The Role of the LMC?

The Local Medical Committee (LMC) is a statutory body and is recognised as a local representative committee under the NHS Acts, able to represent GPs in an area covered by a particular Primary Care Trust.  Its constitution is approved by the PCT, which must be satisfied that the LMC is properly representative of and accountable to its constituent GPs.  Once recognised it is empowered with certain functions and has the statutory right to be consulted by the PCT on many matters.

Within Lincolnshire the LMC has been recognised as such by all three PCTs (East Lincolnshire PCT, West Lincolnshire PCT, and Lincolnshire South West PCT).

The LMC historically has key functions which are:

Statutory Functions

As the Local Representative Committee for independent medical practitioners, the LMC must be consulted about the administration of GP contracts and the local interpretation of their Terms of Service under the following enactments:

  •  The NHS (GMS Contracts) Regulations 2004
  • The Pharmaceutical Services Regulations (e.g. applications to dispense or provide pharmaceutical services etc)
  • The Statement of Financial Entitlements (over 22 separate references on aspects of GP remuneration) 

Representative Functions

The LMC represents the view of GPs to a variety of bodies, including the PCTs and Local Authorities, NHS Trusts, and other contractor professions.  It also consults with the patient representative groups and MPs.  It corresponds with the GP national negotiators, and deals with local and national media.

Pastoral Responsibilities

In addition to the wider body of General Practice, the LMC traditionally has provided an individual service for GPs.  This involves many different aspects including assisting GPs with complaints and appeals, helping “sick” doctors, intervening and making representations between individual GPs and the secondary care services, and finally in conciliating in intra and inter practice disputes.

In order to undertake the above roles the LMC meets with the PCTs regularly, both through bimonthly liaison meeting with the PCT’s executive teams and by attending almost 15 – 20 different PCT sub groups associated with primary care. We liaise with practices through the practice manager groups, individual practice visits, locality meetings and also by responding to individual GPs and practices’ requests.  Most of this work goes on unnoticed in the background and falls into 2 main categories:

  1. Implementing and advising on  national agreements, contractual arrangements, enhanced services, Quality and Outcome Frameworks,  agenda for change etc
  1. Discussions on local issues, e.g. Violent Patient Schemes, Patient Allocations, Eligibility for NHS treatment, Locally Enhanced Services, Clinical Governance etc.

However these are the “easy” areas as in general there are precedents to work to and although compromise in some areas is often necessary to achieve gains, locally we are working to guidance from the GPC (BMA) on what GPs should be expecting.

The more difficult areas concern the individual groups of GPs where precedent may not be of help and interpretation of the regulations is down to local agreement. It is here that the LMC can be of help to most GPs, especially those unfamiliar with the areas in question. In the recent past below are the types of issues raised by GPs

In Partnerships

  • Cost rent valuations and disagreements with the District Valuer
  • Discussions re development of premises and delays due to PCT’s lack of familiarity with the regulations
  • Discussions with the PCTs about failure to fund service delivery improvements  
  •  Partnership Arrangements
  • Access to Information
  • Medico-legal issues
  • Clinical Governance

Employed Salaried Doctors

  • Discussions concerning contracts or the lack of them
  • How to take forward grievances concerning contractual terms, holiday entitlement, and workload issues
  • Access to Information
  • Clinical Governance
  • Applications to the Performers List

Representation of Non-principal GPs Interests

The LMC in Lincolnshire also represents those doctors who have chosen to provide services as either locums, which may be a short-term arrangement or as more long-term employment e.g. a retainer scheme

The LMC is represented on several groups that reflect these contractors’ interests.  They are:

  • The Contractor Services Lists group, which has LMC and PCT representatives and discusses many of the issues relating to how GPs not belonging to the groups above are regulated and their joining of the Performers List
  • Clinical Governance at PCT level and at Countywide level, discussing concerns relating to practice/locum performance, Nice Guidance and dissemination,  appraisal and continuing professional development to name but a few
  • GP’s with Special Interest
  • Out of Hours Development

Obviously the LMC would also be available to non-principals in respect of complaints, other pastoral support, if for example as a result of sickness, in financial difficulties or professional issues.

How do we do this?

Lincolnshire LMC have developed their own web site where as much information as possible pertaining to all contractual groups and their respective practices will be available.  This will be available to all non-principals and will include an area specifically for all non-principals including registrars.

The LMC currently hold Locality meetings which the non-principals are invited to and we intend to hold events specifically for non-principals if interest is shown.

At these events topics of relevance to the group, i.e. joining the performers list, appraisal, and revalidation complaints will be presented. 

Non-principals will also have access to other events that we put on about topical issues such as superannuation.

The LMC are currently producing a Locum Pack for both Locums and the Practices that employ them. This is to ensure that both sides are well informed on what to expect from each other, so that both parties can operate in risk managed environment.  This will be distributed to all non-principals as soon as the pack is completed.  

 

The General Practitioners Committee

The General Practitioners Committee (GPC) is a standing Committee of the British Medical Association (BMA).  It is made up of GPs elected to represent LMC-based constituencies, together with representatives elected by the LMC and BMA Conferences, to serve the interests of all General Practitioners.  The GPC negotiates GPs pay and condition of service with the Department of Health, and prepares evidence for the Doctors and Dentists Review Body.  The annual LMC conference guides GPC policy.

The channels of communication between GPs, LMCs, the GPC, BMA and the Health Service are shown in the diagram below.

 

The General Medical Service Defence Fund Ltd

The General Medical Services Defence Trust was established in 1948.  Its purpose was to pay the expenses of the GPC and the Conference of Local Medical Committees from income, based on GPs’ voluntary contributions, collected by LMCs, and also to build a fighting fund for the profession in negotiations with the Government.  Following advice from a leading tax counsel, the General Medical Defence Fund Limited was incorporated on18th July 1980.

The main categories of expenditure by the GMSDF include:

  1. Honoraria and travel costs for GPs attending meetings of the GPC, which normally meets eleven times a year, plus its specialist sub-committees and working parties.
  2. Honoraria for GPC negotiators whose exacting work entails frequent absences for their practices.
  3. The two day Annual Conference of Representatives of LMCs.
  4. Legal and professional fees in relation to matters affecting GPs' terms and conditions of service.
  5. The costs of preparing the GP's annual submission to the Doctors and Dentists Review Body (DDRB). 

The Fund derives its income from two sources:

  1. Voluntary contributions from doctors collected through LMCs.
  2. Dividends and interest on investments. 

Annual quotas from LMCs are calculated on the basis of the number of patients for whom the corresponding Health Authority is responsible for making payment.  (Over the years, these quotas have risen in step with the increases in the average net remuneration made to General Practitioners by the DDRB).

The finances of the Defence Fund are managed with great care and control.  Investments are under constant surveillance and scrutiny by the Directors of the Fund, the GPC and financial experts, to ensure that the best possible results are obtained.