Representatives:   Drs Alvis, Hubbard and Yerburgh.
Observers:   Dr Fielding (Chairman) and the Secretary

CHAIRMAN’S OPENING SPEECH
The full text and video of Dr Chaand Nagpaul’s speech is on the BMA website and is worth looking at.

FIRST SESSION – DEMAND, SUPPLY AND PATIENT SAFETY

• Conference urged that politicians of all colours should stop using the NHS to win votes but rather should mention at every possible opportunity the amazing work being done by GPs up and down the country.  The vicious spiral of fewer GPs, increasing demands, increased patient expectation fuelled by political statements, lack of investment in premises and sagging morale leading to further difficulties in recruitment and more emigration was frequently referred to throughout the Conference.  There was a unanimous call for GP funding, recruitment and retention to be the first priority for the NHS under the new Conservative government, and for the current barriers to GPs returning from abroad or a career break to be reduced and those individuals dealt with fairly.
• Conference felt that 15 minute appointments should be the norm (extra funding required to achieve it) and that practices should be able to close their lists if they alone decide that it would be unsafe to take on more patients.  (This would require changes to the regulations, but that is what the GPC has now been tasked to address.)
• Training of GP trainees should include many non-clinical business-type skills, but Conference recognised that the fourth year of  training required to achieve that would not be readily introduced when the shortage of GPs was so acute.
• The out of area registration scheme was roundly condemned and for the benefit of patient safety OOHs provision should be better resourced, better tied in to daytime services and provide indemnity cover for its employees.
  More money and prioritisation was required for practice premises.

SESSION 2 – NEW MODELS OF CARE

• The devolution of NHS and social care funding to Manchester was debated. The main risk was that social services could act as a ‘money sponge’ taking  funding from primary care.  The Five Year Forward plan was generally accepted though there was a risk of destroying continuity of care if practices merged into larger entities/federations.  The GPC was asked to look into alternative ways of running general practice than the current partnership model.  The idea of a salaried service was heavily opposed.
• Dr Tom Yerburgh proposed the first lead Gloucestershire motion ‘That Conference believes that allowing GP partners access to the goodwill in their practices would be an effective way to enable general medical practice to evolve to meet the challenges of the future.’  The motion was not carried, not least because in 1948 the government had bought the goodwill off individual GPs as part of introducing the NHS Contract.
• However a later motion did ask the GPC to clarify what was included in essential services and what could be postponed or abandoned if there were so few staff that the services could not be delivered safely.
• Dr Jethro Hubbard proposed the second lead Gloucestershire motion ‘That conference believes patient care would be improved were practices to be allowed to offer ‘top-up’ private services to their NHS patients and requests that the GPC include this in their contract negotiations.’  This proved a step too far and was defeated.
  However, a motion saying that NHS 111 should be scrapped was carried.

SOAPBOX
In many ways this part of the Conference is all too short, but could be a fruitful source of motions for next year. E.g.

• What about instalment prescribing without extra cost to the patient to avoid overdosing and stockpiling of unused drugs?
• Introduce protected time for preparation for all sorts of things.
• Restrain NICE from making suggestions resulting in overtreatment of patients.
• Increase the number of medical schools, and/or places.
• Allow GPs to control the amount of money paid into the NHS pension scheme, as is now possible with private pensions.
• Work with medical defence unions to cover media medics.
• Dr Tom Yerburgh urged that the GPC take steps to deal with the out of stock drugs situation.
• Some excellent registrars are lost to general practice if they cannot deal with actors as ‘patients’ in the final exams.  Why not video actual appointments?
• Can the GPC press office deal more effectively with adverse press coverage?
• Stop other bodies imposing extra work (e.g. appeals for review of benefits) on GPs.

SESSION 3 – REGULATION
Conference unanimously agreed that:

• The GMC seemed to treat GPs as guilty until proven innocent and that this generates a feeling of fear in all GPs, leading to a high rate of suicide amongst those under investigation.  This should be changed.
• The GMC should, however, remain an independent body.
• There should be only one national performers list
• The complaints system should be radically revised to include mediation.
• Regulation should be relevant to clinical outcomes and should not draw resources away from actually delivering healthcare.

