Resolutions of the Conference of Local Medical Committees
June 2003
1. That following the unanimous resolution at this year's special LMC conference calling for unity of the profession, this conference calls for the GPC to be recognised by the government as the sole national negotiator for all forms of general practitioner contracts.
2. That conference:
(i) supports the actions of the GPC following the special conference of representatives of LMCs held on 14 May 2003
(ii) welcomes the significant advances made in the new contract following the special conference of representatives of LMCs held on 14 May 2003.
3. That conference reminds the GPC that conference exists to formulate policy which the GPC endeavours to implement calls for an urgent reassessment of the relationship of the GPC and the LMC conference.
4. That conference believes that whilst the GPC negotiators undoubtedly worked hard to negotiate a new GMS contract the GPC must use professional negotiators in a leading role in all future negotiations with the government or its agents on any future contractual and remuneration issues.
5. That conference agrees it is unhelpful to insist on the publication of plan B unless GPC believes it is necessary and withdraws parts (i) and (ii) of resolution number 28 of the special LMC conference held on 14 May 2003.
6. That conference supports nationally negotiated pay and conditions whatever the outcome of the ballot.
7. That conference insists that whatever the outcome of the ballot, general practice must remain at the centre of a national health service free to all patients at the time of need.
8. That if the new GP contract is rejected conference urges the GPC to:
(i) actively publicise alternative methods of contracting
(ii) arrange a further special conference of LMCs as soon as it can be arranged to discuss further contract options. (as a reference)
9. That conference believes that the quality aspects of the contract are well thought out and should form the basis of the final contract.
10. That conference deplores the continuing refusal of government to recognise a national negotiating structure for PMS GPs insists that PMS practices must have a national structure for negotiating core contracts and remuneration.
11. That conference, following John Hutton's letter, dated 5 June 2003, to all PMS GPs:
(i) finds ministerial delay in informing PMS practices about the effects of the proposed GMS contract on PMS until after the ballot was underway unacceptable
(ii) insists on clarity, by September 2003, on the exact mechanism and funding for those returning to GMS
(iii) on the basis that PMS remains a "separate, permanent, voluntary local option" seeks clarity from the government, by September 2003, as to whether the PMS practices who have been put on a "mainstream statutory basis" will have a permanent option to return to GMS at any time
(iv) believes PMS GPs should be entitled to an MPIG
(v) asks the GPC to ensure that a return from PMS to GMS is made as easy as possible.
12. That conference demands an end to the inequity arising from growth monies being available solely to PMS practices but not to GMS practices and requires an equitable process for allocation of these funds to all practices regardless of contractual status.
13. That conference:
(i) deplores the financial arrangements in PCOs whereby additional resources intended for general practice can be diverted elsewhere
(ii) believes that strategic health authorities should ensure that primary care trusts invest the majority of new NHS resources in primary care, rather than use them to fund secondary care deficits
(iii) requests robust funding arrangements to ensure that resources announced for general practice actually reach their intended destination
(iv) instructs the GPC to ask the Department of Health to insist that PCOs publish a full breakdown of their current and planned expenditure to meet the requirements of HSC2002/012
(v) instructs the GPC to demand that PCOs publish quarterly their expenditure on general practice.
14. That conference:
(i) demands that funding streams from the Department of Health should be clearly labelled, unambiguous and only attributed once
(ii) instructs the GPC to lobby the government for better identification of the various funding streams for primary care, with a view to avoiding the current confusion, double counting and retrospection
(iii) demand that the national audit office be asked to investigate the disappearance of monies which the Departments of Health say have been given to PCOs for specific purposes
(iv) insists that all financial allocations to PCOs are communicated to LMCs in a transparent manner.
15. That conference:
(i) strongly supports the principle that GPs should be fully reimbursed for all expenses incurred whilst undertaking non-practice work for NHS bodies
(ii) urges GPC to persuade the government to provide realistic and fair remuneration to GPs who serve NHS bodies in an advisory capacity, whether as members of PCO boards or executive committee, research ethics committees, or as advisors to complaints convenors or independent review panels.
