LMC leaders have rejected plans for ‘primary care doctors’ in GP practices, arguing this represents ‘a retrograde step’ in both safety and efficiency in patient care.
At their national conference in London last week, England’s LMC leaders voted overwhelmingly in favour of a motion condemning the roles, after speakers raised concerns around patient safety, possible exploitation and supervision.
It comes after the GPCE chair earlier this year said that plans for non-GP ‘primary care doctors’ to be allowed to work in practices are ‘colluding in the demise of the profession’.
The examples of doctors included in the plans cited by the GPC included doctors finishing foundation training, international doctors who are not qualified GPs, Specialty and Associate Specialist (SAS) doctors and other non-GP doctors.
Last year, LMC leaders had already called on the BMA to reject proposals which would allow SAS doctors to work in general practice as primary care doctors.
Proposing the motion at this year’s conference, Dr Vicky Theakston, from Gateshead and South Tyneside LMC, said: ‘There is no existing framework for terms of employment, and the opportunities for career progression are questionable.
‘And who’s going to be supervising them? Does this really ease the workload of general practice? There have already been strong statements of concern made publicly by the BMA, but this is an opportunity to set formal policy and empower GPC England and LMCs to spell out a simple message: general practice must be delivered by general practitioners.
‘I ask that NHS England and this Government stop trying to think of creative solutions for a problem that’s actually very straightforward – fund general practice and support general practice training.’
Speaking in favour of the motion, Cambridgeshire LMC’s Dr Eimear Byrne said: ‘Critically, these are not trained and qualified GPs.
‘In short, they are unable to undertake the requirements of being a GP, having neither trained nor achieved the qualifications and standards required to safely consult patients with undifferentiated illness.
‘This is a safety issue. This is an issue of accountability for the decisions about the use of limited funding for maximal efficiency.
‘The solution lies in investment in general practice, specifically in the core GP contract to allow practices to employ the professionals they need to care for their populations.’
Also in favour of the motion, Dr Zishan Syed, from Kent LMC, said: ‘The term primary care doctor encourages a transactional model of healthcare delivery. It implies episodic care, which fragments the continuity that is fundamental to safety.
‘Patients benefit from having a trusted GP who understands their history, context and concerns. This is not something a generic primary care doctor can replicate. Continuity is proven to reduce hospital admissions and improve outcomes, and the loss of this model threatens to erode these efficiencies.’
As announced in the recovery plan in June last year, the Government and NHS England are working together to ‘ensure that doctors other than GPs are more easily able to work in primary care’.
According to the plan, the medical workforce ‘is expected to change over the next 15 years’, with more SAS doctors and doctors in training choosing different career paths including general practice.
GPC policy lead for education, training and workforce Dr Sarah Matthews told the LMC conference: ‘The NHS England announcement refers to non-GP doctors working in general practice settings as locally employed doctors, meaning that they will not be subject to national terms and conditions.
‘These LED doctors will not be GPs, they will not be on a training program to become GPs, but will be allowed to provide care to patients with undifferentiated, untriaged conditions.
‘This poses a significant risk to patient safety. It undermines the existence of the general practice training program and opens these doctors up to potential exploitation, as they will not receive the protections guaranteed to salaried GPs by the BMA standard contract.’
As revealed exclusively by Pulse, in October 2022, the GMC proposed that the medical performers list regulations should be changed to allow non-GP doctors to provide primary medical services.
Last year, speaking at the Pulse Live conference, GMC chief executive Charlie Massey said regulatory hurdles must be lifted to admit a ‘sizeable’ pool of SAS doctors who are ‘itching’ to work in general practice.
But the idea has proved controversial, with the BMA saying that the proposal could cause doctors to be open to exploitation under a ‘two-tier system’.
And the RCGP has previously said it was ‘not in a position’ to support the introduction of SAS doctors to general practice because NHS England had not yet ironed out concerns around funding and patient safety.
The motion in full
That conference rejects the concept of primary care doctors as it is a retrograde step in both safety and efficiency in patient care OVERWHELMINGLY CARRIED
Source: BMA
“In short, they are unable to undertake the requirements of being a GP, having neither trained nor achieved the qualifications and standards required to safely consult patients with undifferentiated illness.”
The door has already bolted on this with ANP, paramedics pharmacists and PAs already seeing ALL undifferentiated illnesses unsupervised with only minimal training in minor illnesses well outside their remit. It has been allowed to happen and has decimated the locum and salaried GP sector with a race to the bottom financially and in terms of career progression. We have been our own worse enemies.