Exclusive More than 40% of English practices are still limiting patient contacts to 25 a day per GP as part of collective action, a new Pulse survey has found.
The survey of 496 separate practices in England, carried out with our sister title Management in Practice and answered by partners and practice managers, found that 42% are still limiting patient contacts, while 36% are still refusing to take on unfunded work.
It comes after the BMA clarified that following the 2025/26 GP contract deal, collective action is still in place but aimed at ICBs rather than the Government.
In response to the survey results, BMA GP committee England deputy chair Dr David Wrigley told Pulse that new contractual changes ‘may alter how practices deliver care’, increasing patient access to e-consultations, but that this does not mean that GPs ‘must offer unlimited capacity that jeopardises safe patient care’.
He said: ‘While the 2025/26 GP contract agreement ended our national dispute with the Government and took us a step forward on the long road to improving general practice services in England, many practices across the country remain worryingly understaffed and under resourced.
‘With persistent commissioning gaps seeing practices not funded for a lot of the work they do, it is crucial that GP practices, working with local medical committees, are empowered to renegotiate these pathways at a local level so they are sufficiently resourced, can best serve the needs of their local patient populations and operate safely.
He also said that the BMA is urging GPs to follow safe working guidance which has been in existence ‘for nearly a decade’.
Dr Wrigley added: ‘To achieve safe and sustainable patient care throughout the country, practices should never be forced to stretch themselves even more thinly than they already are by accepting under resourced or unfunded work.
‘Instead, they must be able to challenge integrated care boards, with the support of local medical committees, to secure the requisite resources they need to deliver the care some our most vulnerable patients need.’
The survey also found that 15% of GPs reported that secondary care colleagues have been ‘quite unsupportive’ of collective action in general practice.
Bristol GP partner Dr Rachael Kenyon told Pulse that as part of collective action coordinated by her LMC, her practice has served notice to the local ICB on unfunded work, prompting ‘a few frustrated letters’ from secondary care.
Pulse has previously reported on GPs in several areas coming together to serve notice to their ICBs on unfunded work as part of collective action, including various services and shared care arrangements, such as PSA monitoring, phlebotomy, ring pessaries and ECGs.
Dr Kenyon said: ‘It’s been a bit of a wakeup call for secondary care around just how much we have been taking, and most of the time the response back has been good, but there have been times where it has been, let’s say, less good.
‘But that shows the lack of insight, the lack of understanding of how primary care works.’
Doctors’ Association UK GP spokesperson Dr Steve Taylor told Pulse that actions such as limiting patient contacts and refusing to take on unfunded work ‘should be normal’ and ‘not collective action’.
He said: ‘It is not surprising that GP practices are continuing to restrict the number of appointments per GP to safe levels and refusing to take unfunded work.
‘Seeing more patients than is safe and doing unfunded work should not be normal. Sadly it had become normal for far too many GPs and recognition of this has given permission for GP practices to draw a line.’
In some areas, collective action has already led to additional funding from local ICBs. In Kent, it led to an agreement from the ICB to fund new locally-commissioned services, including for CVD and ADHD.
GP collective action in Somerset has highlighted several gaps in services, leading to an additional £2m investment from the ICB.
And GPs in Lancashire will see a £14m boost to local enhanced services funding, celebrated by their LMCs as a ‘huge’ achievement.
The survey results
|
Which of the following forms of collective action have you undertaken? |
Limit daily patient contacts to 25 |
Stop engaging with A&G |
Serve notice on any voluntary services currently undertaken that plug local commissioning gaps |
Stop rationing referrals, investigations, and admissions |
|
We are still undertaking this action |
42% |
10% |
36% |
29% |
|
We never took this action |
50% |
73% |
50% |
61% |
|
We were taking this action, but stopped following the agreement of the new contract |
7% |
16% |
11% |
8% |
|
Don’t know |
0% |
1% |
3% |
2% |
|
Grand Total |
496 |
494 |
494 |
496 |
|
How have secondary care colleagues reacted to GP collective action? |
|
|
Very supportive |
2% |
|
Quite supportive |
12% |
|
Neither supportive not unsupportive |
34% |
|
Quite unsupportive |
15% |
|
Very unsupportive |
5% |
|
Unaware |
23% |
|
Don’t know |
9% |
|
Answered |
315 |
This survey was open between 31 March and 14 April 2025, collating responses using the SurveyMonkey tool. The survey was advertised to our readers via our website and email newsletter, with a prize draw for a £200 John Lewis voucher as an incentive to complete the survey. We asked for GPs’ practice codes or practice names and postcodes, and asked them to confirm what kind of GP they were. We removed those with duplicate email addresses, and searched for duplicate IP addresses, removing obvious duplicate entries. The survey was unweighted, and we do not claim this to be scientific – only a snapshot of the GP population.
To be frankly honest most patients have no idea their GPs are taking “collective action” in response to 14 years of Tory’s active destruction of General Practice. Most patients just think their GPs practice administration just make it very difficult to get an appointment with a nurse or a GP – hence the dreadful GP satisfaction survey results these days. Why didn’t the GPC advise any industrial action during the 14 years GPC’s mates were running the country? I attended 2 LMC conferences as a representative during the Tory years and on each occasion the representatives voted overwhelmingly in favour of industrial action – last conference in 2014 it was virtually unanimous – but GPC merely took the vote “under advisement” preferring instead to work behind the scenes with their old school chums to get a much better deal for GPs – and how did that work out? And now we are where we are – too little – too late – and with the wrong government. You couldn’t make this stuff up?
I thought we were all supposed to be doing this anyway, to ensure good quality care from non-burnt-out GPs, and thet if we were regularly seeing too many, then GMC and our medicolegal cover might be unhappy with us and take retribution.
The question on ‘stop rationing referrals…’ I think you will find the majority of respondents and GP and practices generally have misunderstood the question! Hardly any of us were ever taking the action of ‘rationing referrals’, and therefore we were actually already in a form of industrial action on this point anyway, and could not ‘stop doing it’ without first becoming actively involved in rationing referrals – which would be highly inappropriate action, and hopefully bring down the full force of GMC and law on any GP rationing referrals ! This is not the same as declining a patient who does not need a referral either!
24 f2f at 15 mins each + admin lab/letter workflow HV or two is a pretty full day tbh
More than 40% of English practices are still limiting patient contacts to 25 a day – mainly because of the change to a more salaried model of care – as these colleagues rightly work the hours they are contracted and paid for – then go home.
It is only the shrinking number of partners who hold any semblance of interest in satifying patient demand, and willing to work well beyon their working hours to fit in extra patient contacts, when none of us are actually paid extra to do so, as we have an unlimited all you can eat model of care.
Start paying per patient contact and we would see more patient appointments in the system as doctos are paid to do more work, and then can choose to see more patients, or clock off and go home.
Either way the patient and doctors would both win, but the DOH would struggle to pay for the extra capacity, without realising this would pay for itself easily with savings from unnecessary secondary care charges, for a system bursting at the seams.
Fair pay and demand satisfacation will never be part of the GP contract negotiations unless there is a change in mind set from the negotiators to say no to this unlimited demand contract we currently have force fed to us at every renegotiation. No-one else, and cerrainly no private provider would ever agree to this, as it is unsustainable.
Every extra case seen by private care to help the NHS has a tarif, so wny not contacts in primary care.