Doctors’ Association UK (DAUK) and GP Survival have reacted angrily to the changes to the GP contract imposed without warning or consultation by NHSE, which includes stipulations that GP services are to be offered 9 am to 5 pm on Saturdays as well as expanded during weekday evenings. 

In a joint statement, they said: 

“We are furious that NHS England have chosen to ignore the collective plight of frontline GP teams. The unilateral termination of negotiations by NHSE demonstrates a complete lack of respect for GP teams who have worked tirelessly throughout the pandemic whilst also contributing to the largest vaccination programme in the history of our nation.

“The deal being imposed upon GP contractors needs to be legally tested as it represents a fundamental change to GP contract terms and conditions with no clear defining reason for it.

“We seek to understand the evidence underpinning the mandate that providing routine appointments in the evenings and weekends will improve patient outcomes. There is evidence that continuity of care helps to reduces hospital admissions and improves patient satisfaction. Spreading a thin workforce even further will adversely affect patient safety.

“We are surprised NHSE felt they had no other option than to impose an authoritarian style of leadership. This approach should not be the future of health care decisions. There must be a collaborative approach between patients, staff, commissioners, NHSE and the Government. Only when this approach is adapted will we see the best outcomes for our patients.

“As frontline GPs we seek a contract which enables us to provide the high-quality care our patients deserve. GPs are not obstacles to overcome to achieve further aims, but highly trained professionals with an intimate knowledge and understanding of the communities they serve.

“No amount of spin will placate our dedicated and experienced workers who continue in their attempts to support a failing NHS during extraordinary times. NHS England have failed GP teams, failed the patients they serve, and most significantly have failed the National Health Service.

“We wholeheartedly reject NHS England’s current proposals and we demand they resume negotiations without further delay.”

The recent case of Toombes vs Mitchell made legal history and the medical profession have been considering the potential implications ever since.

read the piece by DAUK, The On-Call Room, NHS Million and GP Survival here

Contrary to widespread reports, GP surgeries have remained open throughout the Covid-19 pandemic. Official NHS data confirms that more GP appointments are being offered than ever before, and GP teams continue to provide over 90 percent of all NHS consultations. 

Practices were already struggling prior to the pandemic and are now facing near-impossible challenges in the face of a “tsunami of demand”.

Attendees at this briefing heard from frontline GPs who described:

• The causes of rising demand on our services
• The increasing cases of burnout amongst GPs
• The damaging effects of unproven bureaucratic interventions
• Consequences of the demoralising, harmful narratives against our profession
• Proposed solutions to our challenges
• How you can help us help our patients

Lizzie Toberty, a 35-year-old GP in north east England who is a member of the grassroots campaign group Doctors’ Association UK, believes in the principle of partner-led practices rooted in communities, she still declined to
become a partner in her former practice. As a doctor, “you want a say in how healthcare is
managed”, she explains, but she worried that when the senior partners retired no one would
replace them and she could end up shouldering the entire liability. “As a partner, technically, your house is on the line and that scared me,” she says. “Among my friends I’d say there’s probably a 50:50 mix of those that go into partnership and those, like me, who go, ‘ooh, this just feels so risky’,” she adds. Practices are experimenting with new ways of
working to help ease stretched resources. The addition of advanced nurse practitioners, paramedics and hysiotherapists into teams with GPs — based in large practices or shared between practices — is one approach being tried. This multi-disciplinary team working allows GPs to focus on the sickest patients and expands the
workforce, which is particularly helpful for practices in deprived and rural communities that struggle to recruit doctors.

Combining digital healthcare with imaginative approaches to flexible working could ease the GP
brain drain, says Ellen Welch, a GP from Cumbria and a member of the Doctors’ Association UK. As mother to a toddler and a 6- month-old baby, born during the pandemic, she spent her pregnancy answering out-of-hours calls
from home. Since her baby’s birth she has also been working with a local surgery, logging on to
her laptop to respond to non-urgent queries that patients submit to a website and making referrals
for face-to-face consultations for patients who need them. She suggests such arrangements
could “tap a whole new workforce” and retain the skills of GPs who leave to become parents and
carers or move abroad for family reasons. For Toberty, the uncertainties within general practice have only heightened her dilemma onwhether to become a partner. To be “scapegoated” because there are not enough
doctors “is incredibly damaging”, she says. “As a GP with 30 years of working ahead of me, it’s
started me thinking: ‘Is this what I want to do?’”

read the full article here

Who is Alan Woodall?

