Sarah Jarvis 

Why do ministers really want to abolish MPC?

The medical practices committee - which ensures the fair distribution of GPs across the NHS - is set to be scrapped under the NHS plan. But committee member Dr Sarah Jarvis fears it is an attempt by ministers to control doctors
  
  


For more than 50 years, the medical practices committee (MPC) - which ministers wish to abolish - has been charged with the task of ensuring that patients have equitable access to GPs.

In recent years, the increasing shortage of GPs has meant that in order to maintain relative national equity, the committee has been forced to make some unpalatable and unpopular decisions, turning down applications for practice or locality vacancies on the basis that other areas needed the GPs more.

At the same time, GP workload - both in terms of consultation rate and bureaucracy - has continued to increase, and some GPs have been understandably upset at being refused the medical workforce they felt they needed to provide a high quality service.

Despite its best efforts, there is still not complete equity of distribution of GP workforce - and in its quest for a scapegoat, the government has picked upon the MPC. The health and social care bill will bring into statute the abolition of the MPC, announced by the secretary of state for health in the NHS plan of June 2000.

But what is the real reason for consigning the MPC to sacrificial bonfire of equity? Has it really failed in its purpose? The general practices committee (GPC) and the royal college of general practitioners (RCGP) think not.

These two bodies might be expected to be among those most likely to gloat at its demise - the former because it represents so many GPs whose requests for new partners have been ignored by the committee; the latter because the MPC has found itself bound by statute to ignore the workforce implications of really high quality practices.

Yet in their joint response to the NHS plan, the bodies state that they "find the proposed abolition of the MPC perplexing and profoundly worrying, not because we seek to preserve an expert body which has served the country well, but because we believe that this proposal will achieve the opposite effect on equitable distribution to that envisaged

"The MPC has never had the ability to influence the socio-economic forces which determine where people, in this case GPs, choose to settle. Despite this, the MPC has succeeded in ensuring all patients across the country have good access to reasonable numbers of GPs. Indeed, matters might have been far worse were it not for the expertise of the MPC over the years."

So what is the government's rationale? At first glance, cost might seem to be the reason. The MPC costs £500,000 per annum to run, and the explanatory notes on the bill state that there is a "potential saving to the government".

Yet the vast majority of the MPC's work centres on workforce planning, and the government proposes instead to set up a series of workforce development confederations, at a cost of many millions of pounds, to address workforce and training issues for GPs and other primary care staff.

The MPC's success has been limited by its powers of negative direction, which allow it to declare vacancies in needy areas but not to direct GPs to work there - issues largely centred on socio-economic forces.

As the GPC/RCGP response states: "Successive governments could have created the necessary financial inducements to counter these forces but have failed to do so."

The government has thrown itself wholeheartedly into the quest for more efficient and innovative working in general practice, via the NHS primary care pilots, but has, as with fundholding, failed to commission any robust research into its effectiveness before rolling out the programme.

Can it be coincidence that a desirable side-effect of the pilots, from the government's point of view, is the change for involved GPs from self-employed (independent) to employed (far more easily controlled) contractor status?

Further, can it be coincidence that abolishing the MPC and incorporating GP workforce planning into general primary care workforce planning makes GPs just one more layer in the health workforce? Could it be that the MPC made them too special, and therefore more difficult to control?

• Dr Sarah Jarvis is a west London GP

 

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