Even though general practice is made up of thousands of individual business partnerships it operates collectively through the GPC, which in turn negotiates the national contract.  It is important the power and value of this ability to operate collectively is understood, so that the most can be made of it moving forward.

It was over a 100 years ago that statutory recognition was granted for local committees of ‘panel doctors’ in the 1911 Insurance Act. These became LMCs, and once these had been set up the BMA established a national committee in 1912 to represent their combined interests in negotiations with the Government, which became the General Practitioners Committee (GPC).

Ever since then general practice has negotiated as a collective, and this has secured some important wins for the profession.

Right at the outset of the NHS it was the power of this committee that resulted in general practice remaining outside of the NHS on its formation in 1948 and retaining its independent contractor status.

In 1965 the profession was in crisis with morale and earnings low, and consultant career earnings reportedly 48% higher than that of a GP.  As a result, 18,000 of the then 22,000 GPs signed undated resignation letters from the NHS.  Consequently the GPC was able to negotiate the 1966 contract which addressed the major grievances of the profession.

In 2004, the biggest change to the GP contract in the history of the NHS was introduced.  Following negotiations by the GPC GPs voted on the deal, and voted overwhelmingly in support. In a BMA ballot, nearly 80% of the 31,945 doctors who voted backed it.

But the GPC has not always come out on top.  In 1990 the GP contract which linked GP pay more strongly to performance was imposed by Kenneth Clarke after it was rejected in a ballot.  In 2008 there was a contractual row between the GPC and the Government over evening and weekend opening, which led to the GPC being forced to accept the imposition of an extended hours deal.

But overall working as a collective has been positive for general practice.  The GPC has been at its most powerful when it has had a clear mandate from the profession, most often in terms of a vote.  It has not always worked, but it has always given the GPC an even stronger mandate going into negotiations.

Now we are in the unprecedented position of two contracts having been imposed in the last two years.  What the GPC is asking for in terms of its referendum (now scheduled for March) is for a stronger mandate, even if the result is a third consecutive contract imposition.  This in turn will not only strengthen their hand in future negotiations, but also pave the way for possible industrial action, and enable the GPC to turn up the heat on the government even further.

In many ways the outcome of this year’s ‘stepping stone’ contract will be less important than the outcome of next year’s ‘major changes’ contract, once the new government has been formed.  What general practice has to do right now is demonstrate that it has muscles it can flex, and make taking the profession on something the next government will be unwilling to do.

The only way that general practice can do this is by standing together.  The stronger the mandate the GPC has from practices (which means the higher the percentage of practices that are members, and the clearer the support it has for its position from those members) then the greater its influence will be.  So if you are not a member of the BMA, sign up now.