The outcome of negotiations is pretty much what could be expected, except
the  concession on PCG Board control, which took me by surprise. The
"ballot" served it's primary purpose simply by the popular pressure to have
one, and by the number of motions on the Conference agenda. With the
climb-down there was little enthusiasm at the LMC Conference to pursue it
further. I hope the negotiators now realise that the profession is far from
impotent if it is coordinated. John Chisholm spoke very convincingly, and as
usual Conference backed his report. There was some concern being bandied
around that a GP majority on the PCG Board could prove to be a poisoned
chalice if GPs are perceived as responsible for the inevitable rationing. I
think the guarantees on GMS funding are probably adequate. Alan Milburn's
letter, even if it is vague on some important issues such as deficits,
adequate payment of GPs outside target net with superannuation etc,   makes
PCGs safer and therefore possible, even if they remain undesirable. Let's
face it they are going to happen, so we might as well get on and try to make
them work for us. That seemed to be the overwhelming view of Conference at
this juncture. What was probably the most important motion of Conference
 P493) slipped quietly through. I wonder how many journalists will realise
the significance of a requested change to Regulations which could in future
free  GPs from the requirement "to provide all medically necessary treatment
for their patients"!
It was certainly worthwhile putting all the pressure on the GMSC
negotiators. Well done everyone!
 The other interesting outcome of Conference was a demand for national
negotiation of non-core services, in spite of another attempt by Simon Fradd
at deflecting it ! Gloucestershire has tried hard in the past to get that
one through without success, and we had given up on it. (We have also given
up for the time being on trying to split the contract into in-hours and
out-of-hours. Perhaps we should resurrect that one next year. It remains my
view that we will never improve our terms of service substantially until we
lose the open ended 24 hour contract.) It has taken the majority of GPs a
very long time to appreciate just how little anyone has managed to negotiate
on non-core services, except in Nottingham! It's a shame that it is probably
now too late, except that if national suggested rates are laid down by GMSC
it will make it easier for PCGs to implement them. We now need to clarify
our national guidance on payment for community hospital work for the same
reason.
 It will be interesting to see how all the new blood at GMSC shapes up. I
see David Roberts has been elected, and has joined the mailbase, so you will
now get another slant on GMSC work. Congratulations David. I was alarmed at
the LMC Conference to learn in a conversation with deputy treasurer Peter
Holden just how much of our Defence Fund money is being spent on legal fees
defending dispensing! Perhaps I can persuade you  to join me in my campaign
to try to build bridges with the pharmacists, and foster nurse prescribing?
We now see what even the threat of a ballot can do if GPs start working
together. Imagine what could be achieved with the professions working
together!


                                        Peter Fellows,  GMSC



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