16. That conference supports the general uplift of allocations of practices, rather than taking everyone down to the same level.
17. That under the new contract no practice should be required to increase their current workload to maintain their current income.
18. That conference asks the BMA to produce a report on recent research or, in the absence of recent research, report for proposals to assist the GMC in stating the safe number of patients that can be seen in the average working day by general practitioners.
19. That conference considers that the government is not doing enough to encourage older doctors to stay in the profession and:
(i) requires the application of enhanced payment to all GPs over the age of 60 to help with the workforce crisis
(ii) demands renegotiation of the minimum average GP earnings to qualify for seniority pay
(iii) requires that urgent consideration be given to increasing significantly the higher levels of seniority payments
(iv) believes a GP who has taken a career break of four weeks for pension purpose should be automatically entitled to seniority pay on returning to an eligible post.
20. That with regard to the golden hello scheme, conference:
(i) instructs the GPC to renegotiate it in such a way that a significant element is related to the length of time a practice vacancy has existed and to the ratio of clinical staff to patients in the practice involved (as a reference)
(ii) notes the level of "golden hellos" received by the Defence Medical Services doctors and urges the Department of Health to introduce a similar level of payment for NHS general practice.
21. That the GPC seeks the views of conference on the following motion from the GP registrars subcommittee: That the BMA should highlight the current situation whereby doctors feel compelled to go to work when they are unwell therefore:
(i) risking their own well being
(ii) risking the welfare of the patients
(iii) adequate provision should be made such that doctors may take sick leave without undue pressure being placed on their colleagues or the service.
22. The GPC seeks the views of conference on the following motion from the non-principals subcommittee: That conference calls for the maternity, paternity and other special leave, sick leave and education of all primary care staff to be paid centrally, to ensure recruitment and retention of staff and to ensure good human resources practice.
23. That conference believes that the White Paper Partnership for care will fail to achieve the desired significant service redesign unless:
(i) LHCCs/CHPs are given real influence over the deployment of resources by NHS boards
(ii) Secondary care clinicians are brought into LHCCs/CHPs.
24. That conference deplores the waste inherent in the bureaucratic change from local health groups to local health boards in Wales whilst maintaining the reduced level of involvement of general practitioners as compared to their English counterparts.
25. That a conference website be established to provide representatives and LMCs with an opportunity to propose motions or issues for debate.
26. That conference may include debates on major issues, chosen by the agenda committee after consultation with LMCs, which are introduced by speakers "for" and "against" the proposition. Those introducing the debate may be selected from those not otherwise entitled to attend conference.
27. That conference may include "themed debates".
28. That conference wishes to restrict the number of motions in "subject debates".
29. That the conference agenda should include a period, not exceeding one hour, reserved for representatives of LMCs to ask questions of the GPC negotiating team.
30. That conference welcomes the proposal that the chairman of GPC subcommittees and their supporting staff make themselves available at a specified place and time to meet representatives.
31. That conference requires the GPC to investigate and report to the 2004 annual conference on the feasibility of introducing electronic voting on motions except where a recorded vote is demanded under standing order 16(d).
32. That standing orders be amended, with effect from the 2004 annual conference, to accord with those resolutions passed relating to the paper "Modernising the Annual Conference of LMCs - the next steps".
33. That standing order 2 be amended to read: "A special conference of representatives of local medical committees may be convened at any time by the GPC, and shall be convened if requested by one sixth, or if that is not a whole number the next higher whole number, of the total number of LMCs entitled to appoint a representative to conference. No business shall be dealt with at the special conference other than that for which it has been specifically convened".
34. That standing order 3(b) be amended to read "365 representatives of local medical committees".
35. That standing order 3(j) be deleted.
36. That standing order 3(k) be deleted.
37. That standing order 4(b) be deleted and replaced with: "The agenda committee shall each year allocate any remaining seats for representatives amongst LMCs. Allocation of additional seats shall be done in such a manner that ensures fair representation of LMCs according to the number GPs they represent. Each year the agenda committee shall publish a list showing the number of representatives each LMC is entitled to appoint and the method of allocating the additional seats.