Alan is a GP partner and OOH Doctor in rural mid Wales and Shropshire. A coal-miner’s son who endured the 84-85 strike just like Billy Elliot, but without the dancing ability, he originally trained as a postdoctoral research scientist working at the University of California Berkeley, before returning to study medicine in the UK. Alan decided to pursue a primary care and public health focus, and during his training published research in a number of areas, including work in the BMJ that helped to secure the smoking ban. He gave over 30 media, radio and TV interviews at the time.

He founded GPSurvival in 2015, recognising the need to give grassroots doctors a voice, and has served as a campaign lead and chair. It now represents over 8,000 GPs UK wide, mainly campaigning on primary care issues initially, but his focus widened over the last year to reform of the GMC, in the light of poor regulatory practices. In that role, he found himself increasingly collaborating with other grassroots groups such as DAUK. His activist work is regularly quoted in the medical press, and he and his team have recognition as partners with NHS England on looking at campaign areas. He is excited to be joining the DAUK team to provide more public health and primary care input, and to strengthen collaboration between different grassroots groups.

Alan is married to Joanne, an education officer/primary teacher, and has a 7 year old daughter Abbie. He is happy to be contacted at any time for advice.

Dr Samantha Batt-Rawden, DAUK Chair said “We are delighted that Alan has come on board with DAUK. We were very keen to have more representation from General Practice on the executive committee, and Alan was the perfect candidate. Alan cares deeply about the wellbeing of GPs and of the medical profession, and his work for GP Survival speaks for itself. We look forward to continuing to advocate for General Practice with renewed energy.”

Despite the request coming from the grassroots, disappointingly no doctors or organisations representing doctors have been invited to give evidence. However, the Health Select Committee will be hearing from Charlie Massey.

We have written to the HSC to urgently clarify, and ask them to include representatives from the medical profession, in what is a very important, at the moment incredibly unbalanced, inquiry for us all.

The HSC has given assurances that doctors can attend and observe. Dr Jenny Vaughan will be attending representing DAUK.

DAUK would like to see as many doctors as possible attend. For those who can’t attend the inquiry will be streamed live on Parliament TV and DAUK will keep our members updated.

let us know you can attend

A doctor-led lobbying group has urged the health secretary to review the GMC’s ability to appeal its own fitness-to-practice tribunal.

In a letter to Matt Hancock, the Doctor’s Association UK said the GMC’s right to appeal the MPTS has led to ‘significant unwelcome and unintended consequences’.

Earlier this year, the Court of Appeal overturned a GMC-led High Court decision to strike-off Dr Hadiza Bawa-Garba, after the MPTS had called for her suspension following the death of Jack Adcock.

Following the case, the Government launched a ‘rapid review’ into the use of gross negligence manslaughter charges in medicine, concluding that the GMC should no longer have the right to appeal MPTS decisions.

However, Pulse revealed that the GMC is not intending to halt appeals against the MPTS until the law is changed.

The letter, which is co-signed by other lobbying groups including GP Survival and Doctors in Unite, said the case made doctors ‘feel that we too, could be pursued through the courts for errors made whilst simply trying our best’.

It said: ‘We, the undersigned, all agree that the GMC cannot be trusted to take a balanced and considered approach in the sanction of doctors who have made honest mistakes in the context of system failures.’

The letter added: ‘We are concerned that should the GMC’s action continue unchecked, that there will be a further breakdown in trust between the medical profession and its regulator, and the NHS will continue to move towards a culture of fear and blame, rather than one of learning.’

