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BMA Cymru Wales GP committee chair delivers speech to annual Welsh LMC conference

Addressing GPs at the annual meeting of representatives of Welsh local medical committees (LMCs) in Llandudno, Dr Phil White, BMA Cymru Wales GP committee chair said:

Croeso, bawb, i Landudno, perl glan môr y gogledd.

I would like to start by thanking Dr Charlotte Jones for six years of untiring determination to better the lot of Welsh GPs. Her vigour and work rate have been phenomenal, and we all owe her a tremendous debt of gratitude. Her unstinting loyalty to GPCW despite various pressures has set the bar for future chairs to aspire to.Conference, please join me in applauding her remarkable work – an act which will be hard to follow.

Let’s start with our contract, and the progress we are making with implementing the agreed aspects of the 2018/19 negotiations. 

We now have state backed indemnity in place, and though there are one or two areas that need further clarification, it marks a new phase for GPs in Wales, as we are released from the burden, anxiety and uncertainty of rising indemnity costs that brought us close to professional collapse. 

We are close to establishing an Existing Liabilities Scheme which will make the state backed scheme complete, and do away with the need for deciding who to contact regarding a complaint.

We love our Q’s don’t we! QOF ditched in favour of QAIF! Less bean counting for GPs but additional requirements around access, with the promise of additional funding to ensure all Wales telephony standards and an increase in Cluster based working. Cluster membership becomes contractual, but the QAIF elements remain voluntary.

Quality Assurance will include registers, flu vaccination and dementia.

Quality Improvement will consist of learning the ropes followed by an improvement programme, with patient safety issues being highlighted. 

We have established the partnership premium to encourage General Practitioners to follow the contractor model of care – the most cost-effective way of providing primary care. Early indications suggest it has been well received and will hopefully go some way to ease the GP shortages that we have experienced in recent years.

GP trainee recruitment is at an all-time high, and the Minister has insisted that where there is a surplus of suitable applicants, then the scheme must accommodate them. 

We would encourage all practices, to consider training despite the pressures of the day job, as in the long term, it boosts recruitment considerably.

In addition, we have retained seniority payments to encourage experienced doctors to remain in post and impart their knowledge and wisdom to General Practice.

GPCW and the Conference of Welsh Local Medical Committees have steered the direction of travel for our 2020 negotiations:

As proposals for Last Person Standing from Welsh Government fell short of the mark, we are actively reviewing the position with the Primary Care Division.

Premises extend beyond leases. Many of the larger developments that the Health Boards encouraged and approved generate considerable service charges, unaffordable by smaller practices. This issue needs addressing.

Premises development needs forward thinking. We need additional rooms for the various training duties that we have accumulated – GP trainees, medical students, ANPs and PAs all need space to learn the art of consultation, and the current premises building regulations are wholly inadequate. 

We are pressing for the re-establishment of Primary Care Trusts (either regional or central). It is 10 years since the amalgamation into Health Boards, and General Practice, and Primary Care in general have become the Cinderella’s of the service, with funding reducing year on year as a proportion of the total NHS expenditure. Conference, this cannot go on. 

Upon graduation, my late father, who was a senior contractor services manager gave me three pieces of advice:

1. Buy back added years as soon as I got a job – this was the very old scheme – done.
2. If you go into general practice, pick a dispensing practice – done.
3. If you are in general practice never allow amalgamation of primary and secondary care budget – failed!

Meat Loaf may consider “two out of three ain’t bad” but the consequences of failure on the last point has been disastrous for general practice. Year on year reduction in percentage expenditure.

GP OOH services in Wales are UNSAFE and UNSUSTAINABLE. Health boards are continuing to fail to fill shifts, and staff and patients are suffering as a result. We are today calling on Health Inspectorate Wales to conduct a complete review of OOH services in Wales. Given the magnitude of the problem, this MUST be prioritised.

As you are only too well aware conference, workload remains a huge issue for general practice, not so much the dealing with sick patients, but the continuing drain on our resources for non-medical issues. This includes Benefits Agency requests, GDPR requests for records and secondary care “advising” patients to get an expedite letter because of their own inability to manage waiting lists. 

Many have regarded the aspirations for access to be unachievable.

We must fight back and set the record straight. GPCW will continue to meet with decision makers to make sure these issues are at the top of the agenda, but to actively demonstrate the volume of issues we are facing we need your help!

Following this conference, you will receive an email from me with a link to download a template letter to send to your local Assembly Members to inform them of your workload issues in General Practice. We must emphasise that we are at capacity, and we must outline what needs to be done to alleviate workload pressures. We must highlight the non – doctor aspect of workload. Work that could easily be undertaken by other agencies were they providing an adequate and comparable service. We are making progress but there is a great deal of work still to do and we need all the support we can get. 

It is crucial we stand together as one profession and I value your support in the fight to achieve meaningful and lasting change. 

We are looking to review and renegotiate Enhanced Services this year, with the aim of making them more robust and less open to “interpretation”. However, the Mental Health DES has been withdrawn and replaced with Suicide Prevention Training for practices. Another new Enhanced Service will be a review of anti-psychotic prescribing in the community for dementia patients. 

So, conference, our pledges for the year:
We will review and strengthen the Enhanced Services structure;
We will resolve the premises issues that have dogged the profession for several years;
We will review the situation regarding exception reporting amongst vaccine refusers – with the introduction of a signed informed dissent form that would form part of the child’s medical record;
We will look at tapering the target payments for childhood immunisation to reduce the big drop from 90% and 75%; and
 We will reinforce the contractor model as the most cost-effective way of providing medical services in the community.

Of course, conference may add to this list as they see fit, as we try our best to serve the GPs of Wales. Together, we will build a brighter future for GPs in Wales.

To close, I would like to thank the team, as it is very much a team effort, the vice chairs, Peter Hovath-Howard and Gareth Oelmann, Ian Harris and David Bailey.

We would be completely dysfunctional were it not for Dulaine Mulcahy and Gareth Rhys Williams who do an enormous amount of work on our and your behalf.

I would also like to thank Rachel Podalak, the boss at BMA Wales, and her excellent, supportive staff who do make our lives easier.

In particular, Carla Murphy, Stacey Snow, Sadie Vidal and Lucy Merredy, who ensure I write nothing inflammatory nor libellous, and Liam Anstey who has left the team. Thanks to Dorine Chantepie for keeping us going at meetings.

I would also like to thank my fellow chairs in Scotland, Northern Ireland and England for their advice and support over the past months. 

Finally, I would like to thank Caroline Eason and her team for organising the conference here today. 

So over to you Conference, the floor is open!

 

For further information please contact:

BMA Cymru Wales, Fifth floor, 2 Caspian Point, Caspian Way, Cardiff Bay, Cardiff, CF10 4DQ
Telephone: 029 2047 4626
Mobile: 07500 765994
Email: Carla Murphy ([email protected])