This site is intended for health professionals only

At the heart of general practice since 1960

It is time for the BMA to ballot GPs on mass resignation

We must bring back the spirit of 1966, before our workforce collapses under the strain argues Dr Una Coales

In 1966 the BMA was able to obtain undated letters of resignation from all 23,000 GPs, who threatened to go back to private practice. With this powerful negotiating tool, Prime Minister Harold Wilson and the Cabinet conceded to the BMA. The GP Charter was agreed upon, which became the Red Book, the basis of modern general practice.

However with a growing and demanding patient population and GP on calls 24/7, NHS GPs of the 1990s were getting desperate. In 2003 the GPC was mandated to negotiate a new contract. BMA allowed a ballot on the new GMS (nGMS) contract to be open to all GPs. The majority of GMS GPs were against the nGMS contract but were outvoted by GPs who would not be affected. However most did see a rise in income (though not matching PMS) and opted out of OOHs.

Since 2004, the pressure on GPs has increased exponentially. The loss of MPIG and QOF income, GP premise costs hike, reduction of GP partner drawings four years in a row, workload increases, consultation rates as high as 12 per patient per year (up from 3.5 in 2004), a consumer culture, increasingly onerous micromanagement (20 bodies or mechanisms whereby a GP or practice may be assessed, criticised and/or punished), withdrawal of occupational health support for GPs, pressure to deliver 7/7 8-8 extended access and dumping from secondary care, have all led GPs to emigrate, take voluntary early retirement, give up their partnerships, burn out, and suffer mental health crises.

The proportion of NHS funding spent on general practice has fallen to an all-time low. Practices in my area, London, are closing because of financial unviability. Alas, the profession is fragmented into sessionals, PMS and GMS GPs (unlike 1966).

A BMA ballot on mass resignation would be the opening salvo in a war. An overwhelming vote in favour would force the BMA and GPC into action.

Many GPs have begun to question whether the time is right to start charging for appointments. This needn’t bankrupt poor patients. If the NHS became fully privatised, the public may pay 100% without provision of state insurance for the poor and elderly. But many UK GPs have gone to work under the Australian system, which has a social insurance scheme the UK could copy.

Medicare reimburses 85% of the cost of a GP appointment and patients pay just 15% - that’s $36 from Medicare and $13 from the patient for a basic GP consultation. An overwhelming vote in favour of a system this like would convince DH that we have the stomach for a fight – otherwise we give them carte blanche to carry on decimating GP morale and workforce. 

I call upon the spirit of 1966 to return before it is too late. At over a million consultations a day, UK GPs have been flogged as cheap labour.

We are no longer doormats to risk our wellbeing and livelihood for £3/patient consultation, nor must patients suffer. Time to regain our self-respect before the job kills us and demand industrial action for a new contract, a 21st-century contract, one that allows GPs to transition into semiprivate GPs to treat both the poor and the wealthy side by side.

Dr Una Coales ia a GP in south London and BMA Council member

Readers' comments (66)

  • Keep it up Una.
    Forget the troll @ 8.11pm.
    I'm registering with the Canadian exams at present and if things don't improve sharpish I'm off.

    Unsuitable or offensive? Report this comment

  • I am a practice manager.
    Can't you GPs understand that this chaos is what the government, DoH and NHS England want? They are not going to listen to you. your actions, protests and potential mass resignation are pointless. The intention, as publicly stated by them, is to deal with just 2 or 3 contractors (e.g. United Healthcare, Virgin, Boots) and not approx 10,000 practices as at present. These current conditions are to force you to either sell out your practice to one of the big firms, or try to go private and they can label you as greedy GPs. Telling Hunt or Cameron that GP land is collapsing does not make them want to fix it, it confirms their plan is working. No wonder JH is always grinning.
    I have seen the future, with the NHS dentist in my town. East European dentists and hygienists no doubt on lower wage expectations than UK dentists, jobbing through, rarely if never get to see same dentist or hygienist twice because of staff turnover, and decisions made by remote managers at some corporate HQ. You can't ever get face to face with the people making the decisions as you can with GPs at the moment. That is how patient care in GP land is going to end up, no continuity, no ability to see the person making the decisions etc. Costs will be far higher as Virgin etc won't do all the little extras that practices do for free, they will demand extortionate fees for each extra little audit or data provision and so on, and they will get it because they can threaten to walk out of the contract. Thus patients will really suffer and they will pay more for it. You could and should mobilise the public on that basis because that will hurt Cameron and Milliband. But bleating that the system is close to collapse tells them their policy is working.

