Exclusive The BMA’s GP Committee in England is preparing for industrial action as another contract imposition looks likely, Pulse can reveal.
Last week, Pulse reported that the Government’s initial offer for the 2024/25 GP contract included a 1.9% uplift, and the GPC subsequently voted down this ‘derisory’ offer.
Committee members instructed the executive team to go back to the negotiating table with the Government and NHS England to improve the offer.
But in a letter, seen by Pulse, to Surrey and Sussex LMCs, GPC deputy chair Dr Julius Parker said it ‘is clear this may not happen’, in which case the current contract offer would be imposed for the third year in a row.
He also advised GPs to prepare for industrial action by registering with the BMA, and said the union is considering discounted membership in preparation, while the GPC will ‘provide detailed guidance’ on how independent contractors can strike.
The current Government offer also includes a reduction in QOF indicators and a move to bring nurses into the Additional Roles Reimbursement Scheme (ARRS).
Dr Parker told LMC members that the GPC’s demands were not ‘unreasonable’ and included an ask for ‘an inflation linked core contract increase’, as well as ringfencing within the contract for ‘dedicated purposes, such as GP supervisory tasks’.
However, he suggested that none of these asks were accepted by NHS England.
More details on the 2024/25 contract
The Government offer
- 1.9% increase to core funding;
- ‘Very modest’ increase in the overall ARRS allocation;
- Confirmation that GP employer NHS contributions will remain unchanged (at 14.38%) despite the employer scheme contribution rising by 3.1%;
- Suspension of a number of QOF indicators and an increase in the percentage aspiration payment;
- Further reduction in IIF indicators;
- Confirmation of the current eight service specifications within the PCN DES being aggregated within an overarching specification;
- Recruitment changes within the ARRS programme (nurses to be included);
- Changes in the arrangements for vaccination and immunisation data recording;
- Changes in the wording of the regulations in relation to patient registration arrangements, the Armed Forces Veterans offer, continuity of care and electronic records.
GPC demands
- Uplift by inflation the vaccination IoS fees and certain Statement of Financial Entitlement payments;
- Ringfence a proportion of current spend for dedicated purposes, such as GP supervisory tasks, or the Enhanced Health in Care Home beds premium;
- Allowing GPs with extended roles to be recruited via the ARRS;
- Inflation-linked core contract increase.
Dr Parker said the Government’s proposed changes to the contract ‘are unlikely to significantly increase’ GP workload, but this will depend on the actual wording of NHS guidance when the contract is published.
But he said that GPs need ‘significant investment’ which is ‘comparable with that seen elsewhere in the system’ if they are to deliver safe services.
He added: ‘In the medium term, General Practice needs to see a fundamental shift in the balance of financial investment across the Primary and Secondary Care sectors to properly reflect the role and workload expected of it.
‘Whilst GPC England did not necessarily expect a substantial change in the more general financial balance in 2024/25, it did expect NHS England to realise and support the principle that General Practice must receive a stabilising award in this coming financial year.
‘Without this, the risks are all too clear: practices cannot invest, reward their staff for their commitment, and meet current financial pressures, such as the planned minimum wage increase from April 2024.’
Whatever happens over the next month with negotiations, the GPC has committed to putting the Government’s offer to the profession in a referendum on 1 March.
‘Whilst GPC England have rejected the current offer, it is far more powerful to be able to convey the views
of the profession as a whole,’ Dr Parker, who is also chief executive of Surrey and Sussex LMCs, told his members.
GPC chair Dr Katie Bramall-Stainer had previously said a formal industrial action ballot may take place after April, and collective action could play out into the autumn and winter, around the time of the general election.
Dr Parker said: ‘I am aware that BMA membership is not universally popular amongst GP colleagues. Nevertheless, if the profession is to move, during this year, towards Industrial Action, albeit reluctantly given the impact on patients, this can only be organised by our Trade Union.
