This site is intended for health professionals only

At the heart of general practice since 1960

Read the latest issue online

GPs buried under trusts' workload dump

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)

  • Took Early Retirement

    I've got 15 days to go- not all of them working days either- and yes, I' counting now!

    Unsuitable or offensive? Report this comment

  • que sera sera

    Unsuitable or offensive? Report this comment

  • Una I totally and utterly agree with you 100% but I fear that there is no political will to make this happen and even if every GP in the UK submitted an unsigned resignation I fear that the government will simply block every effort to change. They do not want to introduce this idea of semi-privatised healthcare to the general public and to add to the problem the patient population will probably need 5 decades to make this transition in their minds that nothing in life is for "free" and good service needs to be paid for in all walks of life. The change in a culture of automatic entitlement in the UK is a far bigger challenge than changing the healthcare system itself. Good luck with that !

    Unsuitable or offensive? Report this comment

  • A hugely depressing post.

    user charges will not keep the frivolous from your practice. They will keep the poor from your practice. They will ensure that when people DO come to your practice you have missed the chance to stop their health problems escalating, so the workload will be greater. And more people will die avoidable deaths.

    Mass resignation would lose at a stroke the ace card the profession holds - an in perpetuity contract. Expect immediate acceptance then a time limited contract offer should you wish to return.

    The reactionary 'industrial relations' approach is why GPs have been out manoeuvred by the hospital sector that is sucking up more money than the NHS has for ever inflating levels of clinical coding.

    The real influence would be to insist your funding is regulated through the same process as hospitals and so reflects the volume of need more appropriately with more science to it. You could rightly claim the current differences are anti-competitive as they discriminate against the primary care sector.

    How do the businesses that grow revenue achieve it? By creating solutions to the big problems those they contract with face. The level of avoidable hospital spend is huge, and the level of quality in primary care is far too variable (and no,not correlated to funding levels by the way) Primary care can and should be at the heart of much broader services, doing everything at which it can be more cost effective than hospitals. Offer a solution to these 2 issues and you can almost write your own cheque. I am yet to meet a commissioner that wouldn't welcome you with open arms and gladly pay you more.

    Unsuitable or offensive? Report this comment

  • I agree to what you say, but giving a
    Statement is not enough.please start a petition at least.

    Unsuitable or offensive? Report this comment

  • Sadly I agree with NHS manager 8.27.
    The government see us and the way we work as part of the problem. They have no interest in maintaining the status quo and have the press and the public behind them. Individual patient Ike individual doctors and practices but don't understand or care about the contractual issues.
    The only way to protect your own personal health and finances is to resign if you are a partner. Salaried GPs should stay put as they will be entitled to redundancy pay or TUPE when it all collapses.
    I desperately hope that those GPs left holding the partnership responsibility will be looked after when the shit hits the fan, but am not confident.
    I wish you all good luck.

    Ex GP partner

    Unsuitable or offensive? Report this comment

  • UNA I will be at ARM. I have been making these noises about workloads and pay for a few years and getting no where. The agenda committee just does not bother. There are not enough doctors in the system. Never worry about Virgin etc. They cannot deliver at £3 per consult. We can and must get reasonable pay and conditions. That is all we wish - a REASONABLE solution to burn out and depression.

    Unsuitable or offensive? Report this comment

  • All that have posted on agreeing to mass resignation please put your money where your mouth is and sign Una's petition for the sake of future patient care and our health!

    https://secure.avaaz.org/en/petition/British_Medical_Association_Chair_of_Council_Dr_Mark_Porter_We_call_on_the_BMA_to_ballot_GPs_on_mass_resignation_from_th/?twi

    Unsuitable or offensive? Report this comment

  • send in your post dated resignation,you have nothing to loose anymore.i just resigned from my partnership reluctantly,but by God,what a feeling!!

    Unsuitable or offensive? Report this comment

  • Una Coales

    @3:38 if we do nothing, the domino effect will start with 98 GP practices facing bankruptcy within the next 3 months. We have a window of opportunity to raise public awareness of the imminent danger to patient safety when local areas start losing GP surgeries to foreclosure.

    Mass resignation or an OOHs boycott will alert the public that our health service is in dire straits. If your surgery is going to close within the year, then why not support mass resignation with 3 months notice?

    John is right, the private firms are not ready to provide bulk capacity to 60 million, especially when NHS GPs provided a lot of unpaid goodwill. Even migrant workers are not prepared to work for free.

    I am hearing that some EU GPs are finding appraisal/revalidation onerous and some are returning to Europe. When we say there is a national GP shortage, this already includes the bums on seats the NHS has tried to recruit from overseas and Europe!

    Unsuitable or offensive? Report this comment

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

Have your say