    Unsuitable or offensive? Report this comment

  • Another major problem that you face is that the BMA is a political lobbying organisation, not a doctors' union. The GPC overwhelmingly acts as if it's political ideological belief in the "free at the point of abuse" NHS is what the GPC exists to protect, instead of protecting its members' interests. As long as the majority of GPC senior staff believe in their politics more than anything, they will always put the free NHS system ahead of GPs.

    Unsuitable or offensive? Report this comment

  • Una Coales

    @10:43 the mass resignation ballot is a bargaining tool. If we do nothing, we watch our NHS GP surgeries go bankrupt. I agree I see the BIG private giants taking over and subjecting our GPs to salaried workerbee status and it will be a case of profits over pts.

    The ballot will grind the system to a halt long enough for the public to listen to GPs and ask questions of government. Then can we offer semiprivate healthcare and keep our UK GPs who are leaving in droves! It is the only viable option against 100% privatisation.

    Unsuitable or offensive? Report this comment

  • Una, the Govt knows that GPs will not risk losing their income for even a few days, so mass resignation is a bluff, and if you try that they will call your bluff with the big firms ready to step in. As usual the GPC will be completely out-smarted and out-manoeuvred by the government publicity machine, and GPs made to look the villains. Then GPs will really regret it with many not getting jobs with the new firms, (far more nurse triaging as its cheaper etc etc) and those that do getting much less pay. I appreciate that many are now struggling, but plenty GPs are still making 6 figure or nearly 6 figure profits. When a few big firms take over, GPs will be paid £60-£70k, no final salary pension, your supervisor will get daily computer reports of how long you took on each consultation and you will be given performance interviews every Friday morning and told to speed up or consider your position and be "managed out" as they put it. Your job will be gladly filled by a GP from a different land and a different ethic who thinks £60k is terrific and happily pushes patients out the door every 10 minutes regardless.
    You need to get a critical mass of surgeries in an area to simply go private, so that patients can't all just load onto the ones that don't. Making threats to govt just gets their backs up and gives them time to call their chums in the big firms to get ready. Once again you are playing into their hands, this is what bothpolitical parties, the DoH, the NHSE want you to do.

    Unsuitable or offensive? Report this comment

  • To Practice Manager 3:38pm, I was just wondering why you think both parties are united on this idea? Not often that they have shared vision - do you think Labour would go down same route as Tory for General Practice and why?

    Unsuitable or offensive? Report this comment

  • Because the move to force GP into the hands of a few big businesses was started under Labour. They started the involvement of supermarkets. Virgin was already taking over some practices and was poised to make a bigger move into GP when the credit crunch happened in 2008. Virgin made a public announcement that they were scaling back their proposals to open health centres, due to the economic uncertainty at the time. That was all under Labour. Which party doesn't matter, they are all politicians and politicians resent GPs independence, and the people in DoH and NHSE who want rid of independent GPs don't change.

    Unsuitable or offensive? Report this comment

  • Took Early Retirement

    3.38- the big firms are just not ready- nor do they have the doctors- we do!

    Unsuitable or offensive? Report this comment

  • The depressing reality is the only rational thing to do is to quit being a GP. Change is coming and there's nothing we can do about it.

    I agree with much of what 'Practice Manager 10:43am' has said but I think the idea that we can somehow mobilise the public and stop it happening is completely naive ...take a brief look at the positions of both major parties and the mainstream media, it's all been stitched up...we haven't a hope in hell.

    In the future you won't know your GP, you'll see a different person each time you visit - it most likely won't be a Dr in fact but a knowledgable and experienced nurse. When you do see a GP Dr you're likely to feel frustrated because they'll be working to fairly strict direction and they won't have much control or say over what they are allowed to offer - this will be set primarily to ensure maximum return for the shareholders in the business that owns the company running the surgery. You'll probably be able to upgrade to 'premium' though if you've got the cash.

    When you're dying and the hospital has given up on you, let's hope they haven't destroyed district nursing too...because your Dr won't know you..because the shareholders won't see profit in it. Thank God for nurses that's all I can say.

    Unsuitable or offensive? Report this comment

  • 15.38 Mass resignation from GMS does not mean we all down tools and earn nothing. Before an exit strategy is considered we should work up a number of transition plans to a mixed health economy. Such plans might involve the big firms so long as appropriate terms are agreed but the private sector does not have the capability to replace the partnerships within a few months and I doubt enough GPs would sign up with them anyway. Virgin et al have struggled to profit from primary care because they have a much larger cost base and it still takes a long time to build a PFI health centre. Trying to replace us with 'practitioners' has been tried in the NHS for years with rather dubious success rates. Fundamentally there is a shortage of GPs so the power of market forces is on our side.

    Unsuitable or offensive? Report this comment

View results 10 results per page20 results per page50 results per page

Have your say