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Key questions for 21 June

Pulse answers some of the most pressing questions faced by GPs as they prepare for the BMA’s ‘day of action’

What action have GPs been asked to take?

Doctors taking part in the day of action will not do routine work, but GPs will still attend surgery for the whole day and see patients in urgent need of care.

 

 

The BMA says providing urgent and emergency care will consist of any treatment you believe cannot be safely postponed to another day.

Examples it gives include:

• in primary care, patients who consider themselves in need of urgent attention that day

• any patient who doctors feel uncomfortable postponing for clinical reasons
• emergency and urgent procedures, investigations and discharges for inpatients
• outpatients under close review for an unstable condition (for instance deteriorating Crohn's)
• documentation necessary for safe discharge and any urgent community care or follow-up
• attendances at A&E, labour ward or patients in early pregnancy.

When will doctors be taking action?

The first planned day of action is Thursday 21 June. The BMA has yet to decide whether it will hold further days of action.

Is it a strike?

No. On the ballot paper, the BMA asked whether doctors would be prepared to take strike action, but this was to provide the union with the necessary legal protection and to provide flexibility.

What happens if not all GPs in a practice wish to participate in industrial action?

Each practice will need to decide for itself how to operate. If not all partners wish to participate, an agreement should be reached on operational issues.

The BMA says it would be reasonable for a practice to ask a salaried GP or locum not to undertake routine appointments for the day and it would encourage all practices to support salaried and other colleagues who choose to participate in industrial action, regardless of the practice's stance. Employees are protected from unfair dismissal. 

Do I have to take industrial action?

The BMA says it would strongly encourage you to support your colleagues by taking action or demonstrating your support (whatever you voted in the ballot). However, you are under no obligation to take part in the day of action.

Isn't the dispute really with the Government, and not my employer?

Although the dispute over pensions is with the Government, and not an employer directly, lawful industrial action can still be taken. Trade union law recognises that a dispute about pensions is, in reality, a dispute between ‘workers and their employer' as pension benefits form part of the employment contract.

Should locum GPs be taking industrial action too?

If a locum is contracted by the PCO, they can take part in action. However, if they are self-employed or employed by an agency, they will not have been balloted and therefore will not be allowed to take action.

Protecting patient safety

Dr Michael Devlin, head of advisory services at the Medical Defence Union, explains how GPs can minimise clinical risk during industrial action

How do I honour my duty of care to patients?

All doctors have a contractual and ethical obligation to provide appropriate clinical services to their registered patients.

Ultimately it will be your decision as to whether or not a patient requires an urgent appointment on the day of 21 June.

You may be required to justify any decisions not to see patients, for example if a problem is not detected or if the patient's condition worsens.

It is important to always keep clear and comprehensive notes of any discussions that take place about a patient's health, including those where a patient's request for an appointment during industrial action is refused.

What about requests for prescriptions?

If a patient was to request an urgent prescription and also had non-urgent prescriptions to collect, for example, it's not obvious what you should do. It would be difficult to justify declining to issue an urgent prescription.

And while it might be possible to justify declining to provide an additional non-urgent prescription, the patient's individual circumstances would be relevant.

Some patients might be merely inconvenienced, others might be put in significant difficulties – for example if they rely on carers to collect medications for them.

What about urgent referrals?

If a patient called up with an urgent concern, for example if she had noticed a lump in her breast, although it could wait until the next day, most GPs would normally offer to see such a patient straight away if they could.

Even if you feel that clinically (from the perspective of managing the lump) the patient could wait to be seen, they are likely to be very worried. That anxiety could potentially be heightened if they have to wait before being seen, examined and given reassurance or urgent referral if necessary.

If you have questions about industrial action, please email them to feedback@pulsetoday.co.uk or post them in the comments.

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