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GP's on Strike? BMA rejects government 'rescue package' for Practices

Violence towards practice staff. GPs pushed to breaking point. The UK media discrediting practices at every turn - how much more can General Practice take?

The BMA and the General Practice Committee England (GPCE) seem to have said that enough is enough - last week they issued a statement advising LMCs and Practices not to engage with the government’s rescue plan. This included plans for practices to spend more time on bureaucratic processes and ramping up face-to-face appointments, as well as complying with league tables that would name and shame practices, something that the Health Secretary Sajid Javid has both defended and denied in the last few weeks.

But Why Now?

The Rescue Plan issued by the government is regarded by the GP unions as ‘the straw that broke the camel’s back’, that general practice is in crisis and instead of support, the Rescue Plan promised league tables to monitor practices and funding that is considerably lacking.

The BMA has highlighted the ‘continuous rejection of the severity of the issues' being faced by Practices and a belief that this rescue plan would do very little to help ease the burden on General Practice. An example being cited is that in Europe, it is considered safe for doctors to see around 25 patients in a day. GP’s in the UK are sometimes seeing 25 patients before their morning coffee break (if they’re lucky enough to get a morning coffee break).

GPCE listed several actions that could be taken by practices to make a stand and take action, the first one being that they reject and do not comply with the “Rescue Plan”. A more controversial request is for practices to withdraw from their PCN DES. This has been met with less support as it would lead to a lot of questions that need answering;

  • If you withdraw from the PCN DES, what happens to the staff employed by the PCN?
  • Will PCN lead practices have to bear the brunt of salary payments themselves?
  • Are they made redundant?
  • Stopping Additional Roles Reimbursement Scheme recruitment could have a negative impact on the practice and patients – how will they meet demand?
  • How would this move be seen by the public?

There is another side to this argument, however, as withdrawing from the PCN DES would potentially allow practices to return to an older model of GP Practice (favoured by some), allowing practices to simply put their heads down, see their patients and carry on. The GPCE asked for support from the BMA to fight the need for GPs to declare their earnings and to force them to review Covid Vaccination exemptions.

For GPs, being forced to declare their earnings is upsetting and controversial. GPs are well paid - we all know that, patients know that. They are highly trained, hardworking professionals that can get over £150k a year, but so can other highly skilled professionals, such as a lawyers, doctors working in secondary care etc. but they aren’t being asked to declare their earnings publicly.

One thought for this is that patients might be more aggressive towards GPs if they know their earnings. A further thought is that with the current pressures and state of General Practice, many practitioners no longer work full time and as such, the number of doctors earning over £150k per year is likely to be low. The GPC and BMA have promised to support any GPs that refuse to comply with such unreasonable demands.

Perhaps most importantly, GPCE wants to negotiate a new contract that allows for safe practice and increased funding.

Workload Control Measures

The GPCE also issued advice for practices, essentially to begin a soft “Work to Rule”, a form of industrial action whereby the very basic conditions of a contract are met, with the “extras” that are often done without thinking to deliver targets and results not being done. This is being referred to by the BMA as “Workload Control”.

“Work to Rule” limits the risk for the practice as the contract essentials are being carried out but will likely have a big impact for the NHS as the practices will not be doing the extra work that has no doubt carried Primary Care for a considerable amount of time. Essentially, practices are being told to do what they need to do to ensure the safety of patients and the wellbeing of employees. This includes:

  • Stop working to 10-minute guidance and take 15+minutes per appointment
  • Apply to close the practice list and focus on current patients
  • Stop all non- GMS work
  • Reject all work passed from secondary care that has not been properly commissioned
  • Not to accept any extra 111 patients more than the contracted 1 per 3000 patients
  • An end to any unnecessary cost-based prescribing audits
  • Turn down any additional extended access sessions

Votes, ballots and resignations

The BMA are pushing ahead with a ballot of their members just as we hear of the recent resignation of the BMA Committee chair Richard Vautrey on Monday (1st November). GPs have until 14th November to respond to the BMA’s ballot on what action GPs are prepared to take against NHS England and the Government’s access plan. It also transpires that NHS England supplementary guidance suggested it would not publish the list of the 20% of worst-performing practices identified by each ICS to receive access support, something that the BMA have considered as a concession, that the government might just be starting to listen to GP feedback on this new proposal.

You can download factsheets on the details of the 'Improving Patient Access' plans here.

Our weekly Primary Care News Round-Up is published every Friday with all the practice-related headlines from around the UK.


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