Politics - Should GPC be wound up?

SHOULD GPC BE WOUND UP?

Such an idea may well be thought to be heresy especially coming from a long-standing member of the BMA Council but close observation over the past ten or fifteen years has made me wonder what GMSC/GPC has achieved.

Under a disastrous series of leaderships from Dr Michael Wilson, through Dr Ian Bogle and culminating in Dr John Chisholm general practice has sunk lower and lower until it is now, finally and possibly irretrievably fragmenting into tiny pieces.

Mind you, none of these lack-lustre leaders could have achieved their aims without the security of almost sycophantic committees behind them.   Committees which seemed to always, when push came to shove, quietly go along with whatever the leadership said.

An outstanding example of this came in March 2003 when the present negotiators set a special LMC Conference to announce to GPs (and the world, at a preceding press conference) the enormous financial benefits to GPs of the Carr-Hill formula.

It appeared that the negotiators had neither understood nor tested the formula but even before the press conference GPs in their shoals had and phoned in to complain about potential multi-thousand pound losses to their practices.

The Chairman, with appalling political judgement, declined to cancel the press conference and the meeting went ahead.   Afterwards the committee, rather than severely censure and perhaps remove the negotiating team or its leader, seemingly endorsed their position and quietly let them get on with it.

And again, two weeks later a Special LMC Conference was so unhappy with the proceedings that it demanded six more months for negotiations only to be ignored the following day by the negotiators who said they could do it in two weeks.  The tame GPC huffed and puffed and immediately backed down, reneging on the will of the LMC Conference and allowed the team their way. And, of course, let their constituents down.

The result was an unfinished, unpriced and well-spun contract which the committee agreed to persuade GPs to accept.     The damage limitation exercise continues to this day.

A committee that provides no checks and balances on a leadership which is plainly out of control is worse than no committee at all.

But all this is recent history.  What about the past?    There can be no argument about the failures of previous general practice leaders.   Had they been successful then general practice would not be in the sorry state that it is, with declining morale, declining numbers, poor recruitment and early retirements.

Indeed, if general practice was a patient it would be on the critical list.   Yet the treatment it received has not been life-saving but life-threatening.

Back in 1989 many of us will remember that the profession was already in crisis.  The grass roots made threats of resignations and this was emphasised by an LMC Conference before New Contract negotiations began.   GPs were stirred up.

Kenneth Clarke proposed Contract Mark I which was received, to put it mildly, unfavourably by the profession yet Dr Wilson, GMSC Chairman, let it be known to all and sundry that neither it nor subsequently proposed contracts were “a resignation issue”.   To all intents and purposes that was the end of the matter.  Clarke imposed Mark II, Wilson gave no leadership, GMSC collapsed and general practice took another dive downwards.

GMSC had failed their colleagues again.

Perhaps even more significantly governments learned that GP leaders may huff and may puff for the benefit of their own constituency but they will never bite government.     Wilson put it very succinctly in 1989 when he said, about his GP colleagues’ vigorous antipathy to the negotiations:

“This has pushed our contract issues and how we are paid back into the public arena, back where they never belonged, back to confuse the real debate, the national debate on the NHS review”.

At least he was honest and we knew where the BMA stood.

Despite, throughout the negotiations, dithering about his personal resignation like a spoiled child Michael Wilson fell to the temptation of standing for re-election as GMSC Chairman and notwithstanding the appalling contract fiasco a supine GMSC allowed him to achieve his ambition.

The decline in morale and numbers accelerated.

His successor, Dr Ian Bogle, several times led GPs up the militant mountain over the monstrous decline in their comparative pay but he always deserted them when it became obvious that battle was looming.   Miniscule pay rises were accepted by the negotiators and rubber stamped by GMSC.

In exasperation I then campaigned for the abolition of GMSC and its replacement by a democratic committee.   GPC was born but it was emasculated at the start by a GMSC, under Dr Chisholm, who arrogantly ensured that fewer than 50% of GPC members would be directly elected by regional GPs.

It was possibly out of this self-interested failure that the disaster of today's contract was born.

Dr Chisholm did nothing in his early years to improve morale but nevertheless he unaccountably received a CBE from the government. Morale, recruitment and retention reached crisis point to the extent that 80% of the profession voted to go for resignation if a satisfactory contract did not come out of the forthcoming negotiations.

Once again ignoring this and after outstandingly incompetent conduct during negotiations his team came up with a contract which potentially sets partner against partner, GPs and PCOs at loggerheads and provides an open door for the authorities to trample over practices whilst, at the same time, destroying that great British institution, family general practice.

The negotiating team even failed to secure sole negotiating rights on behalf of all GPs.

Despite all this, the committee sycophantly in childish awe of the leaders agreed to recommend the contract.

Workload increased, retention and recruitment appear to have been unaffected and nobody seems very clear about the financial aspects.

And still the emasculated and awestruck GPC failed to provide leadership and, instead endorsed everything the leaders threw at them even to the extent of electing one of the past team of failures as future leader

Surely GPs have waited and suffered long enough. GPC should be wound up and replaced by a much more democratic and efficient trade union body.

(A truncated version of this article will be published "as a letter" in one of the papers shortly)

(9/8/04)