018/19 is close to sign off - There will be improved indemnity arrangements There has been an IT reprocurement, EMIS decided not to meet the spec, forcing many practices to change systems. 5
There is continuing pressure on OOH services, staff are treated as employees for tax purposes, but do not have the associated employment rights. Transgender services have been contracted as an enhanced service. This is changing to contracting with a number of specialist GPs directly. MOTION 14 - Report from GPC Northern Ireland Tom Black told us that General Practice funding is at its worst in Northern Ireland. The GPC continues to collect undated signatures. Practice pharmacists are fully funded in NI. Practice numbers have dropped by 10%, the vast majority being GMS. He referred to a miracle of delivery coming from General Practice every day despite the pressures on it. He felt that GP professionalism was not reciprocated by those in power. The NHS must not be taken for granted and the case for it needs to be constantly remade. MOTION 15 - AGENDA COMMITTEE MOTION TO BE PROPOSED BY HERTFORDSHIRE: That conference is concerned that new online GP services are targeting healthy, less complex patients, the funding for whom is partly used to subsidise care for more complex patients on the registered list and calls on GPC to: - (i) demand a stop to the undermining of general practice by private companies who cherry pick the patients to whom they offer services - (ii) demand that online consultation schemes do not become established unless they are prepared to provide a comprehensive package for all patients - (iii) support general practice to explore innovative ways of providing health care - (iv) demand the allocation of additional funds to NHS general practice to provide training, support and appropriate so ware and hardware in order to establish on 6
line consultation services. The proposer condemned the cherry picking of patients shown by GP At Hand. GPs should however embrace online consulting. An opposing speaker felt there were unintended consequences of section (iv), he felt that accepting the money would oblige GPs to implement the service when their priorities might lie elsewhere. Another speaker reflected on the requirement to provide a comprehensive service and that GP At Hand fails to do so. A GP who works for GP At Hand claimed that the service was being misrepresented, she appeared to conflate the service she was representing and online consulting as a whole. MOTION 16 - AGENDA COMMITTEE TO BE PROPOSED BY BEDFORDSHIRE: That conference with respect to the GDPR (General Data Protection Regulation): - (i) believes that GPs feel highly exposed to the GDPR - (ii) believes that it is no longer sustainable for the GP to be the sole data controller - (iii) calls on GPC to urgently explore the possibility of commissioning health organisations having one data protection officer for all GP practices in their area - (iv) calls on GPC to negotiate with governments a review of the application of GDPR to general practice - (v) demands an appropriate uplift in the core contract to reflect the resulting impact of the new regulation. The proposer advised us of the new higher fines for data breaches in the GDPR regulations. 7
A speaker against the motion warned us about the risks of sharing data control with NHSE. THEMED DEBATE - CONFERENCE OF ENGLAND LMCs: That conference: - (i) believes tired doctors are potentially unsafe doctors. - (ii) calls on GPC England to issue guidance to support GPs to limit their working day to ensure patient safety. - (iii) calls on NHS England and the government, working with GPC England, to make patients aware of the importance of reducing GP workload to safe levels. - (iv) believes GPs should be supported to say NO without feeling guilt. The proposer talked about the impact of uncontrolled workload and encouraged GP to work out what was safe for them. Several speakers strongly supported the motion from the floor. The term make it real and put it in the contract cropped up several times. Several speakers felt that the future of the GPs service was at serious risk if things did not change. Another speaker felt that is was inappropriate to restrict control over workload to practice settings as the same risks apply to other settings such as OOH. Hub models were cautioned against as they do not enhance continuity of care and divert GP resource away from practices. One GP gave a very moving account of her experience of burnout. - The debate concluded by asking us to support 5 statements: Agree the principles outlined in the BMA paper Workload Control in General Practice behind safe working and work with other organisations to promote its introduction. 8
Undertake further work to specify precise safe limits to workload in practice settings (Expressed in appointments, time or list size). Produce resources for practices and locality groups with examples of how this model of working can be introduced. Endorse a locality approach which supports groups of practices or LMCs in setting their own safe limits. Collect and publish of hub-based working and workload control from around the UK. - The statements were supported, though there was some divergence of opinion on statement 3. MOTION 24 - THE GPC: That the GPC seeks the views of conference on the following motion from the GP trainees subcommittee: That conference is concerned by the 3+1 proposal from the Shape of Training report for GP Trainees and calls on GPC and the BMA to: - (i) oppose mandatory post-cct jobs - (ii) work with relevant bodies to improve current training and make hospital jobs for training and not for service - (iii) pressurise programme directors to withdraw GP trainees from units that do not offer trainees regular clinics (if applicable eg A&E), reasonable study leave opportunities and formal teaching. The proposer described the 3+1 training system, where fully trained GPs are being forced into jobs in psychiatry with undetermined status. This has been pushed through in Scotland. with part (iii) as a reference MOTION 25 - THE GPC: That the GPC seeks the views of conference on the following motion from the GP trainees subcommittee: That conference finds out of hours training for GP trainees requires stringent guidelines and restructuring so it calls upon GPC to work with relevant bodies to ensure: 9
