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Consultation with the LMC: the traditional pattern
The imposition of the 1990 contract
The General Medical Services Committee (GMSC), a standing committee of the BMA with full authority to deal with all matters affecting NHS GPs, is the only body that represents all GPs irrespective of whether they are BMA members (although around 75% are). It is recognized as the GPs' sole negotiating body by the Department of Health. The GMSC is ultimately responsible for determining the advice given and representations made to ministers and government officials. Although the GMSC has final responsibility for determining policies to be followed in negotiations, these cannot be formulated in a vacuum. It therefore convenes annually (and on other special occasions) a conference of LMC representatives. Over 300 GPs attend these conferences; they are not confined to BMA members because LMCs represent all GPs locally, just as the GMSC does at national level. The resolutions of these conferences are referred to the GMSC and provide the basis of its policy. It is said that the GMSC ignores conference policy at its peril.
In negotiations with ministers and government officials, the GMSC is represented by a negotiating team of five members, who are working GPs. They provide a direct input of their everyday experience of general practice into national negotiations, and are assisted by expert economic, industrial relations, legal and accountancy advisers. There is a regular cycle of meetings between the GMSC negotiators and Health Department officials, and these are supplemented by many other meetings to deal with specific matters. The experience of the GMSC's negotiating team has provided the Department with invaluable advice on the practicalities of its plans for the family doctor service, and LMCs have provided health authorities with equally valuable advice.
Over the years negotiations between the GMSC and the Department of Health have covered a wide range of issues. In practice, the satisfactory completion of negotiations has only occasionally required major amendments of the Red Book, while amendment of the legal framework of general practice, the NHS Regulations (which include the GP's terms of service), is rarer still. It is important to note that the Red Book, although a part of the regulations, can be amended without legislation, whereas the NHS regulations are parliamentary enactments and thus require legislation to amend their provisions.
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| Book Title: Making Sense of The Red Book | ||