Big questions: Special LMC conference; welfare reforms

Maya Dhillon takes on March’s talking points – what happened at the private special LMC conference, and what do the new welfare reforms mean for GPs?

What happened at the special LMC conference?

At November’s England LMC conference, GP leaders voted to hold a special conference to ‘discuss and determine what escalatory steps will be needed to ensure the survival of what still remains of English general practice’. The BMA had already been ‘in dispute’ with the Government since August, but tensions had increased since the Autumn Budget, where it was announced that Employer National Insurance Contributions (NICs) would rise.

GPs found themselves in a uniquely awful position where they were denied funding to cover the increase because they were private companies, but were simultaneously ineligible for NI reimbursements available to small private companies, because they were deemed to be in the public sector. Therefore, the special conference was demanded because of the NI hike paradox.

The agenda was not publicly released ahead of the conference, but Pulse did obtain a copy. We exclusively revealed that GP leaders would vote on escalating collective action in England, which could include coordinated practice closures, demonstrations and mass resignations.

The special conference was held earlier this month on 19 March. But almost two weeks on, Englands have not been told what was decided upon. The BMA chose to hold it behind closed doors so that it could control ‘how and when’ outcomes of motions were released.

The timing of the conference was particularly interesting. It was the same day as the deadline that GPC England chair Dr Katie Bramall-Stainer had given the health secretary to agree to negotiating a wholesale new GP contract. Though the BMA had agreed to the contract deal, it was conditional on Wes Streeting making this commitment by 19 March. We had previously speculated on what would happen if Mr Streeting didn’t meet this deadline, with the most likely outcome being that we would essentially be in another contract imposition.

Obviously the scheduling of the contract deadline and the special conference wasn’t a coincidence, given that they were both set by the BMA. But it did mean that certain motions did have to be removed on the day, once the health secretary published a letter agreeing to a new wholesale contract.

However, what is somewhat strange is how little has been said since. Pulse was told about the result of one motion regarding primary care networks, where attendees voted that the PCN DES had been used by NHS England to exert control over and undermine GP partnerships, and that any future industrial action should include targeted efforts to disband PCNs (though they stopped short of voting for GP practices to withdraw from the DES at the next contract renewal date). But we have not been told anything else about the conference, and it’s not something that we are sure has happened before.

Perhaps it is to do with the fact that a lot of the motions were about collective action. Given that the BMA is no longer officially ‘in dispute’ with the Government, one could argue that maybe the special conference ended up being obsolete. If that is the case, considering that the GPDF estimated that a special conference would cost over £100,000, perhaps the union is trying to work out how to release information in a way that doesn’t render the conference looking like an extortionate use of money.

The other side of the coin might be that the BMA is keeping a hand in its pocket in case the Government does not stick to its promises. Yes, having motions about collective action when no longer in dispute seems odd. But, a lot of these motions referred to ‘future’ action – as an insurance in case negotiations for the wholesale contract fall through. Contemplating further industrial action when officially in agreement with the Government may not endear the BMA to DHSC, hence being a factor in why information has not been released. And let’s not pretend that governments never go back on their words…

‘Overdiagnosis’ and welfare reforms: where do GPs stand?

Earlier this month, work and pensions secretary Liz Kendall unveiled a set of welfare reforms, billed as the ‘biggest shake up to welfare system in a generation’. These included scrapping the Work Capability Assessment (WCA) in favour of a single assessment, as well as narrowing eligibility for the Personal Independence Payment (PIP). Alongside the intended savings of £5bn, Ms Kendall also announced an extra £1bn to help support disabled people and those with health conditions to get back into work.

This followed comments made by the health secretary on mental health conditions being ‘overdiagnosed’. When questioned on BBC One’s Sunday with Laura Kuenssberg, Mr Streeting said: ‘I think definitely there’s an overdiagnosis, but there’s too many people being written off and, to your point about treatment, too many people who just aren’t getting the support they need. So if you can get that support to people much earlier, then you can help people to either stay in work or get back to work.’

His comments were echoed that week by the minister for primary care. Stephen Kinnock said that the Government’s aim to reduce the number of people on PIP was connected to the numbers of people with mental health problems. He added that the Government was looking into cracking down on ‘unregulated private sector’ therapists which had partly caused demand for mental health diagnoses to go ‘through the roof’ – and that he was concerned that diagnoses given out by the private sector were ‘not rooted in clinical expertise.’

But what does any of this have to do with GPs? Well, it seems to come part and parcel that whenever reforms concerning health are introduced, GPs are inevitably lumped with the extra work. It’s part of the territory what with being the ‘front door’/’at the coalface’/what have you etc.

The Government has promised that these changes will not increase pressure on GPs. But even though the Department for Work and Pensions (DWP) has said it will work with the DHSC to ensure that narrowing of PIP eligibility doesn’t negatively impact on GP workload, that doesn’t guarantee protection.

Professor Azeem Majeed, GP and head of primary care and public health at Imperial College London, said that any changes made to the welfare system will have an ‘inevitable’ impact on GPs because of their role in the welfare system. He continued by saying that PIP changes and getting rid of WCA ‘could shift GPs’ responsibilities from certifying work capability to assessing how health conditions impact daily living’. His point was emphasised by the proposed vote on GPs writing ‘indefinite’ fit notes as part of collective action at last month’s special LMC conference. The proposals would see GPs bouncing all further fitness-for-work assessment back to the DWP.

This brings us back almost a year ago, when the previous Government laid out its own welfare reforms, to address the UK’s ‘sick note’ culture. Former prime minister Rishi Sunak announced that GPs would no longer be responsible for issuing fit notes. At the time, we pointed out that even though the reduction of admin would be welcomed by GPs, it would be unlikely that there would be a clean and immediate separation between GPs and fit notes.

A year on and this seems only more so, given that the new Government has not given any details on whether this policy has been picked up for implementation. However, an independent Government-commissioned review also questioned the ability of GPs to issue fit notes and deal with work/health issues.

GPs can freely agree or disagree with Mr Streeting’s view that mental health conditions in the UK are overdiagnosed; our very own Copperfield is a supporter. But tying this to welfare reform and using it as a tool to accuse people of not working is a different matter. And it isn’t the first time that this Government has done it. In October, when a collaboration between the Government and the company that makes tirzepatide was announced, the health secretary was quick to say that he hoped that the weight-loss jabs would ‘help [obese people] get back to work.’

It’s easy to point the finger at obesity/mental health/insert condition of your choice as the reason individuals cannot work. But these problems are not so simple and conflating them automatically with unemployment and – let’s face it because this is what it is implying – laziness, misses the opportunity to fully tackle why these conditions are so pronounced in the UK already. As Pulse editor-in-chief Jaimie Kaffash pointed out at the time, health, and welfare, is far more complex than that.