Preparing for a day of action
Dr Laurence Buckman, GPC chair, advises practices on the practical steps they should take to get ready for 21 June
For most of us who voted in favour of industrial action over pensions it was a decision taken with regret; none of us will really have wanted to get to this stage. But the results of the ballot – which we only held after repeatedly trying to get the Government to the table for genuine negotiations – show how let down we feel.
The fact that a majority of the 17,500 GPs who took part (representing a turnout of well over 50%) voted in favour of both industrial action short of a strike, and strike action, demonstrates how let-down we feel by the attack on the NHS pension scheme. It also represents a clear mandate.
Views within the profession on whether this is the right way forward are still mixed. But whatever your opinion, with the 21 June date now set, what's most important is that we respect each other's rights. That means no coercion or pressure on colleagues in either direction, and us all getting on with preparing for the day.
Patient safety has to be our number one priority. To help with this we would suggest that if you haven't done so already, you meet as a team to discuss the action and what the implications are for you as a practice. We would also recommend that you appoint a practice lead as co-ordinator. If all doctors in the practice want to take part in industrial action, the way ahead will be relatively straightforward.
If not, you need to reach agreement on operational issues. If as a partner you are not taking part in industrial action, but you employ salaried GPs who wish to take part, then be aware that arrangements for cover for staff participating in industrial action have to be made within the complement of practice staff. It is an offence to engage an agency to provide locum cover for doctors participating in industrial action.
Practices will also be under no obligation to pay salaried GPs taking part in industrial action, but we hope you will be supportive and, in particular, not make any deductions in pay. In a situation where partners wanted to take action but a salaried GP did not, it would be reasonable for partners to ask salaried GPs not to undertake routine appointments for the day.
When it comes to other staff working in the practice, as employers you will be expected to act reasonably in what you can ask staff to do on the day, so you shouldn't ask them to carry out additional duties not specified in their contract. However it would, for example, be reasonable to ask reception staff to operate a different system for booking appointments during the day. The GPC will shortly be issuing a core script to help reception staff dealing with patients' queries about the industrial action and the impact on their care.
Approaching your PCO
Once you have come to an agreement within your practice you will need to have a discussion with your PCO. Ideally, you want to be able to agree the extent of the service provided on the day of action itself. We have issued a template letter to send to your PCO giving them notice of your proposed arrangements. It would help us to monitor participation if you could also email a copy of the letter to your LMC, and to email@example.com.
When it comes to non-clinical activities, these do not usually constitute urgent or emergency care. Some duties may, however, be necessary for the safe delivery of clinical services on the day of action. If so, you should engage and co-operate as necessary. There will also be activities taking place on the day that may have a serious impact on doctors or students if unfulfilled – for example participating in exams, interviews for training and so on. Where possible, these ought to be postponed but this may not always be possible.
You may have time during the day that is not being spent on urgent or emergency care and you will need to take a decision on how best to spend it. We suggest you support colleagues who are carrying out urgent or emergency work, or take part in activities to raise awareness of the unfairness of the major changes to our pensions. It is up to you to take decisions about what other work could be done, which would still be compatible with the overall aim of having an impact.
Getting the message across
The other crucial priority is communication. The huge media coverage the ballot result has attracted means you have probably already had questions from patients about the action. Those whose appointments on 21 June need to be postponed should be given as much notice as possible and there should be clear information on your website and in your waiting room about your plans for service provision.
However, the communication challenge facing us is obviously not just explaining the mechanics of 21 June – it's about explaining why it's happening. In the face of a generally hostile media, and in the current economic climate, we might not get the public to support our action, but we can hope that they will understand why we are taking it. Adverts, in the form of a letter from BMA chair Dr Hamish Meldrum, appeared in three national newspapers the day after we announced the ballot results. The BMA will also shortly be distributing posters making the same points to help get the message across to your patients.
As you will be aware by now, the form of action we are taking does not involve the full withdrawal of doctors' labour, and is not strike action as the term is normally understood by the public. Patient safety is our over-riding priority. Any patient who is, or believes themselves to be, in need of urgent and emergency care on 21 June should be seen. You should look to operate your usual systems for patients needing urgent attention that day, including telephone triage. You should also deal with urgent administration, for example reviewing test results and acting on abnormal results, in the normal way. Urgent prescription requests should be processed but routine repeat prescription requests should not. You should also continue to make proper clinical records on the patients you are managing, but you shouldn't do other administrative work if it is not urgent.
This is new territory for all of us. If you have any questions or need any advice please contact the BMA: firstname.lastname@example.org.
Dr Laurence Buckman is GPC chair and a GP in Finchley, north London.