38. That standing order 4(d) shall be replaced by "Representatives shall be registered medical practitioners" appointed at the absolute discretion of the appropriate local medical committee".
39. That in standing order 4(e) "elected" be replaced by "appointed".
40. That standing orders be amended to include at 6(a) "A local medical committee is a committee recognised by a PCO or PCOs as representative of medical practitioners under the NHS Act 1977 as amended or by equivalent provisions in Scotland, Wales, and Northern Ireland."
41. That standing orders be amended to include at 9(f)(iii) "The allocation of representatives in accordance with standing order 4(b)".
42. That lay executives of LMCs should be permitted to speak to all business of the annual conference at the request of their LMCs.
43. That conference while welcoming the changes to the proposed contract achieved in the past month:
(i) condemns the four governments' insistence that GP core work must be further devalued to fund the changes
(ii) continues to believe that the daily care of patients who are ill or believe themselves to be ill is worth more than £51 per patient per year
(iii) finds the proposal that in the year 2005/06 the reduced global sum will be uplifted by only £1 per patient, without adjustment for inflationary pressures completely unacceptable
(iv) instructs the GPC, should the contract be accepted, to negotiate an annual uplift to the global sum which as a minimum will cover inflation and increases to the cost of employing staff.
44. That conference insists that full quality and outcome payments under the GMS contract be paid to practices from the first quarter of 2004.
45. That conference believes that the Carr-Hill formula is fundamentally flawed and should not be used to underpin GP remuneration until it has been peer reviewed and validated, is backed by reliable data and is proven to be sensitive to GP workload.
46. That conference believes it is deplorable that since LIFT has been announced PCOs have not allocated any funds for improvement grants or cost rent schemes, thereby denying practices the opportunity to improve premises to DDA directive standards. (as a reference)
47. That more needs to be done in allowing suitably qualified refugees and asylum seekers to work in the medical field, especially at a time of shortage in the UK medical workforce.
48. That to ensure full indemnity for general practitioners conference asks the GPC to seek clarification of the indemnity position for GPs working:
(i) for PCOs
(ii) under practice based contracts.
49. That conference believes that:
(i) a practice or a GP must have the right to close their list without enforced allocations ensuing
(ii) while enforced allocations continue when practice lists are closed, a supplementary capitation fee should accrue
(iii) GPs should continue to be able to remove patients within 7 days of an enforced allocation deemed to be inappropriate by the practice.
50. That conference:
(i) urges the GPC to sponsor a change in legislation to ensure that GPs providing services for violent patients do not find themselves in contractual jeopardy
(ii) insists that PCOs, in consultation with LMCs, must allocate an adequate budget to provide secure facilities for treating violent patients
(iii) requests the GPC to ask the Home Secretary to order all police authorities to co-operate with the NHS in the setting up of safe haven schemes for treating violent patients
(iv) requires PCOs to be given legal immunity should relevant patients refuse to avail themselves of specific services for violent patients
(v) insists that zero tolerance in the NHS should be the same in primary care as in secondary care.
1. That conference believes that the GPC should take every step to ensure that the proposed changes to death certification do not impose extra and unnecessary burdens on family doctors.
2. That conference believes that the continued ban on 'opted out' GPs providing medical care to their patients on a private basis during the hours for which they have no contractual responsibility represents
(i) a missed opportunity to improve the provision of primary care to working patients (as a reference)
(ii) a triumph for dogma over flexibility (as a reference)
(iii) an infringement of the basic freedoms of patients and GPs (as a reference).
3. That whenever money for proposed enhanced services is not forthcoming, GPs should be allowed to provide these services to their own patients on a private basis.
4. That conference welcomes the recent Audit Commission report on targets and strongly agrees that they distort clinical priorities and could harm patients.