- (i) a minimum of 6 weeks notice is provided for shifts - (ii) the supernumerary status of trainees is recognised - (iii) direct supervision of trainees is performed by a GP, whilst working in GP out of hours - (iv) the trainees can choose the shifts they work - (v) trainees can access opportunities to work with other out of hours services in a shadowing capacity, to achieve their curriculum competencies. The proposer described his experience of OOH work as a trainee which was positive and led him to follow a career in OOH. Faye Wilson opposed part (iii) which she said was ambiguous and that direct supervision (GP in the room) was inappropriate, particularly with more experienced trainees., with sections (iii) & (v) as references MOTION 403 - That conference, following the recent case of Dr Bawa-Garba: - (i) has no confidence in the GMC as a regulatory body - (ii) directs GPC to advise GPs disengage from written reflection in both appraisal and revalidation until adequate safeguards are in place - (iii) request the Health Select Committee review the GMC s conduct regarding this case - (iv) mandates the GPC to implement a system urgently whereby GPs can make collective statements of concern regarding unsafe care Zoe Norris made an impassioned proposal of this motion. One speaker cautioned against passing a motion of no confidence in the GMC overwhelmingly, even part (i) despite warnings to the contrary. 10
MOTION 26 Friday, 9 March 2018 - THE GPC: That the GPC seeks the views of conference on the following motion from the GP trainees subcommittee: That conference calls upon GPC to work with RCGP e-portfolio and revalidation portfolios to ensure GP trainees and GPs are made aware their reflections can be used against them in court. MOTION 27 - AVON: That conference is concerned about the number of gross negligence manslaughter trials which involve members of the medical profession and calls on GPC to work with the BMA and other relevant organisations to petition the government for less adversarial approach to adverse events that recognises the importance of system failures and seeks to learn rather than blame. The proposer argued that it was inappropriate to scapegoat doctors who make mistakes as a result of working in an unsafe system. A further speaker called for investigation to be more similar to the process used by the airline industry. MOTION 28 - MID MERSEY: That conference is concerned that assessment of GPs and practices performance may be based on unreasonably high standards, insists that any such assessments must be based on the typical achievement of peers and must take into account both workload and funding constraints, and asks that GPC takes appropriate steps to help establish real world benchmarks that reflect current normal standards of practice. A speaker described his experience of dealing with a complaint where he had only made a short record due to lack of time Another speaker asked if we all knew all the NICE guidelines intimately unanimously 11
MOTION 29 Friday, 9 March 2018 - MID MERSEY: That conference is concerned at the very significant impact on practitioners and practices subject to NHS Performance Investigation and at the lack of independent oversight or accountability of NHS Medical Directorates, and asks GPC to undertake or commission research to determine the total number of practitioners and practices investigated per year, the range of reasons for such investigations, the typical timescales for completion of investigations and the range of outcomes, and also to obtain and collate the views of practitioners and practices that have experienced such investigation. MOTION 31 - AYRSHIRE AND ARRAN: That this conference: - (i) views with alarm moves to further restrict GPs prescribing of medicines that are available over the counter (OTC) rather than by efficacy - (ii) is appalled that no account has been taken of patients in remote and rural areas where there is no counter available over which to buy such OTC medicines - (iii) calls on the relevant health bodies throughout the UK to ensure that patients are not disadvantaged by restrictions to provision of medicines either through poverty or simply because of where they live - (iv) demands that the GP contracts are amended to permit doctors who dispense to be permitted to provide OTC medicines to their patients other than by prescription. The proposer pointed out that the proposals were contrary to the principles of the NHS.. 12
MOTION 32 - AGENDA COMMITTEE TO BE PROPOSED BY CONFERENCE OF NORTHERN IRELAND LMCs: That conference welcomes the recent hospital contract changes in England and further insists; - (i) on the implementation throughout all of the four nations - (ii) that hospital discharge summaries and clinic letters conform to a national standard and name the responsible hospital clinician, thus improving communication and therefore patient safety - (iii) that the commissioners must ensure that the responsible hospital clinician acts upon the results of patient investigations whilst in hospital, outpatients or at accident and emergency departments - (iv) that GPC negotiate a tariff system which can be used to assign value and, consequently, payment to work carried out by practices, which should be done by secondary care providers - (v) on the imposition of sanctions on trusts that are not compliant with the Hospital Standard Contract The proposer called for standardisation of these arrangements across the UK - Parts (i)-(iv) were carried, part (v) was lost. MOTION 33 - HERTFORDSHIRE: That conference believes that the survival of the profession should take precedence over the survival of the NHS. The motion was carried 13