“The aim of Beds and Herts LMC Ltd is to support GPs and practices to aspire to excellence in patient care by advising on and promoting the development of all aspects of general practice”
Local Medical Committees (LMC) are statutory organisations recognised in the NHS Act since 1948 as the only elected professional body representing all local GPs. Set up in 1911, they predate the NHS and have played pivotal roles in facilitating the functioning of the NHS. They have survived many NHS re-organisations and have adapted when necessary to new NHS structures. Area Teams have a statutory duty to consult with their local LMC on certain issues.
Because of their adaptability, the way local LMCs are structured varies around the country. For Bedfordshire and Hertfordshire there is one LMC covering the two counties, and the main committee delegates all its strategic and policy functions to two sub-committees – one for Bedfordshire (including Luton) and one for Hertfordshire. The sub-committees are made up of elected GP representatives and are supported by a secretariat team based in Stevenage. In 2006, the Beds and Herts LMC became incorporated as Beds and Herts LMC Ltd allowing us to expand the services we provide whilst ensuring adequate liability insurance for all LMC representatives.
Even though the LMC is a Limited Company it remains a not-for-profit organisation, limited by guarantee only: there are no share-holders and no one benefits from dividends. Any profit made is put back into the organisation and used for the benefit of GPs and their practices and helps to keep the levy as low as possible.
Values of Beds and Herts LMC Ltd
Beds and Herts LMC Ltd prides itself on having strong values of Leadership, Expertise, Integrity, Adaptability and Collaboration. We strongly support development of high quality general practice, in order that patients may receive excellent health care. We promote teamwork and multidisciplinary practice, and facilitate this wherever possible. We not condone or support poor performance or poor professional behaviour in any way, however, we will support colleagues going through performance or disciplinary procedures in order to ensure they are dealt with fairly and appropriately. In summary, we believe that on the whole ‘If it’s good for patients, it’s good for GPs’.
Roles and Functions of Beds and Herts LMC Ltd
As the representative body for all GPs in Bedfordshire and Hertfordshire, the LMC Ltd supports practices in several ways including:
- Negotiating on behalf of practices with the Area Team, CCGs and other organisations on issues that affect general practice.
- Supporting individual practices going through periods of difficulty (such as partnership disagreements, contractual problems or performance issues).
- Providing practices with information about local and national health policies, contracts, and legal and ethical matters pertaining to the running of the complex business of general practice, through a multitude of mechanisms including courses and lectures, a comprehensive website, regular newsletters and direct mailing. The LMC is also happy to advise the Area Team, CCG or Local Authority staff on any of these areas.
LMCs are statutory organisations recognised in the 2006 NHS Act (as amended by the Health and Social Care Act 2012). LMCs are the only democratically elected body representing GPs. As such LMCs have statutory obligations under Part 6 of The NHS (General Medical Services Contracts) Regulations 2004 (Functions of Local Medical Committees). In summary these are:
- To consider any complaint made by any medical practitioner against another, and report its findings to the NHS Commissioning Board if there are concerns relating to the efficiency of services provided under a contract resulting from the complaint.
- To make arrangements for a medical examination of a practitioner when there are concerns that the practitioner might be ill, or that his or her health might be putting patients at risk, and to make a written report for the NHS Commissioning Board regarding the practitioner’s capability to carry out his or her role.
Part 7, of Schedule 6 (para. 99 (2)) of The NHS (General Medical Services Contracts) Regulations 2004 gives the NHS Commissioning Board or practices the option of involving the LMC in resolving disputes between the NHS Commissioning Board and practices. The committees are happy to be involved in helping to resolve such disputes. This will remain a critical role in the future.
A summary of all the functions of an LMC can be found in the GPC guidance on the Role of LMCs.
LMC/Primary Care, CCGs or Local Authority Liaison meetings
Formal LMC/Primary Care Liaison meetings are held every two months and provide an opportunity to discuss plans or proposals from the Area Team, CCGs or Local Authorities which impact on general practice. These meetings are attended by members of the LMC Secretariat, LMC representatives and key staff from the Area Team, CCGs and Local Authorities. A number of informal meetings between secretariat and staff from the Area Team, CCGs and Local Authorities also take place to progress work arising from formal meetings.
Formal LMC Consultation
Where the Area Team, CCG or Local Authority is seeking formal LMC approval or an opinion on a proposal or issue, the LMC sub-committee would need to be consulted. The sub-committees meet every two months (excluding August). In months when the sub-committee does not meet there is an Executive Committee which will also consider proposals from the Area Team, CCG or Local Authority and is able to give approval if appropriate.
