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CAMHS won't see you now

Why GPs should declare a nationwide 'black alert'

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Watching the junior doctors in their struggle against the Government has been a real education.

They have reframed the argument to be about patient safety and larger concerns about the direction of the health service, despite all attempts by the Government to reduce discussion to pay and working hours.

And if a recent BBC poll is to be believed, then public support is holding up so far, with 66% in favour of the strike. They are now in an even stronger position to glean concessions from ministers in the next round of negotiations.  

And all this is very instructive for GPs. As I understand it, contractual negotiations between the Government and the GPC continue to meander on. Despite recent promises from the health secretary that he will end the ‘neglect’ of general practice, there is little sign of a radical deal capable of reversing the rising pressure on practices. 

I am hearing about more and more practices simply closing their doors for good, and this will only put more pressure on those left behind. We are in dangerous territory for general practice.

Every practice should say they are full and cannot safely take on any more patients 

So what can the profession do? As we reported last year, many LMCs have submitted motions to the special LMCs Conference at the end of the month demanding industrial action and/or mass resignation. But let’s be realistic. This is a hard message to sell.

GPs do not command the same sympathy as junior doctors and I will eat my hat if the (inherently conservative) LMCs Conference vote anything like this through as GPC policy. Boycotting the CQC would be popular, but illegal. Refusing to co-operate with appraisal would definitely send out a message, but perhaps not the right one.

I have thought long and hard about this and – for what it is worth – this is the best idea I have.

The only way forward I can see is for GP practices to declare a nationwide ‘black alert’ en masse and for all practices to close their lists. That is right – every practice should say they are full and cannot safely take on any more patients until the Government sorts out the GP shortages, funds practices fairly and drastically reduces workload dump, pointless regulation and paperwork.

Practices can do this on your own ‘informally’ (you do not want to go down the formal route as you require area team agreement) and NHS England said itself that practices could do this if there was ‘urgent action needs to be taken’ and there is a ‘sudden impact on a practice’s ability to provide patient services’.

I would suspect that most would categorise what is going on at the moment as well past ‘urgent’ and almost definitely impacting on patient care.

Hospitals are able to declare emergencies and shut their doors unilaterally, why on earth can’t general practice? Alright, the NHS can still allocate patients to you, but it will still be a lot of hassle, and will be the kind of ’grand gesture’ that will grab the right kind of headlines.

It ticks all the boxes. It is collective (Tick), about protecting patients (Tick), it will draw attention to the unsustainable way general practice is being run (Tick) and it will irritate the Government (Tick).

We have come to the point where talking is not enough. Something needs to change and fast. Are you with me?

Nigel Praities is editor of Pulse

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Readers' comments (18)

  • How do you do it informally and not face the wrath?

    I know of a few local practices that could go bang, if we don't go before them and extra patients would just put undue pressure on us.

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  • Vinci Ho

    Civil disobedience
    Non-cooperation campaign
    The principle is always about everybody of a lot of people ,each takes a small step 'forward' to test the boundary of the rules. Solidarity is the pre-requisite .

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  • i think its a great idea, but the problem in GP-land is the army of cardigan wearing oldies that are approaching the end of their careers - they wont do it.

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  • Agree with above. Carigans need to go before action is taken. Me phinks April will see many of them retire.

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  • Declare a real black alert
    Primary care is very busy. We are not able to take any referrals from secondary care - please sort your own follow ups, "GP to chase", certificates etc etc

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  • I agree - It's a total mess . Perfect storm - so glad I resigned as a partner.

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  • Collectively refusing to take on new patients is fine, but as has been said, many practices will not participate.

    Whether we like it or not the NHS will be privatised. Past labour governments and the present Tory government are working on it. If JC becomes the next PM he may try and reverse changes, but with TTIP around the corner it may be too late.

    GPs cannot cope with the present workload, non-evidence based directives coming from the Government and media negativity. They are leaving the NHS in droves. We have seen nothing yet.

    So would it not be a good idea for the GPC to develop a private insurance based primary care federation. The GPC would put the insurance out to tender. This would be UK wide and allow GPs to deliver good quality primary healthcare with appropriate family insurance health plans. GP practices could join as and when they decide to abandon the NHS. Practices could gradually move towards the new model while still seeing some NHS patients. The DoH would be asked if they wanted to subsidise the cost of the new model.

    So in effect we could develop our own GP controlled HMO / Kaiser Permanente

    Some GP practices already treat a few private patients in addition to their NHS workload. However only a small percentage of patients are willing to pay for care on a cost per consultation basis. This applies everywhere in the world. The UK must be one of the few countries that does not have private primary health care insurance. Having a common private health insurance package across the UK would allow more patients to afford private primary health care.

    Primary-care would become a two tiered system, NHS and insurance funded private care. The NHS will be increasing defunded so I think this is the only answer. It will be important for GPs to have some control over the insurance companies.

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  • To be honest the cardigan wearing oldies are most likely to do it.Lets be honest if it is a disaster chances are their mortgages are paid, their kids have left school and they are probably in the best position to give up

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  • I agree and disagree. I agree that we must have an imperative right to close our lists for safety reasons at will. We should not have to apply etc. Just state.
    But I disagree that we cannot resign.
    We must. No self respecting profession would put up with imposed Contracts, Penance [ for what?], and Neglect.
    Never mind CQC, pension and pay cuts, Medical defence , GMC, QOF, Appraisal and re validation , patient, papers, peer derision and criticism to name a few.
    I, for one, have left. I could not put up with this rubbish any longer.
    I disagree. We MUST ballot for resignation from this MAD Contract.

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  • Non-cooperation with CQC and appraisal also should be high on the agenda.

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