Local Medical Committees (LMCs)

LMCs ^{Note 1} were given statutory recognition in the 1911 National Insurance Act. The Act required health service managers to consult all GPs via the LMC. After LMCs were set up a national representatives committee was established within the BMA to represent the interests of LMCs in negotiations with government. The National Insurance Acts Committee, the forerunner of the GMSC, was recognised by government as the democratic voice of GPs. It was this committee that fought hard to retain the independent contractor status of GPs, fearing that a salaried service would undermine the freedom of doctors to practise without State interference.

Now LMCs have to have formal approval by a health authority (HA) and recognition of their constitution. The recognition gives the committee certain statutory functions which it is required to perform. Broadly these are to do with:

• The functions based on the ‘partnership principle’. HAs and LMCs should work in partnership to determine what policies and actions should be implemented locally. This ensures efficient provision of GMS enabling health authorities to draw upon the expertise of local GPs, and it ensures fair and reasonable application of centrally negotiated terms of service. (There are concerns that recent re-organisation of the NHS has weakened this partnership and proposed changes in the 1997 White Paper. The New NHS Modern and Dependable will reduce that further).
• Administration of the contract. Health authorities are required by statute to consult the LMCs on many issues within GMS Regulations including issues within Terms of Service, Pharmaceutical Service Regulations, Statement of Fees and Allowances (the Red Book), Complaints Procedures, and investigations of matters of professional conduct.
• Representation of GPs as a whole. LMCs give advice on partnership agreements and disagreements, on cost rent, valuations and the sale of good will, and it has a medico-political function; through the GMSC it can influence negotiations with the Department of Health.

LMCs also deal with ethical dilemmas, aim to maintain the standing of general practice in the media and public eye, ensure representation of GPs on outside bodies and nominate members of local medical audit groups.

LMCs act as a point of reference for other NHS bodies seeking GP’s views and as a consequence are often in dialogue with medical advisory committees, purchasing committees, education committees and with secondary care providers, for example, about clinical assistant posts, GP beds and access to diagnostic facilities.

LMCs are independent self-financing bodies. Independent status enables it to exercise medico- political functions in addition to its statutory functions. This role is carried out via GMSC members and at the national conference of LMC representatives held annually in June. The conference is convened by GMSC which prepares a report, a copy of which is sent to all GPs who then have the opportunity to express their view to their conference representative on the LMC. LMCs send one representative per 120 GP principals within their area to the conference. LMCs submit motions for inclusion in the agenda of conference which, if carried, are used to formulate GMSC policy. Over 300 GPs attend the conference. The whole process is very democratic and underpins the work of the GMSC and its negotiators.

The actual constitution of LMCs varies. They tend to split their locality into constituencies and a proportion of members are elected per constituency. Some have additional members without constituencies. Members serve for 2 or 3 years and so half or a third are re-elected each year. Some have other members co-opted such as the local Director of Public Health. Many have seats for GP registrars’ observers and recently many GPs have co-opted non-principal representatives. LMCs usually co-opt members to represent groups of doctors in general practice who would otherwise be unrepresented. The Norfolk LMC has been ahead of many in this respect and now has four non-principal representatives. One of these, Dr Jessica Harris gives her personal view on LMCs.

Why join your LMC?
Three years ago when I realised I was going to be a non-principal for a while, I joined our LMC. I wanted to stay in touch with what was going on locally and hoped it would give me a way to improve things for non-principals. It has done both of these things, and, I even enjoy it!

In Norfolk there is a well organised LMC with an enlightened chairperson who invited non- principals to stand for election three years ago. There are now four representatives and I feel that we have made an impact both locally and nationally. Over my three years on the committee I have noticed a change in the way we are perceived on the committee; our opinions are now respected. I think this has come about through our continued presence as confident, articulate doctors who are positively achieving change.

Locally there is scope for as many initiatives as can be thought up and coherently argued for! We have set up a database of non-principals and this has given power to our arguments as we know that we represent 60-70 doctors. The mailing list and locum list derived from it enable non- principals to stay up-to-date and in touch and helps practices find cover. Our next big push will be for some system of postgraduate education payments locally.

Nationally we have been successful in putting forward motions to the annual conference of LMCs, some of which have then been passed and so have become GMSC policy. Last year these were on negotiating for a salaried service option, updating the retainer scheme, ring fenced new money for continuing education for non-principals and non-principal representation on the GMSC and LMC. We now need to follow these up and make sure that they actually happen. The GP press have publicised Norfolk LMC’s lead and as a result we have been contacted by and have advised other non-principals around the country who would like to get onto their LMCs.

I certainly now feel that if you want to change things you’ve got to get involved. Find out if your LMC have non-principal members and if so join it. If they don’t, then lobby them to co-opt you. It is GMSC policy to have you there and you can make a real difference.

Jessica Harris, Retainee, Member of Norfolk LMC.

Note 1
Source: GMSC - The work of Local Medical Committees in England and Wales and BMA Handbook for GPs 1997 -8

Update from the NASGP Webmaster May 1999
A lot has changed since this chapter was written and many LMCs have opened their doors to Non-Principals. To keep up to date with the latest developments keep an eye on the NASGP Latest News web page.

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