‘LMCs are not Trade Unions and cannot legally organise a strike. To ensure the profession can use this route, and for each GP to vote, all GP colleagues need to join the BMA.
‘GPC England have suggested the BMA organises discounted membership rates (which already exist based on income thresholds and spouse membership) to ensure this option is as widely available and as attractive as possible to all General Practitioners.’
I remember when the GPC were negotiating the ‘new’ contract some of us raised concerns about the clause allowing government to impose contract changes should they so wish and thus the famous ‘Vote No FFS’ thread on DNUK was born.
Chisholm and co rubbished these concerns, stating that contract impositions would only be necessary in times of national emergency. Mugs.
Wont be wasting my money.My own industiral action. reducing commitment starts in April.No reversing that one,Spose I could support a strike in sympathy.
This is the wrong move. Strikes are not going to happen. The government knows it that is why they have given us the worst possible deal. Even the juniors had 6% forced on them, and yet following genuine attempts at negotiation we get 1.9%.
We need to team up with the consultants and the juniors to negotiate collectively, this is the only way we are going to be able to seriously challenge the government.
Katie, if you read these comments, you have my full support doing this difficult job, but I worry a failed attempt at strike action will weaken us even further. We have to explore other options.
JMO: it doesn’t have to be a straightforward, down-tools kind of strike. There are lots of forms of industrial action that we can get behind as a whole profession. Let’s wait and see what BMA put on the table. I for one could support a work-to-rule approach, combined with setting a reasonable level of access commensurate with the funding in the GMS contract (which will be 30-50% of what we typically offer today). We would still offer care, but the overspill into the rest of the system would be huge.
Just perhaps it’s time to face reality. While acknowledging that the partner/dispensing option, is what the majority of us that are in the trenches know to be , the most efficient and patient beneficial option. It is not being championed by either HMG,NHSE and their various mouthpieces.
Why is there no Plan B! You don’t see the Dentist’s having to deal with this nonsense. Anathema to some but the writing is on the wall perhaps it would be better to change tack and start preparing the public for what’s coming down the line. Suspect politicians would change their tune!!
Useless organisation.
GP strikes are a fantasy.
Wrong on pretty much everything for decades.
Remember – pay offers to other branches of practice such as Juniors and Consultants are for 2023/24, not 2024/25 – but even on that basis, 1.9% is unacceptable.
IA can take many forms. We need to consider what actions are easy for contractors; acceptable to patients; and an absolute logistical nightmare to NHSE/DHSC. Email me your thoughts: info.gpc@bma.org.uk
Before we even entertain any such prospect, we need to give the profession an opportunity to reflect on the final 2024/25 offer, and as many GPs as possible have their say. We aren’t there yet – hence the notice. Govt have until the end of the month.
A more radical approach would be to leave the NHS en masse and force a scheme whereby the government could pay towards the cost of a patient’s care but practice decided top ups – the safety valve balancing cost, convenience and choice of clinician – was allowed without losing access to NHS referrals, investigations and scripts.
Time to dust down the mythical ‘Guernsey Option’ to reduce reliance on government: https://www.doctors.net.uk/DocStore/DSView/Document.aspx?docid=810796
BMA already beginning to look like the boy who cried wolf…again. HMG’s TruthShufflers have already wargamed this BMA move. The only game really left to play is the chicken game. Take the IA.
Bytheway, is it true after intense grilling by the GPC team, Andrea stormed out of the last meeting, reaching for a sneaky ciggy and grumbling “Well, I never expected the Spanish Inquisition”?
Sadly the 1.9% is just a demonstration to the electorate that HMG do not value them enough to increase necessary funding to the part of the NHS that they need the most and interacts with them the most. We have a responsibility to patients to remain solvent and that will mean a reduction in service or no service at all. Shame on HMG 😢
It’s hard to not feel there is an evil plan with this offer, the complete lack of national news coverage or understanding. I wonder if we will get £20k handshakes in a few years to see those patients primary care has failed……
I support the BMA but the action required is complex with nuances and necessitates joint ongoing thinking from all colleagues.
