GPs could deliberately breach contracts in Government dispute

Exclusive The new dispute between GPs and the Government is likely to look ‘different’ to last year’s, and could include industrial action and the breaching of contracts, the BMA’s GP leader has told Pulse.

BMA’s GPC England wrote to health secretary Wes Streeting yesterday to declare a formal dispute over online consultation requirements, data access and the 10-year plan.

Its chair Dr Katie Bramall also wrote to BMA members yesterday evening to set out what was needed to end the dispute – including allowing practices to divert online access to telephone and walk-ins.

But, in an exclusive interview with Pulse, Dr Bramall outlined what next steps the BMA will likely take should these demands not be met – including the potential of a judicial review.

Contingent on internal advice from senior BMA leaders, the GPCE would consider balloting the profession on industrial action – and practices could be urged to actively breach their contracts by diverting or switching off online access.

However, a ballot of members would also allow them to choose to ‘do nothing’; or take less drastic collective action, similar to that of last year.

She told Pulse: ‘I think it has the potential to be a bit different. We’ve got a number of options:

‘It can be “you do nothing, and you accept what has been done to you”. And I think there’s the option for an indicative ballot to test the waters. Then there’s the option to undertake industrial action, including breaching your contract – over diverting and switching off online access when you’re full.

‘There’s also the option of wanting to take actions that fall short of breaching your contract – which would look more like a suite of collective action that we undertook in 2024. But it would need to be completely different, because so much has changed in the past 12 months.

‘So those, as I see it, are the options that we have before us, and I’ll be taking advice from colleagues in senior BMA roles, and also we’ve got ongoing focus groups with the profession.’

She told Pulse that by the time of the England LMCs conference in November, she hopes to have ‘greater clarity’ on what the ‘next steps’ are.

Alongside the work towards a potential ballot, the BMA is also still pursuing the potential of a judicial review into the contract changes.

Dr Bramall said: ‘We also have spoken to a KC, and papers are currently sitting with a KC at the moment to see if there is a potential avenue to undertake a judicial review. Because I think it’s fair to say that it looks on paper as if what has been progressed has not been reasonable. And so we await that with keen interest, in terms of one of our potential next steps.’

However, she stressed that the potential judicial review would not hold up any other dispute escalation actions.

‘I mentioned the potential opportunity for a judicial review. That can take time, but it doesn’t mean that we have to await the findings. We can continue in parallel to have discussions with the profession, whilst that’s going on in the background, if that gains traction.

‘So really, nothing is off the table.’

In an email to members last night, Dr Bramall urged colleagues to ‘encourage any GPs or GP registrars who are not BMA members to join so that they may vote in any potential future ballot’ as ‘we prepare for further escalation’.

The email included a list of demands to end the dispute, including written assurance from NHS England that practices won’t receive a breach notice if they have to divert urgent-same day patient contacts to telephone and walk-in; for NHSE to work with GPCE and online tools providers on safeguards against urgent requests; resolution to GP Connect Update Record (write access) liability concerns; and a confirmation of a roadmap towards the promised wholesale new GMS contract.

In the interview with Pulse, Dr Bramall said: ‘We need NHS England to work in good faith with the Joint GP IT Committee, to work through their documented concerns around the functionality of GP Connect Update Record before we can have write access deployed, and we want them to allow practices to keep that switched off whilst we work through that so we know it’s safe.

‘With online consultations, we need practices to have the functionality to be able to safely discriminate between what’s urgent and what’s not, and if a practice has hit capacity, they need to be able to divert patients accordingly. It is not fair and not reasonable and not safe to expect them to continue to accommodate requests when they are not going to be able to meet those expectations.

‘And also, as per the motion I put to GPC England, there’s also further assurances we need, working with senior figures in government and the Department of Health, around the 10-year plan and commitments to the protection of GMS, and clarity over funding envelopes for 2027 and beyond – and also around the single and multi-neighbourhood provider contracts as well.’

Dr Bramall also accused the Government of being ‘tone deaf’ to GP concerns, and using ‘inflammatory language’, while NHS England was ‘doubling down’ on advice the BMA has said is unsafe in a new FAQ on the changes.

Mr Streeting told the Labour Party conference this week that GP leaders seemed to be trying to turn the NHS into a 20th century ‘museum’, and he’d also previously called some GP practices ‘laggards’.

Meanwhile, primary care minister Stephen Kinnock told Pulse in an interview that he was ‘mystified’ by the GPC’s dispute; and that online access changes were about ‘maximum convenience’ for patients.

Read the full interview