Our History, Role and How We Can Support You

What is a Local Medical Committee (LMC)?

An LMC is a local, recognised, statutory committee that represents General Practitioners working under all contract types: GMS, PMS, APMS as well as salaried and locum GPs and Registrars – in fact all GPs working within the NHS.  LMCs vary in size – some represent a small number of GPs whilst others cover much larger areas where LMCs form confederations consisting of a number of LMCs supported by a central organisation.  In Kent we have details of and represent approximately 1400 GPs effectively and economically.

The LMC in the Wider Context

The LMC operates as the link between local GPs and their national negotiating body, the General Practitioners Committee (GPC).  The GPC is a permanent Committee of the British Medical Association (BMA), recognised as the sole negotiating body for all NHS GPs.

GPC membership consists of 44 GPs elected from regional seats, 8 from the LMC Annual Conference and 10 from the Annual Representative Meeting of the British Medical Association (BMA).

The GPC is responsible for advising the Secretary of State, the Department for Health and NHS Employers with whom it negotiates, GPs terms and conditions and pay.  It is guided by policy decisions determined at the LMC Annual Conference.

The Annual LMC Conference is the main policy-making event where representatives from LMCs nationally attend to debate motions that reflect local GP concerns and objectives.  The LMC Conference is the body to which the GPC is directly accountable.

The 6 Main Functions of the LMC

The 6 Main Functions of the LMC

A Statutory Body
Has rights and responsibilities defined in the NHS Acts & Regulations and serves as the local representative committee for all NHS GPs.

An Independent Body
Represents the interests of general practice solely and acts as its advocate, remains independent from political constraints and the need to satisfy other interests.

A Professional Body
Promotes quality and maintains standards of professional practice through support and demonstration in collaboration with other professional and educational bodies

A Representative Body
Listens, debates and responds to feedback and represents the majority view of its GPs to NHS England, ICB and other national and local organisations.

A Democratic Body
Elected by and consisting of local GPs who represent their local and diverse interests.

A Resource
Provides advice and support to all GPs in all matters relating to their professional lives and actions.

A Resource
Provides advice and support to all GPs in all matters relating to their professional lives and actions.

History of Local Medical Committees (LMCs)

The BMA was founded, as the Provincial Medical and Surgical Association, in Worcester in 1832 when there was no regulation of the profession; anyone could practice as a doctor. It lobbied for a regulatory body, which led to the setting up of the General Medical Council in 1858.  The Association’s membership grew rapidly and became the British Medical Association in 1856.

In 1911, the Chancellor of the Exchequer, Mr David Lloyd George, introduced a National Health Insurance Bill, giving statutory recognition to the Local Panel Committees as the representative, local voice of the doctors who took patients on their “panel”.  The 1911 National Insurance Act required the Local Insurance Committee to consult, through the Local Panel Committees, all panel doctors on a wide range of issues.  In 1912, the BMA established a national committee to represent all panel doctors, the Insurance Acts Committee which was recognised by the Government as the authoritative voice of General Practitioners.

The profession broadly supported the introduction of a State medical scheme but strongly opposed the introduction of a salaried service.  It was feared that the loss of the independent contractor status would undermine the GP’s ability to practice without state interference and ultimately put patient’s care at risk.  If it were not for the tenacity of the Insurance Acts Committee, general practice would have been drawn into a salaried service (as our hospital colleagues subsequently were in 1948).  In 1913 the Local Panel Committee became known as the Local Medical Committee (LMC).

The establishment of the NHS in 1948, after the 1942 Beveridge Report, endorsed a number of issues that General Practice demanded:

• Independent contractor status upheld
• Freedom to practice without State interference
• Freedom of choice by patient and doctor whether to take part in the NHS
• Freedom of choice for the doctor of form and place of work
• Adequate medical representation on all administrative bodies in the NHS

Due to the fixed amount of money in the “pool” system, by 1964 General Practice faced a serious crisis.  GPs felt neglected and under-funded, morale was poor and recruitment was very low.  General Practice had lost faith with both the Government and GP leaders.  This crisis led to the Family Doctors Charter, which received widespread support of the profession (including 18,000 undated resignations) and was then negotiated with the Government.