5. That conference reaffirms the fundamental principle of the NHS that treatment will be free and according to need, and therefore rejects the proposal that GPs enter into contracts with patients who smoke or who are obese, making free treatment dependent on compliance with the advice given.
6. That whilst conference welcomes the initiative of "Making a difference" to reduce administrative burdens on GPs, its recommendations need to be far more widely publicised and fully implemented.
7. That conference continues to deplore the resources which are being wasted on NHS Direct and NHS 24.
8. That conference calls on government to ensure that any new out-of-hours arrangements:
(i) do not lead to an increase in daytime work for GPs
(ii) maintain the quality of out-of-hours provision
(iii) adequately resources PCOs from new central funding in addition to the monies that will be vired from general practice following opt out of GPs
(iv) subject all out-of-hours providers, including NHS bodies, to the same standards of accreditation (as a reference).
9. That conference supports the role of nurses in the diagnostic aspects of primary care but only with appropriate training and indemnity.
10. That conference is alarmed at the implication of pay scales and the new contractual arrangements for nursing staff set out in Agenda for change and requires a robust mechanism within any future contractual system to ensure that GPs are fully resourced for such increased costs.
11. That conference believes that no government committed to the principle of demand management can sensibly promote targets which actively undermine that principle, and
(i) deplores the governments' continued obsession with providing appointments within 48 hours without any reference to clinical need
(ii) believes it to be anomalous that access targets are confined to GP practices, and requires the governments to equally target improvements in access to other primary health and social care services.
12. That conference opposes the creation of foundation hospitals as it considers that these would create further inequality:
(i) by drawing already inadequate resources away from essential but less commercial areas of NHS provision such as care of the elderly and disabled, maternity and mental health services, and from primary health care
(ii) by destabilising PCOs as commissioners and providers of appropriate services for each geographical area
(iii) by undermining many other NHS hospitals who would lose in competition for staff and facilities
(iv) and calls upon the government to affirm its commitment to publicly funded and provided national health services of high quality for all served by it and working in it.
13. That conference deplores the abuse of emergency ambulances as holding areas for patients unable to access acute hospital beds.
14. That conference:
(i) deplores the lack of progress over many years made with regard to remuneration for clinical assistants and hospital practitioners and GPs working in community hospitals, and
(ii) et again, demands that the GPC takes over negotiating rights for clinical assistants and hospital practitioners and GPs working in community hospitals.
15. That conference wishes to ensure that practices which currently provide services categorised as "Enhanced Services" under the new contract must be able to continue providing such services, if they so wish and must be paid so to do, irrespective of financial pressures on the PCO's budget.
16. That conference supports the concept of intermediate care but insists that it is fully funded with new money and that clinical responsibility over the full 24 hours for patients under these arrangements is clearly defined.
17. That conference insists that:
(i) there is no interference from local authorities in healthcare provision
(ii) that the social care functions of local authorities are devolved to the PCOs by 2005.
18. That conference insists that the GPC should ensure LMCs' continued role in the management of GP poor performance so that:
(i) LMCs' expertise in protecting patients and GPs is not lost
(ii) LMCs are part of PCOs' decision making groups on poor performance
(iii) LMCs are part of each professional advisory group (PAG) or equivalent.
19. That conference demands that the new GMS contract must recognise and remunerate the additional workload arising from caring for patients who are refugees, asylum seekers and where there are language barriers requiring the use of interpreters.
20. That conference considers the proposals for NHS childcare facilities for GPs and their staff to be woefully inadequate and insists:
(i) GPs and their staff should have access to proper childcare support
(ii) that if the Departments of Health are serious about the family friendly NHS they should make adequate provision to support doctors taking time off when their children are sick
(iii) that childcare funds should be used to provide childcare.
