The 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 to 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
- Improve medical education, orientated to General Practice
- Improve 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 nGMS 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 for over 95 years and is still the only local, elected and representative body of General Practitioners.