Summary of the 1965 Doctors’ Charter proposals:

• Increased recruitment to General Practice
• Reduce maximum patient lists to 2,000 per GP
• Improved medical education, orientated to General Practice
• Improved premises and equipment
• Introduction of direct reimbursement of staff and premises expenditure
• Payment to reflect workload, skills and responsibility
• Reasonable working hours
• Proper remuneration for out of hours work

This led to the establishment of the famous `Red Book’, which increased in complexity over time.
The Trade Union and Industrial Relations Act of 1974 led to the BMA being recognised as the Trade Union representing the medical profession. It should be made clear that LMCs are not Trade Unions.  The NHS Acts of 1977 and 1984 reinforced and expanded the statutory recognition and functions of LMCs.

In 1990 the Conservative Secretary of State for Health, Mr Kenneth Clarke, imposed a new Contract. This seemed to cause more problems than it solved but laid the way for many of the recent concepts such as Fundholding, practice-led commissioning, PMS and now the GMS contract.
Structures seem to change at an alarming rate in the NHS.  What is clear though, from reading the history of medical politics, is that the issues GPs face today are not dissimilar to those faced at times of crisis in 1911, 1948, 1964 and the mid-1990’s.  The LMC has been in existence since 1912 and is still the only local, elected and representative body of General Practitioners.

This Guide will hopefully inform you of the roles and responsibilities of the LMC.  In addition, it should demonstrate the importance of the benefits of a strong, well-organised, local body representing you.

How are we funded?

The LMC is funded from Statutory & Voluntary Levies.  We raise levies to cover the expenses of the office function as below:

The Statutory Levy
This sum, collected from all practices based on a number of pence per patient, is reviewed annually.  This ensures LMC independence from any other NHS body and enables us to represent and work neutrally on behalf of our GP constituents.  This funding is used exclusively for the running of the local LMC office and its functioning.

The Voluntary Levy
The Voluntary Levy is collected to contribute Kent’s share of the cost of the operation of the national negotiating committee and the GP Defence Fund.  The rate is set by the GP Defence Fund, based on an amount per patient and reviewed annually. Access to services funded from this levy will be made available to those who contribute.

Kent LMC Advice, Guidance and Support

We provide guidance, advice and support in the following areas, to name but a few:

• PMS/GMS/APMS contracts
• Salaried GP contracts and terms and conditions
• GMS/PMS and APMS regulations and the Statement of Financial Entitlement
• Patient Lists and allocations
• Patient Medical Records
• IT & Information Governance
• Superannuation issues
• Ethical responsibilities
• Doctors whose performance causes concern
• Medico-legal issues
• Complaints and disciplinary issues
• Partnership Agreements
• Pastoral support
• Dispensing application appeals
• Integrated Care Board
• Enhanced Services
• Occupational Health negotiation
• Private Fees
• Collaborative Fees
• Dispute resolution in partnerships
• CQC advice and support
• Premises

If in doubt, always contact us first and we will be able to help or guide you to the most appropriate organisation i.e. BMA, your own accountant or solicitor etc if we are not able to help.

Kent LMC Statutory Role

The LMC’s role is to represent the views of all GPs to a variety of bodies i.e. NHS England, ICBs, Social Services, Education, patient representative bodies, the BMA via the GPC, Members of Parliament, the Royal College of General Practitioners (RCGP) and the local and national press.

The LMC role is enhanced under the NHS Health & Social Care Act in respect to doctors whose performance gives cause for concern.

Our wider responsibilities include the following:

Are you keen to join the LMC?

LMC representatives are elected for a 3 year term (although we do have some occasional vacancies that occur mid-term).  All GPs are informed of forthcoming elections in their constituency in advance.  If you are keen to contribute and influence events in your local area we would be pleased to hear from you.  You can contact the office if you require more information.