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Local Medical Committees (LMCs)

LMCs are the only organisations recognised by statute as the bodies representing all the NHS GPs practising in an area.

Although there have been countless changes within the NHS and community care, the Local Medical Committees across the UK are the single element of continuity throughout all the re-organisations since the NHS was inaugurated with statutory functions set out by Act of Parliament. Birmingham LMC is made up of democratically elected GP members elected from among their peers in accordance with the terms of the LMCs constitution. The electoral term is four years, with the next one due in October 2019.

Work of the LMC

Birmingham LMC is proactive in keeping abreast of all local and national issues affecting general practice as soon as they arise. We keep aware of the NHS England policies and activities to ensure any issues affecting GPs and their practices are dealt with appropriately. Similarly we also liaise closely and work with the CCGs and local authority.

The LMC works with and liaises closely with the BMA General Practitioners Committee (GPC) in order to ensure that all national issues affecting general practice are quickly acted upon and important guidance disseminated locally soon as it is available.

LMCs influence the policies of the GPC on a national level, particularly through submission of motions to the National Annual Conference of LMCs to which Birmingham LMC actively contributes. Apart from the statutory functions, Birmingham LMC undertake a range of pastoral care and support functions advising individual GPs and practices in difficulties and various other functions determined by the needs of GPs and their practices, which include:

If there are issues affecting general practice you feel the LMC should be made aware of please let us know- phone us on 0121-454 5008 or email us using the facility here on the website.

LMC funding

Birmingham LMC is funded by its GPs though the collection of levies on its behalf by the NHS Commissioning Board (NHS England), in accordance with the Health and Social Care Act. This function is now carried out on NHS England's behalf by Capita and SBS following the privatisation of primary care support services.

The Statutory Levy (for GMS practices) and the Administrative Levy (for PMS practices) fund the work of the LMC on behalf of its GPs and practices. These levies allow all practice partners and employed GPs working within a practice, to benefit from the LMC's advice and support. Freelance locum GPs can also be represented by the LMC by signing up to a levy mandate and paying an administrative levy.

As well as the statutory/administrative levies practices may choose to sign an additional voluntary levy. This funds Birmingham LMC's contribution to the work of the GPC through the General Practitioners Defence Fund (GPDF) as well as small payments to certain medical charities which have historical links to Birmingham general practice. Payment of the additional voluntary levy allows GPs to vote in and to stand for regional elections to the GPC.

LMC Origins

The origins of LMCs go back to the 1911 Lloyd George state health insurance scheme. The BMA at that time was determined that the profession should have a voice in its day-to-day running. It ensured that locally elected committees of GPs were recognised in the 1911 National Insurance Act as the representative voice of the panel doctors. Local Medical Committees are still recognised under the Health and Social Care Act as formally representing the interests of the GPs in their area.

Guy DainMany worthy doctors have led and influenced the LMC in the hundred years of its existence. Two, however, merit special mention for the impact they made at national level, thereby having a direct effect on the health of the whole UK population. One was Sir Guy Dain (see picture, right) and the other Dr Solomon (Solly) Wand (see picture, below, left). Guy Dain, a GP who practised in Selly Oak, was Chairman of the LMC from 1915 to 1937. He was also the BMA´ s national Chairman in the immediate post war period and was responsible for the delicate and Solomon Wanddifficult negotiations between the profession and the Atlee Government that secured the co-operation of doctors in the formation of the National Health Service in 1948. Dr Solly Wand, who practised in Balsall Heath, was an LMC member for over 50 years. He, too, held many high offices within the BMA including both Chairman of Council and Chairman of the General Medical Services Committee, forerunner to today´ s GPC. Solly achieved many notable negotiating successes on behalf of the profession but none greater than securing a 100% increase in GPs´ fees in 1952. Their combined achievements led to the view then held by many doctors, that the BMA was merely a sub-committee of the Birmingham LMC!

NHS Commissioning Board (NHS England)

The Health and Social Care Act 2012 outlined the new structure of the NHS with the abolition of PCTs and SHAs and the establishment in 2013 of Clinical Commissioning Groups accountable to the NHS Commissioning Board (NHS England) which also has responsibility for commissioning all primary care services, including general practice. Under the Act it is the NHS Commissioning Board (NHS England) which formally recognises the LMC as the local representative body. However in April 2015 NHS England gave delegated responsibility for commissioning general practice in Birmingham to the city's three CCGs through the co-commissioning arrangements. This means that the CCGs too now have a delegated statutory duty to recognise the LMC as the formal representative body for all their member GPs. NHS England however retains responsibility for all issues concerning professional performance and the GP performers list, including responsibility for GP appraisals and recommendations for revalidation.

NHS England's responsibilities have been further delegated through the rationalisation and privatisation of all their primary care support services (formerly Family Health Service functions) to Capita, with the loss of the local primary care support office and staff.

Clinical Commissioning Groups (CCGs)

There are currently three CCGs in Birmingham: Birmingham South Central CCG, Birmingham Cross City CCG and Sandwell and West Birmingham CCG. CCGs are made up of member GP practices, which are all contractually obliged to be CCG members. Birmingham LMC has made a significant contribution advising both constituent practices and their CCGs on the content of their legally-binding constitutions. As detailed above, the three Birmingham CCGs now have full delegated responsibility for commissioning general practice and holding GP practice contracts. This function is carried out through the CCGs' Primary Care Co-Commissioning Committees, at which the LMC is represented in an observer and advisory capacity.

In 2016 it was announced that Birmingham Cross City and South Central CCGs and Solihull CCG would “functionally merge” to form a single commissioning organisation covering most of Birmingham and Solihull. It was also suggested that this would be the precursor to a full formal merger of the CCGs. As a result of the functional merger a single “joint primary care committee in common” was formed by the three CCGs to consider all issues related to primary care co-commissioning. The LMC was again represented on this body in an observer and advisory capacity.

The responsibility for commissioning public health local enhanced services has been transferred to local authorities rather than CCGs and the LMC therefore also has a role in liaising with Birmingham City Council in respect if these services and other matters of relevance to general practice. The LMC regularly liaises with GPs, practice staff, the CCGs, the NHS England regional team, Birmingham City Council and all other relevant bodies, including the Birmingham and Solihull and the West Birmingham and Black Country Sustainability and Transformation Plan (STP) boards in order to represent and to provide help, advice and support to GPs and their practices wherever appropriate across all areas of their responsibilities.

General Practitioners

The LMC plays a crucial role advising and support GPs and their practices in many different circumstances. For example it plays an active part in supporting GPs who are experiencing professional conduct procedures or local performance measures.

Birmingham LMC has a major role to play where a GP is unable to practice through ill health - not only from an advisory and pastoral perspective but because the LMC has a statutory role in securing an expert opinion about continued fitness-to-practice on medical grounds - very important in securing continued income for GPs, particularly if the practitioner is suspended because of ill-health or other reason.

The LMC has a statutory role where a practitioner is under investigation by the Commissioning Board (NHS England) in certain areas of clinical practice. The LMC has a specific role in considering certain types of complaints by GPs about their colleagues.