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Focus on the role of Local Medical Committees

Updated September 2006

• Contract documentation
• Further information/resources
• Getting started
• LMCs and BMA regional offices
• LMCs and practices
• PCOs and LMCs
• Scotland, Wales and Northern Ireland
• The GPC and LMCs

This guidance has been produced by the General Practitioners Committee (GPC) to help GPs and Local Medical Committees (LMCs) by explaining LMCs’ role under the new General Medical Services (GMS) contract. It is one in a series of GPC guidance notes on the new contract.

Although there may be some differences in process in each of the four countries of the UK, the principles of this guidance note apply to all.

Contract documentation
We would advise all GPs to read the contract document and supporting documentation. The GMS contract regulations, a draft standard contract and the draft Statement of Financial Entitlements (SFE) are also available on the website together with detailed guidance about the new contract from the Department of Health. While many doctors may not wish to read every word of the documentation we would suggest that LMCs and practice managers, at the very least, should become fully familiar with each document. The GPC has also produced a list of frequently asked questions and answers.

The Department has also produced guidance for Personal Medical Services (PMS) practices which LMCs may wish to become familiar with. It is also available on this website.

LMCs will play a key role in the local implementation of GMS2, supporting practices and engaging with Primary Care Organisations (PCOs). This role will be analogous to, but more wide-ranging than, that under the current contract. We have previously issued separate guidance on specific aspects of the new contract that will not be repeated here.

In Scotland, the functions and roles pertaining to LMCs in this paper will apply instead to the GP Sub-committee of the Area Medical Committee. The Scottish Executive Health Department will instruct Health Boards that appropriate resources and funds should be made available to fully support the work of GP Sub-committees in this vital work.

Getting started
Annex 1 sets out the sections of the contract document, Investing in General Practice, the Department of Health’s guidance, Delivering Investment in General Practice: Implementing the New GMS Contract, the GMS Contracts Regulations 2004 and Statement of Financial Entitlements (SFE) which specifically refer to LMCs. This is in addition to the existing responsibilities of LMCs as set out in the GPC guidance note The Work of LMCs in England & Wales. The statutory provisions listed in this document will continue under the Health and Social Care Bill currently before the Westminster Parliament, but be subject to considerable revision.

The GPC and LMCs
As the implementation of GMS2continues, LMCs are best placed to inform the GPC of any local divergence from the national agreement made with the NHS Confederation (NHSC).
The GPC and NHS Confederation have published a protocol for the handling of implementation problems that arise at local level. It is published in Annex E of the Department of Health’s guidance Delivering Investment in General Practice: Implementing the New GMS Contract. It is hoped that the protocol will help deal with misinterpretations of the contract and manage rumour. This protocol suggests that “wherever possible, solutions should be sought at local level. This avenue should be exhausted before other interventions are instigated.” The role of LMCs is vital in this regard, however “if a problem cannot be resolved at local level, the LMC, practice or GP should write to the GPC setting out the problem. The GPC will then take it to the relevant country’s Implementation Co-ordination Group, which includes a GPC representative.”

Therefore, in the event that a problem occurs, it is desirable that every attempt be made to resolve this locally between the practice or LMC and PCO, if necessary utilising the Strategic Health Authority, or its equivalent. The LMC should be involved in this process as appropriate.

In the event of an unsatisfactory resolution at local level, the GPC will raise issues with the NHS Confederation or the relevant Department of Health. This will require the submission of appropriate evidence, usually in writing.

In Scotland, Wales and Northern Ireland, the national GPC secretariat can raise issues at the regular meetings with the devolved administrations or the Northern Ireland Office.

PCOs and LMCs
In England, all Strategic Health Authorities have identified a member of staff to lead on GMS2 implementation and they are responsible for performance managing Primary Care Trusts (PCTs). PCTs should now have in place implementation apparatus with LMC representation.

A number of LMCs have appointed dedicated PCO liaison managers to develop better communication with LMCs and these are often experienced former PCO Primary Care Development Managers. Others have strengthened their existing liaison mechanisms.

It has become clear through discussions that the NHS Confederation has had with PCOs that they would welcome examples of how their colleagues are tackling some of the challenges presented by the new GMS contract. They are therefore collecting examples of good practice in the commissioning of enhanced services and in the innovative re-provision of out of hours and will be producing a briefing as part of their wider programme of support to NHS Confederation members.

It would be valuable for LMCs to send GPC-produced guidance notes to their PCOs. This would hopefully aid understanding between LMCs and PCOs and prevent misinformation being disseminated locally.

Scotland, Wales and Northern Ireland
Separate implementation arrangements have been established by the Scottish Executive Health Department, National Assembly for Wales and Northern Ireland Department of Health, Social Services and Public Safety. The details of the relevant implementation leads and structures in Scotland, Wales and Northern Ireland can be found in annex 3. If you have specific queries pertaining to these, please contact the relevant GPC secretariat in the National BMA offices in the first instance:

• SGPC - Carrie Young - email: cyoung@bma.org.uk
• GPC Wales - Donna Martin - email: dmartin@bma.org.uk
• Northern Ireland GPC - Zoe Collins - email: zcollins@bma.org.uk

LMCs and BMA regional offices
There are aspects of the new GMS contract and its implementation that will impinge on the services provided by BMA Regional Offices – for example, in the areas of premises, vacancies and practice splits, practice assignment and choice of practice, partnership agreements and strengthening liaison with practice managers. In view of the professional advice available to individual GPs, it is important for there to be good liaison and communication between LMCs and local BMA offices. A number of LMCs have established regular meetings with their local BMA Industrial Relations Officer(s) and we would encourage others, that have not yet done so, to do the same.

We have recently confirmed that GPs who are BMA members can seek advice from their local BMA office before signing their new contract with the PCO.

LMCs and practices
In order for practices to maximise their performance and derive the greatest benefit from the new contract, it is vital that practice managers are in receipt of the most up-to-date information on implementation.

Establishing or strengthening liaison with practice managers and practice manager groups will be crucial to successful local implementation. Sharing best practice and arranging visits to well-organised surgeries would be a way to facilitate this.

If there is a particular practice, or practices, in your area which require additional support some PCOs offer Practice Manager Mentoring Schemes for “priority practices”. These involve targeted packages of support which allow for managers to meet with experienced colleagues who can offer tried and tested solutions to common issues which regularly arise in general practice.

Further information/resources
BMA Website
The contract documentation and all GPC guidance can be found on the new contract area of the GPC section of the website, and the GPC has produced Focus on how to access information on the new contract.