For urgent matters, we can consult committee members through various other channels to obtain an early opinion without waiting for a formal committee meeting.
Please note that while LMC representatives or members of the Secretariat can represent the LMC at meetings and provide advice and opinion, they cannot give LMC approval without further discussion at an LMC sub-committee or executive committee.
The NHS Act (2006) stipulates that every area must have a Local Medical Committee (LMC) acting as a representative body of GPs within its area. It must be recognised, as such, by NHS England. The Act also stipulates that this must be funded and resourced by the local GPs through levy payments.
The Beds and Herts LMC Ltd is a company limited by guarantee and is a ‘not for profit’ organisation. Any surplus made during the year is put back into the services for local GPs, or held in reserve. There are no bonuses or dividends paid. The Beds and Herts LMC incorporated in October 2006 in order to be able to provide more comprehensive services for the GPs of Bedfordshire, Luton and Hertfordshire.
LMCs are mainly funded through a statutory levy paid by all practices (taken at source). The statutory levy is worked out on a capitation basis per patient registered. Based upon the previous year’s expenditure, the board proposes a budget and the following year’s levy to the Annual General Meeting (AGM) of the members of the company. As every LMC sub-committee representative is a ‘member’ of the company every member of the LMC sub-committees has an opportunity to agree or not to the levy being proposed, as is statutorily required. Meanwhile all GPs are invited to the AGM to hear what we have achieved in the previous year and what we propose for the coming year.
The annual accounts are drawn up and audited at the end of the financial year on 31st March. They are presented at the AGM. A report of the accounts is also presented at the first LMC sub-committee meeting following the AGM (a constitutional requirement) and a detailed report of the accounts appears in the Annual Report. As a limited company, the accounts are posted at Companies House and are available at the LMC Ltd offices, on request. LMC representatives are paid travel expenses and a sessional fee to prepare for and attend meetings. The amount paid is agreed at the AGM.
The LMC Ltd also collects a voluntary levy from practices (taken at source). To date, this has been used to support the national negotiations undertaken by the General Practitioners Committee of the BMA (via the GPDF Ltd – General Practitioners Defence Fund.
As custodians of both levies, the Beds & Herts LMC has a statutory responsibility to the GPs of Bedfordshire, Luton and Hertfordshire to account fully for how the levies collected are utilised to the benefit of the GPs and their practices that pay them.
Bedfordshire and Hertfordshire LMC (as defined in the NHS Act 2006) is the overarching LMC. It has a statutory obligation to collect levies from GPs for the running of the committees and serves no other purpose. All income from the levies is granted over to Beds and Herts LMC Ltd. At its AGM each spring, it delegates the strategic and policy setting functions to two county-wide sub-committees (the Bedfordshire LMC Sub-committee and the Hertfordshire LMC Sub-committee) and all other functions to Beds and Herts LMC Ltd.
On 1st October 2006 ‘Beds and Herts LMC Ltd’ (the company), took over the day-to-day running of the Beds and Herts LMC. The company has full responsibility for all the functions of and services run by the LMC, including the setting up and running of the two county sub-committees; for example the company runs the election process for the committees. All functions undertaken by the company are regulated by a Service Agreement between Beds and Herts LMC and the company.
Beds and Herts LMC Ltd is a company limited by guarantee so there are no shareholders and the company is non-profit making – exactly as the LMC has always been. Any profit shown in the accounts at the end of the year is put back into the organisation for the benefit of GPs and their practices and helps to maintain the lowest possible statutory levy. There is a board of the company which is made up of representatives from the two county sub-committees and the Chief Executive of the Secretariat, who acts as Company Secretary. All LMC representatives are members of Beds and Herts LMC Ltd.
As a limited company, the LMC is able to provide a far wider range of support and services for practices.
Relationship between LMCs, GPC and BMA
The General Practitioners Committee (GPC) is a committee of the British Medical Association (BMA) and is recognised as the negotiating body for all NHS GPs. Amongst other things, the GPC negotiates with the Department of Health through the NHS Employers on GPs’ terms, conditions and pay. Local Medical Committees are the link between local GPs and the GPC. Each LMC has a regional GPC representative. This way, the views and opinions of all GPs can be represented at national level via the LMCs to the GPC.