21. That conference:
(i) condemns the governments' lamentable failure to persuade the public of the safety of the MMR vaccine which continues to penalise GPs twice
(ii) urges the governments to accept that the target payment system is a significant contributory factor to the continuing lack of parental confidence in the MMR vaccine
(iii) deplores the attitude of the Chief Medical Officers to target payments for immunisations and calls upon the Chief Medical Officers to resign
(iv) insists that exception reporting, including informed dissent by parents, is allowed for all target payments, particularly with regard to MMR
(v) believes that it is indefensible to deny the alternative of separate immunisations to vulnerable children while the public remain unsure of the safety of the MMR vaccine (as a reference).
22. That conference believes that recent information regarding porcine material being used in MRR vaccine production, and the Director of Public Health Medicine (Forth Valley) recommendation that this information must be given to parents, will further compromise uptake of this vaccine and make targets impossible in many areas (as a reference).
23. That conference condemns the failure of the new GMS contract to take into consideration the effect of diseconomies of scale:
(i) which will bring into question the viability of small practices
(ii) which fails to recognise the important of branch surgeries in the provision of accessible health care, especially in rural areas
(iii) which devalues staff working in those affected practices
(iv) and requests GPC UK to continue negotiation with government regarding the including of diseconomies of scale factor in the new contract formula.
24. That conference:
(i) believes that prescribing incentive schemes must be evidence-based
(ii) believes that prescribing incentive schemes must not be directed towards reducing prescribing budgets for GPs
(iii) demands that prescribing incentive schemes must be developed to reward GPs for achieving quality standards irrespective of budgetary savings
(iv) requests that GPs should boycott prescribing incentive schemes which ration healthcare
(v) deplores prescribing incentive schemes developed by some PCOs, which prohibit individual GP practices from accessing primary care development funds in the event of overspending on their prescribing budget beyond a defined threshold.
25. That conference:
(i) demands that GPs should not be expected to issue 7 day prescriptions for patients to receive a monitored dosage system
(ii) demands urgent action to ensure adequate funding for dispensing monitored dosage systems.
26. That conference instructs the GPC to reject the proposal that all correspondence between hospitals and GPs is copied to patients. The extra administrative burden is not necessary and will detract from the flow of information.
27. That conference believes that where clinical letters are copied to patients for their information:
(i) the initiative is fully funded
(ii) the responsibility for dealing with queries arising from the letter lies with the writer and not the recipient
(iii) all clinical letters copies to patients must contain instructions to enable the patient to raise such issues with the writer.
28. That conference:
(i) demands that the governments stop raising public expectations of what primary care can deliver until the current shortage of doctors and nurses has been successfully addressed
(ii) instructs the GPC to mount a public campaign highlighting cuts to primary care services and correcting the governments' 'spin' (as a reference).
29. That conference is opposed to identifiable clinical patient information being held by PCOs on a central server and instructs the GPC to promote a public debate highlighting the potential risks to patient confidentiality (as a reference).
30. That conference regrets the lack of clarity over practices IT funding arrangements currently in place and asks the GPC to work with the Departments of Health to ensure that all PCOs:
(i) have a transparent and open policy to provide practices with adequate IT systems
(ii) comply with the Departments' own guidance on the right of a practice to choose or have input into the choice of IT systems and must not have decisions imposed upon them
(iii) reimburse upgrades of all computers and software every three years, irrespective of the condition of the equipment (as a reference)
(iv) reimburse practices at 100% for all IT equipment (as a reference).
31. That conference deplores the haphazard introduction and inadequate resourcing of GP appraisals and:
(i) records its serious concerns that this will threaten successful GMC revalidation of NHS GPs
(ii) insists that it is adequately funded, such that no GP is out of pocket as a result of participation
(iii) insists that protected time is available for all those involved
(iv) believes that all GPs should be subject to the same regulations and provided with the same funding support for the process.
32. That conference believes that, whilst practices are reliant on the minimum practice income guarantee, the resources for appraisal and protected time should be separate from the global sum.