They also agreed, not unanimously, that:

• All regulation should be evidence based.
• That the CQC was a bureaucratic and incompetent nightmare, lacking in internal quality assurance, and should be decommissioned.  The GPC tried to persuade Conference that this would not run as the CQC was needed to inspect other care organisations, but feelings ran high.

Medical indemnity was a sore point.  Those involved as media medics could not obtain cover.  Those involved in anything other than GMS were loaded with extra premiums – one figure was that in OOHs a GP would have to pay a premium of £35 an hour.  Those deemed by the insurance company to be of a higher risk also faced premiums so high that it made one question whether to continue in practice; nor would the reasons for the high risk assessment be revealed – ‘commercial sensitivity’.

Under prescribing there was complete agreement that the expected use of antivirals demanded by Public Health (England) has weak evidence and is not part of core services.  The Conference also shied away from recommending an abolition of prescription fees or withholding prescriptions if the medicine could easily be bought over the counter.  However, they agreed that GPs should not be prescribing non-drug products, appliances and food products. And that drugs prescribed in secondary care to patients on discharge should be from the same formulary as that used in primary care.

Dispensing practices should have the same access to EPS2 as pharmacists.

Conference also called on the government to scrap the unplanned admissions enhanced service for 2016/17.

BREAK-OUT  GROUPS
All attended break-out groups of 8 to 10 to address the questions:
   1. What should LMCs be delivering for GPs over the next few years?
   2. What should the GPC/GPDF be delivering for GPs and LMCs over the next few years?
   3. What should Conference be delivering for GPs, LMCs, and the GPC over the next few years?
The responses agreed at the last LMC meeting were put forward, but the GPC must now collate all the slips of paper.
A hot-wash-up using electronic voting systems to indicate on a scale of 1 to 6 how representatives felt about various issues was tried as an experiment, which produced some interesting responses.  The same system may be tried again next year

ASK THE EXECUTIVE TEAM (PREVIOUSLY KNOWN AS ‘THE NEGOTIATORS’)

• Dr Steve Alvis asked that in order to encourage GP representation on NICE committees from grassroots GPs could they ensure that adequate remuneration and backfill was available. They commented that they had just met with Professor Haslam and raised that.
• Seven-day opening was a deeply unpopular concept.
• Perhaps the LMC Conference in 5 years’ time could be held two weeks before the next General Election.
• There was some discontent about the publication of GP earnings, even though it was GMS earnings only, averaged across the practice.
• Advertising charges in the BMJ were punitive and should be reduced.
• CQC was again pilloried, this time for non-engagement.
• Lay appraisers were anathema.  Appraisals were a legal requirement but how could they be conducted if the appraisers resigned from the job over unfair tax regulations?
• There was a general loathing of mixed funding streams under different bids and contracts.

SESSION 4 – FUNDING, IM&T, CO-COMMISSIONING, CERTIFICATES, OCCUPATIONAL HEALTH, PAY AND PENSIONS

Lack of funding for practices was a common theme, nor was it seen to be improved in the long term by the one-year-only Prime Minister’s Challenge Fund.  The situation was exacerbated in some cases by the removal of MPIG.  Long term year-on-year adequate funding was needed if practices were to continue.

GPC was tasked to set up a national approval process for data sharing agreements.  In particular that GPs should be indemnified for any compromise of data occurring outside the GP’s clinical system and that they should have control over who has remote access to their system.

The most pressing IM&T demand was that the funding of SMS text reminders etc to patients should continue.
Conference believed that the system of collaborative arrangement fees was a mess and needed to be sorted out.
Conference agreed unanimously that:

• NHS England should immediately restore a fully funded and accessible occupational health service for GPs and their staff.
• That the recent change in GP pensions regulations should be condemned.
• That public health campaigns should be planned in conjunction with the GPC to ensure that they are evidence based rather than politically motivated.

Finally, self-care and appropriate use of scarce NHS resources should be the main message to put across to the public.