GPs may be balloted over NHS reforms

BMJ 1998; 316 doi: (Published 30 May 1998) Cite this as: BMJ 1998;316:1625
  1. Linda Beecham
  1. BMJ

    GPs in England may be balloted on some of the sticking points that remain unresolved between the profession and the health department over the introduction of primary care groups (PCGs). PCGs were proposed in the government's white paper for England, The New NHS.

    The General Medical Services Committee decided last week to continue talks with departmental officials, including a meeting with the health minister, Alan Milburn, scheduled for 11 June. GP negotiators will report back to a special GMSC meeting on 18 June. The committee gave its leaders the freedom to ballot GPs at any time. The annual conference of representatives of local medical committees takes place the following week: PCGs will be a major topic of debate.

    GPs' leaders have been voicing their worries about some of the government's proposals since the white paper was published. But despite assurances from Mr Milburn that the proposals would not be imposed and that the GMSC would have an input at the planning stage, the committee has grown increasingly frustrated (16 May, p 1481). Its chairman, Dr John Chisholm, wrote to the minister at the beginning of May setting out several issues which needed to be resolved.

    The minister's reply failed to reassure the GMSC about the statutory representative role of LMCs or about writing off health authorities' debts and liabilities to ensure that PCGs do not operate within financial restraints which prevent GPs delivering the care their patients need. Speakers called his response “unsatisfactory” and “threadbare.”

    But the committee was particularly angry at the failure to ring fence general medical services cash limited funds for staff, premises, and computers within the proposed unified budgets. The chairman of the LMC conference, Dr Eric Rose, said that there were over 34 motions on the agenda on the ring fencing of cash limited funds. But he and other speakers thought that the real issue was about control. “If we are in control of PCGs we can look after the funding.” And Dr David Pickersgill said that the proposals on clinical governance were just as worrying as the ring fencing. The chairman of the Welsh GMSC, Dr Tony Calland, agreed. Unified budgets were at the core of government policy, he said, and the profession would find it difficult to win public support over cash limiting. “Ministers will start talking about doctors feeling for their wallets and we will lose the argument,” he warned.

    “This is not a selfish issue about GPs' pay,” Dr Chisholm said. “It is about protecting patients and the environment in which they are treated.” He said later: “We are not holding a gun to the minister's head. We are not calling the profession to industrial action. We are still in constructive talks on the key issues which matter for GPs and for their patients, but it essential that the minister now does listen and addresses and resolves all those issues when we meet him.”

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