33. That conference recognises that the current funding of GP training is inadequate and:
(i) calls on the Departments of Health to conduct a comprehensive review of the funding of GP training
(ii) demands that remuneration for training practices should be increased to adequately reflect the time and effort of those involved
(iii) that those who undertake training of special groups, including non UK doctors, those requiring remedial education and pre-registration house officers should receive an additional weighted training grant to cover the extra work required
(iv) believes that retention and recruitment of GPs has been hampered by lack of progress to a conclusion of negotiation on GP educator pay and GP registrars' pay.
34. That conference considers that all postgraduate specialist training must include a period in general practice.
35. That conference calls on the BMA to investigate, and address the serious concerns of discrimination against GP registrars in hospital posts, in particular:
(i) access to study leave
(ii) access to GP orientated training
(iii) compulsory cover for colleagues undertaking specialist training sessions
(iv) inadequate assessment of training needs specific to GP trainees
(v) the culture of portraying general practice in a negative light.
36. That conference believes that the bye-laws of the BMA should be amended so that the two sessions electoral requirement should be waived for a period of not more than 12 months and not in two consecutive sets of elections for those GPs who would normally have complied with this requirement but are prevented from doing so by sickness or absence on maternity leave, have a reasonable expectation of returning to clinical practice sufficient to meet the requirement and intend to do so.
37. That conference believes that the bye-laws of the BMA should be amended so that GPC shall have the power to appoint up to 10 additional voting members to represent categories of GP contractual arrangement or classes of experience which, in the view of the committee, are not otherwise adequately represented.
38. That conference believes that the bye-laws of the BMA should be amended to indicate clearly that 10 members will be elected to the GPC by the ARM of the BMA of whom at least one will have their principle place of work in England, one in Scotland, one in Wales and one in Northern Ireland and that the electorate for all 10 seats will be all voting members of the ARM.
39. That the GPC needs to recognise that approximately one third of its income comes from the levies of PMS GPs and that the representation, activity and staffing of the GPC should more obviously represent this contribution.
40. That conference instructs the GPC to:
(i) resist robustly any of the pension green paper proposals that may adversely affect GP pension arrangements
(ii) make the government aware of the devastating effects that a reduction of the actuarial pension by 5% for every year prior to 65 years of age rather than the present 60 years would have on the GP workforce in the UK
(iii) continue to pressurise the government with the aim of ensuring that GP pension arrangements become equivalent to those of consultants
(iv) pressurise the government to honour its commitment that all locum income be pensionable from April 2001 regardless of progress on the new contract
(v) ensure that all PCO or workforce confederation work becomes superannuable for GP non-principals.
41. That conference requires the GPC and Professional Fees Committee to:
(i) undertake a full assessment of the basis of fees for non-NHS services to ensure that such fees properly reflect the professional time, skill and responsibilities required in carrying out such activity
(ii) negotiate non-NHS fees on the basis of an assessment of the professional time, responsibility and skill required in carrying such activity
(iii) ensure that uplifts in NHS remuneration for GPs are reflected in non-NHS fees
(iv) negotiate an urgent uplift in the "Treasury Rate"
(v) negotiate an adequate fee for benefits agency reports.
42. That conference:
(i) believes that the recently introduced revised DBD forms are no more appropriate than their predecessors
(ii) insists that the recently introduced revised DBD forms are replaced with an appropriately funded and structured mechanism to obtain factual information
(iii) expresses its profound surprise at the assertion of Professor Mansel Aylward that the revised DBD forms are in accord with the Cabinet Office report on reducing GP paperwork
(iv) requires all future revisions of the mechanisms whereby GPs provide information in connection with state benefits to be properly piloted and introduced only after full negotiation with the GPC on both content and funding.
43. That conference demands a reduction in the bureaucracy surrounding supplementary lists as well as the process of GP practices obtaining references for prospective locums (as a reference).
44. That conference demands that all GPs facing a hearing of the General Medical Council should have in the panel sitting in judgment upon them at least one general practitioner still in active practice.
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Last Updated on 19 June 2003
By John BakerEmail: jb@devonlmc.org