NHSE and HMG have fragmented General Practice so actions such as strikes would have variable support so firstly we need to raise areas where we all feel we can act jointly.
HMG and NHSE to date have outsmarted hospital and primary care doctors in particular , as in the latter they will cover any strikes with ARRs and then say GPs are either not important required whilst simultaneously blaming any damage to patient care on striking GPs,
The action for me seems clear in that the government relies on data not simply to drive improvements but to produce data to denigrate GPs as we see on a daily basis in the media.
Hence, we should broadly work to rule i.e. not agree to look at any of their PCN targets , not to be roped in data production in respect of appointments mapping etc etc and there are countless areas colleagues could suggest where we can drop unnecessary or low priority as we know these are just tick boxes for ICBs to relay to the government and do not assist in current day to day care where other deficits and priorities exist.
We could refuse certain ICB meetings where they simply relay government directives.
PCN meetings could be declined.
Future PCN targets should simply be declined, and no meetings attended where we simply look at charts with no current infrastructure to actually undertake current any work required.
There are other areas such as medicines management where we attend meetings with pages of chart production and are often directed to change medications simply for them to have to be changed back a few months later etc.
The above would achieve 2 objectives -firstly that we can act together and secondly, we know which of the work introduced by NHSE is low priority and actually inhibiting patient care in a shattered NHS.
The above modified could be done and led by the BMA , would reduce workload and would not at the very least lack support from the public as we would have actively for the present chosen not to strike.
I feel IA is almost inevitable now. However a word of caution to the BMA-we would need the buy in and support from the other areas of the NHS as any IA from us will lead to pressure on other areas ie A and E, and we lose impact if our colleagues are not supporting us to patients and in the media.
I would be happy with a full strike, but it is difficult with contractors.
i.e. for an employee they give up their pay for that day.
For a contractor there is no idea how much their individual pay for the day is. And if it is the entire contract payment for the day that means that the contractors would still have to pay employed staff for that day without any money coming in.
The answer is to look at industrial action which harms the bottom line, perhaps protects patients but has an impact. Like Japanese bus drivers who continued driving their routes, but just forgot to collect the fares.
Can look at some of the interface between GP and hospital – for example every admission directed to A+E. Every inappropriate workload dump directed to A+E etc.
Could look at steps which inconvenience patients to make a point, like weekly prescriptions for everyone. (Pharmacies would not mind). Could step up to daily if things are not resolved.
Or could like at steps which cost money without harming – or even while benefitting patients. For example prescribing on an FP10 medications which are licensed and useful, but not recommended because of expense. Such as:
– weight loss drugs for anyone with a BMI >30 (who signs up to a support system)
– emmolient creams
– paracetamol/ calpol/ cough mixture.
Or finally when given the choice of inexpensive generic drug or expensive branded drug, can choose the later – like plavix and lipitor.
When did gps go on strike last ?? When dentist did not like pay structure they left nhs . Can gps do this??
Strike is nonstarter. .handing over contract if offer is not changed ? It have serious implications for gps , staff and premises. . Thankfully I am out of it.
It has not have
G.P.s on strike?——all together now—–1—-2—-3—-”and the band played believe if you like”
If the BMA had any real commitment to improving life for GP members there would be a fully costed plan to leave the NHS en-mass; Denplan for Doctors, the Guernsey option.
Increasingly doctors and patients are choosing alternatives to the NHS, as it slow-motion collapses around it’s failed ideological construction.
The BMA will become increasingly irrelevant as the state monopoly disintegrates -: and deservedly so.
We could change all prescriptions to branded medications.
We need to show unity and action that would not affect patients, refusal to engage with :
appraisal
revalidation
CQC inspections
new ME service
All pointless activities that have zero impact on patient care and would show we can unite
Can anybody give me a good reason why this approach would not be a good start ( apart from fact some GPs make money out of the above activities)