GPs are taking ‘collective action’. What does that mean?

Are GPs on strike? People might reasonably be confused. On 1 August, GPs voted to take industrial action. But the ballot was of a sub-section of GPs, and – unlike recent industrial action taken by other staff groups in the NHS – this isn’t a strike. This short piece explains the background to the dispute, what action GPs plan to take, and what this might mean for patients and the government.

Why the dispute?

GP leaders at the British Medical Association (BMA) formally entered a dispute with NHS England in April this year over changes to the GP contract. Usually held between groups of GP partners and NHS England, the GP contract is negotiated annually, setting out the services GP surgeries must offer, and what they’ll be paid in return. It’s often been controversial – and for the past three years has been ‘imposed’ on GPs – meaning that the BMA did not agree to the contract.

For the past five years, annual increases to core contract payments have fallen well below inflation in the wider economy. GP partners use funds received through the contract to operate their practices – including covering the cost of most staff (some are employed through primary care networks and paid for separately), and running costs like utility bills. BMA leaders say that below-inflation increases have decreased the value of the contract by £660 million, making it hard for GPs to meet rising costs, and driving hundreds of practices to close. The contract imposed on GPs in April this year amounted to a 1.9% uplift in core funding – and proved the final straw.

The role of pay

BMA leaders argue that industrial action is about ‘safety, security and hope’, and stress that under-funding of GP services is detrimental to patients. At just 8.4%, the proportion of total NHS funding spent on primary medical care is at a historic low. But this is at least a little bit about pay too: GP partners take a share of any surplus they can generate from their contract.

The government would also argue that GP partners have had other boosts to their practice funding, for example to cover pay rises for salaried GPs.

What action are GPs taking?

The BMA are asking GP partners to take at least one of nine possible actions. None of the options breach the GP contract, and partners are encouraged to ‘choose as they see fit’. Actions range from withdrawing from data-sharing agreements, to writing referral letters in place of preferred hospital referral forms. The most immediately impactful option is to limit daily patient contacts to 25 – which the BMA say is the recommended safe maximum – but is well below the volume most GPs currently see.

With a mandate for action from 1 August, BMA leaders are urging GP partners to act immediately. But they’re framing this as ‘a marathon not a sprint’ – being clear that they expect this to be protracted (some actions may be permanent), and for practices to participate in different ways.

What does this mean for patients?

It’s very unclear how this will play out. First – we don’t know how many practices will take part. Only GP partners who are BMA members voted – around 23% of the GP workforce. And although partners will have voted individually, presumably they’ll have to agree actions within their partnerships, which may not be easy. It’s also unclear how salaried GPs – now a majority of the GP workforce – will feel about participating. The potential for disagreement at practice level is palpable.

Second, we don’t know which actions participating practices will take, and when.  Some options, like those related to data sharing, are unlikely to immediately impact patients. Others, like changing referral behaviour, would be more disruptive to the wider NHS. And if GPs significantly reduce the number of people they’re seeing, the impact on patients – and on urgent and emergency care services – could be significant. NHS England has modelled some of the different options – and come up with a very wide range of outcomes.

What are the implications for the government?

Collective action from GPs is an important moment for the NHS. For years, general practice has been under-funded and under-doctored. Patient satisfaction has plummeted, and GPs believe that the quality of care they provide has declined. General practice is the foundation of the NHS, and it’s clearly shaky. 

The new Secretary of State has been clear that he wants to ‘fix’ general practice. On the day that ballot results were reported, the government announced an additional £82 million to employ newly qualified GPs – and published a letter from Wes Streeting promising to ‘reset the relationship between GPs and your government’. Patients, GPs, the BMA and government will be united in wanting a stable, strong general practice. Ultimately, they’ll need to work together to deliver it.