The association then urges Mr Hancock to:

• Call upon the GMC to cease appealing MPTS verdicts

• Confirm that the GMC’s right to appeal MPTS verdicts will be repealed, as per the recommendations of the Williams Review

• Set out a timeframe for when and how this legislation will be changed

The letter comes after the appeals court told the GMC to show ‘restraint’ after it quashed another GMC-bid to sanction a doctor last month.

In a letter to health and social care secretary Matt Hancock, the Doctors Association UK (DAUK) and others including campaign group GP Survival voiced ‘collective concern’ over the GMC’s decision to continue to appeal decisions by the Medical Practitioners Tribunal Service (MPTS) in court following the Bawa-Garba case.

The government set out plans to strip the the GMC of its power to appeal decisions made by the MPTS after a review triggered by the damaging, high-profile case of Dr Hadiza Bawa-Garba – struck off after a GMC appeal against a tribunal ruling, but later reinstated.

The government review warned GMC appeals had created ‘fear and mistrust’ among doctors and were ‘deterring reflection and learning from errors to the detriment of patient safety’.

Tribunal appeal

However, the government has yet to pass legislation to remove the GMC’s power of appeal, and GPonline revealed last month that the regulator is currently appealing four tribunal decisions.

In each of these cases, the GMC is asking the Court of Appeal to replace an MPTS decision with a more severe sanction. In three cases it is recommending – as it did in the Bawa-Garba case – that suspension be substituted for erasure from the medical register.

The letter, signed by 14 representatives from 11 different organisations, urged Mr Hancock to ‘call upon the GMC to cease appealing MPTS verdicts’ and confirm when the regulator’s right to appeal will be repealed, as recommended by the Williams review earlier this year.

The letter reads: ‘We, the undersigned, all agree that the GMC cannot be trusted to take a balanced and considered approach in the sanction of doctors who have made honest mistakes in the context of system failures.

read the full coverge

These concerns relate to cases being brought to the Court of Appeal by the GMC in an attempt to overrule the findings of doctors’ tribunal proceedings, in order to have doctors erased from the medical register. DAUK and its affiliates are calling for the Health Secretary to undertake an urgent review of the current and ongoing actions of the GMC, and to put a stop to such appeals being brought, pending a review of relevant legislation.

This call for action has come following the landmark case involving Dr Hadiza Bawa-Garba. The GMC had sought to overturn a decision made by the Medical Practitioners Tribunal Service (MPTS), in order to erase Dr Bawa-Garba from the medical register. To the relief of the medical profession, the Court of Appeal unanimously rejected the GMC’s case, and ruled that Dr Bawa-Garba ought to be reinstated to the medical register, thus allowing her to continue to work as a doctor.

The Bawa-Garba case resulted in the launch of the Williams Review, with recommendations being made in June of 2018. Professor Norman Williams stated that the GMC ought to have its right to appeal MPTS verdicts removed, and noted that granting the GMC this right of appeal in 2015 had come with significant unwelcome and unintended consequences. DAUK concludes that the GMC cannot be trusted to take a balanced and considered approach in placing sanctions upon doctors in circumstances such as those faced by Dr Bawa- Garba – doctors making honest mistakes in the context of system failure.

The Doctors’ Association UK are alarmed to learn that, despite the outcome of the Bawa-Garba case, along with the recommendations of the Williams Review, the GMC has continued to appeal MPTS verdicts in the courts. Within the last weeks, the GMC has been urged to show “restraint”, and judges have expressed “regret” at such cases having been brought to the Court of Appeal. DAUK understands that there are a further four appeals due to be heard, all of which involve the GMC appealing to overturn tribunal verdicts.

The Doctors’ Association UK believes that the continuation of such unchecked action by the GMC will lead to a further breakdown in trust between the medical profession and its regulator, with a progressive move towards a culture of fear and blame, rather than one of learning. DAUK urges the Health Secretary to request that the GMC halts its appeals against MPTS verdicts forthwith. Furthermore, DAUK asks the Health Secretary to confirm that the recommendations of the Williams review will be upheld, and that the relevant changes to legislation are made without delay.

read the full letter here