GPs across England have voted overwhelmingly in favour of taking collective action
More than 8,500 GPs in England took part in the ballot (68% of those eligible) and 98.3% voted in favour of taking part in one or more acts of collective action.
This means from today, 1 August 2024, the GPs’ trade union, the BMA, will encourage practices to choose from a list of ten actions, and practices can choose to implement as few or as many as they think appropriate.
Actions may include refusing to share patient data unless it’s in the best interests of a patient, referring patients directly to specialist care rather than following longer and more complex NHS processes and switching off NHS software which tries to cut prescribing costs.
Historically, practices have worked above and beyond their contracts to keep up with patient demand, while being instructed to offer extra services by NHS England.
Despite warning the Government that they’re being forced to do more with less, GPs have been repeatedly ignored and not given the funding they need to handle growing pressures.
Of the entire NHS budget, general practices get only 6% of guaranteed funding. The BMA’s GPC England Committee believes this needs to gradually increase by 1% year on year, to 15% - all the while protecting existing funding across the wider system.
GPs have now reached a desperate point but will not be shutting their doors. In fact, many of the actions will lead to GPs spending more time with their patients, according to the BMA's GP committee for England (GPCE), while showing how problems are generated by NHS wider system and national mismanagement and bureaucracy, in a bid to make the Government take seriously GP practices’ requests for extra support.
However, depending on what action - or actions - practices choose, general practice nurses could find themselves caught in the crossfire. Nurse practitioner and Practice Nurse editor in chief, Beverley Bostock, commented: 'GPNs need to support both colleagues and patients, which could put them in a tricky position.
'If safe working levels are an issue for GPs, they should be for nurses too. Nurses are not there to jeopardise their own working practices by mopping up GPs' wowrk.'
GPCE chair Dr Katie Bramall-Stainer said: ‘We had a huge response to this ballot, and the results are clear – GPs are at the end of their tether. This is an act of desperation. For too long, we’ve been unable to provide the care we want to. We are witnessing general practice being broken. The era of the family doctor has been wiped out by recent consecutive Governments and our patients are suffering as a result.
‘There have been countless opportunities to address the funding crisis in general practice, and despite almost 100% of GPs voting to reject the 2024/25 contract earlier this year, still nothing was done. Practices are now struggling to keep the lights on, can’t afford to hire much needed GPs and other staff, and some have even closed for good. The new Government is keen to find solutions but the causes of practices closing and GPs leaving remain, these actions will help keep practices open and keep GPs in the NHS workforce so can buy time for Mr Streeting to make the necessary changes that were promised in the Labour Party’s election manifesto.
‘We understand that the new Government has inherited a broken NHS, and we’ve had some positive conversations with the new Health Secretary about the situation in general practice. The DDRB award is a small a step in the right direction but we still have hundreds of millions less resource to run our practices compared to even five years ago. Practices are still closing, so we have no choice but to move ahead with collective action to protect our practices, and our patients.
‘This will not be a “big bang”. It will be a slow burn. It’s likely that impact may not be felt for some time. We hope this will give the new Government time to consider our proposed solutions including fixing our contract once and for all.
‘General practice should be the front door of the NHS, not the doormat. We don’t want to have to take this next step but must if we’re to stop our services from collapsing completely. A key Labour manifesto promise was to bring back the family doctor, and we look forward to making sure that can become a reality as soon as possible.’
Potential actions
1. Limit daily patient contacts per clinician to the recommended safe maximum of 25. Divert patients to local urgent care settings once daily maximum capacity has been reached
2. Stop engaging with the e-Referral Advice & Guidance pathway
3. Serve notice on any voluntary services currently undertaken that plug local commissioning gaps and stop supporting the system at the expense of the practice and staff.
4. Stop rationing referrals, investigations, and admissions
5. Switch off GPConnect Update Record functionality that permits the entry of coding into the GP clinical record by third-party providers.
6. Withdraw permission for data sharing agreements that exclusively use data for secondary purposes (i.e. not direct care).
7. Freeze sign-up to any new data sharing agreements or local system data sharing platforms.
8. Switch off Medicines Optimisation Software embedded by the local ICB to make financial savings and/or rationing
9. Defer signing declarations of completion for ‘better digital telephony’ and ‘simpler online requests’ until further GPC England guidance is available. In the meantime:
- Defer signing off ‘Better digital telephony’ until after October 2024: do not agree to share your call volume data metrics with NHS England.
- Defer signing off ‘Simpler online requests’ until Spring 2025: do not agree to keep your online triage tools on throughout core practice opening hours, even when you have reached your maximum safe capacity.
10. Defer making any decisions to accept local or national NHSE Pilot programmes while the BMA explores opportunities with the new Government.
Funding
The Government has committed to honouring the 2024/25 DDRB (Doctors’ and Dentists’ Review Body) recommendation of a of 6% uplift, after NHS England and the DHSC only provided a 1.9% uplift in the interim in April 2024 – a real-terms cut in funding. The GPCE says it could not have stressed more, or evidenced better, how precarious practice finances are currently, and says it is greatly concerned that some GPs will have to hand back contracts and close their practice before the new Government can intervene.
Even if the Government were to more than quadruple the initial 1.9% uplift, which the GPCE thinks is highly unlikely, practices will still be facing a huge shortfall compared with 2018/19 at a time when running costs and staffing expenses are significantly higher.
