The Local Medical Committee (LMC) is the statutory forum for representing and preserving GPs' interests, and there is a committee roughly equivalent to each Health Authority area. Each committee sends a few of its members to the Annual Conference of LMCs, and from this conference, a number of GPs are elected to the national forum for GPs, the General Practice Committee (GPC). The GPC, in turn, is a committee of the BMA, and 6 or so GPC members comprise the "Negotiating Team" which represents GPs in discussions with the Government and the Dept. of Health.

None of this, of course, is for free! GP principals pay for it, in two ways: the "statutory levy" and the "voluntary levy". Whereas, in reality, both these payments go into the same pot, the former is meant to help pay for the running costs of the LMC, and the latter goes towards helping pay for national representation, in the form of the General Medical Services Defence Fund, (GMSDF). There is a legal requirement for "GPs" to be represented by this system and, as can be inferred from the name, paying the "statutory levy" is obligatory, but is allowed for in the intended gross pay of principals, and doesn't affect their intended net pay. The voluntary levy is just that but very nearly all principals pay this as well.

However, the system is flawed to the extent that the wording of the statutory levy requirement only enables GP principals to participate. This is not a deliberate act of omission, but simply reflects the historical times when the regulations were drafted. Only very recently has there been both a significant number of NPs, and a "culture" of, and indeed demand for, NPs remaining as NPs for a significant part of their careers. However, there is no reason why LMCs should not represent NPs, and as equally as principals.

Last year, a Task Force from the GPC's Representation Subcommittee reported on how the system could be changed to accommodate NPs within the LMC system. The Non Principals' Subcommittee of the GPC, and the chairman of the Representation Subcommittee, recently added their voices and the outcome was a united call for LMCs to "allow" NPs to participate fully in representation and voting within LMCs. Of late, LMCs have been able to co-opt NPs as members, but the degree to which this has been taken up, and the ability of those co-opted NPs to vote or claim expenses or honoraria, has been very patchy from area to area. For LMCs who have proved reluctant to involve NPs, the usual "excuse" is that NPs do not contribute to the running costs of the LMC, in other words, don't pay either of the levies.

Pending change in the legislation which is necessary to enable NPs to pay the statutory levy, the GPC has recently encouraged LMCs and NPs to get together and set a voluntary levy for NPs. This requires neither any change in the law, nor any "official directives" from the GPC or the BMA. This is because the voluntary levy is set and collected by each LMC. What happens is that the GPC, effectively, sends a "bill" to each LMC, which is proportionate to the number of patients covered, and each LMC decides how it wants to collect it from it's own GPs. For example, the LMC might set it in terms of the list size, the superannuable income, or the contracted hours, of each principal.

The GPC has now recommended that the sum of £25 represents an appropriate amount for non-principals to contribute on an annual basis to LMCs and the NASGP is happy to endorse this proposal.

If NPs were to register and pay a voluntary levy, there would be enormous benefits for all parties:

• NPs would be able to stand and vote in LMC elections in their own right, and thus to further elected stages of regional and GPC level.
• The LMC would have an obligation to represent NPs fairly, and would be answerable to NPs. It would facilitate ultimate involvement within the area's PCGs, and, hence, clinical governance and revalidation.
• The number of "GPs" being ultimately represented by the GPC would rise, which would carry more weight for the Negotiators when meeting the Dept of Health.
• It would either help dilute the amount of voluntary levy payable by all GPs, or contribute valuable funds for the LMC; in the light of all that the LMC has done for NPs, it's a chance to recognise this.
• It would be an enormously helpful step towards mutual respect and understanding.

This is another small step towards all GPs being as equal as others. We don't know how the representation side will be actioned - whether each NP will join a constituency and simply vote and participate alongside principals, or whether the local NP group will be given separate constituency status. And at the moment, the main point is to get registered and pay that levy, which is, by the way, tax deductible for all NPs and payable annually.

If you wish to pay the levy, simply contact your local LMC who will advise you on their charge and method of payment.

Peter Harvey
NASGP Secretary