Northern Ireland GPs to begin collective action this week

GPs in Northern Ireland will begin collective action this week, implementing measures ‘designed to reduce the unfunded work they carry out’, the BMA has announced.

Some of the actions which practices will take as part of this include limiting patient consultations, serving notice on any voluntary work and insisting on referrals for specialist appointments ‘when clinically appropriate’.

The union said that GP collective action will continue until they receive ‘an improved financial offer’ from the Department of Health.

It comes after earlier this month NI GPs voted in favour of taking collective action for the first time, following this year’s first-ever contract imposition.

The country’s health minister Mike Nesbitt imposed the GMS contract for 2025/26 on GP practices for the first time this year, despite the offer being overwhelmingly rejected by the profession.

Now the BMA wants the Government to reopen contract negotiations for this year and for more resources to be allocated ‘immediately’ to stabilise general practice, as well as discussions for long-term improvements.

The BMA’s NI GP committee chair Dr Frances O’Hagan said: ‘The decision to take collective action has not been made lightly; it is a last resort to draw attention to the critical needs of the general practice and to advocate for immediate funding and sustainable solutions.

‘We have taken comprehensive legal advice and are making every effort to ensure that patient care remains as unaffected as possible during collective action.

‘Patients are not the focus of our dispute; it is the Department’s approach that is forcing us into action.’

She added that this is ‘a clear call’ for the Department of Health to ‘recognise the severity of the situation’ and to take ‘immediate and decisive action’.

The BMA previously warned that a ‘new neighbourhood model of care’ being planned by the Government in Northern Ireland will not happen without first resolving the current dispute with GPs.

The Department of Health published a document earlier this month committing to ‘establishing a neighbourhood centred system of health and social care’, bringing more services ‘closer to communities’.

But Dr O’Hagan added that the profession needs immediate action to stabilise services before planning for long term changes and improvements.

She added: ‘GPs are willing to work collaboratively with the health minister and other stakeholders to develop and implement solutions that will protect and enhance patient care, but we can’t keep doing more for less money the rising demands on general practice require corresponding increases in resources to ensure continued service delivery.

‘Our patients don’t deserve the funding they are being offered. Current funding levels are insufficient to meet patient needs, and increased investment is required to maintain safe, high-quality care.

‘Patients deserve and need a properly funding service that is sustainable and retains quality of patient care. It is vital that immediate, targeted action is taken to address current funding gaps and resource challenges in general practice.’

Pulse has contacted the Department of Health for comment.

The collective action measures

Limit daily patient consultations

Each contact will require appropriate care navigation, with practices ensuring that urgent care provision is protected and caution taken for vulnerable groups. If demand for urgent care exceeds safe levels, consider directing patients to appropriate alternative settings such as urgent care centres, Phone First, GP out-of-hours, Accident and Emergency, and the Northern Ireland Ambulance service. 
Self-referral routes for AHP services (Physio, OT) within the Trust area may also be available. 
BMA safe working guidance also provides for moving to 15-minute appointments.  
Consider using one afternoon per week to ensure that your educational needs, clinical tasks which do not require direct interaction with a patient, and governance work, are all undertaken in-hours. During this afternoon, you will need to provide urgent cover for your practice patients.

Serve notice on any voluntary activity

Cease non-contractual activities that are voluntary and/or completely unfunded. These services are non-contractual, and are often undertaken by GPs to plug local service gaps, but they would be more appropriately and safely provided within secondary care services.  
Professional obligations may require consideration of serving appropriate notice on ceasing such services, for example, where a practice has been providing such services for a significant period of time, despite not being resourced to do so.

Activity falling under these actions include:

Undertaking ECGs where this is more appropriately delivered in secondary care 
Preprocedural medications or medications used for hospital tests (as per HSS MD 26/2022) 
Complex wound and ulcer dressings/post-op wound care where there is no enhanced service with the appropriate governance requirements in place 
PSA / MGUS chronic monitoring  
Bloods for secondary care, particularly those with clinical risk (e.g. PSA with unusual reference interval)  
Urgent scripts for secondary care services such as Psych Home Treatment teams (unless funded to do so) 
Non-emergency ambulance ordering e.g. for first outpatient attendance  
New activity associated with waiting list initiative  suggesting GP provision of pre-/post-op care 
Fit Notes through Epic for patients under their care of Trust at outpatient or on discharge from acute care.

This is a non-exhaustive list intended to give individual GPs, their practices and Local Medical Committees an idea of what this action intends to incorporate. Local circumstances will need to be considered and action taken as appropriate.  

Insist on referrals for specialist appointments when clinically appropriate

GPs make clinical decisions on whether to make referrals for specialist secondary care, based on their best judgement and professional obligations. Using the Clinical Communication Gateway (CCG), GPs have distinct options – either to refer for a face-to-face appointment with an appropriate specialist or, for a limited number of specialties, request advice and guidance from a specialist on how a patient’s treatment can be locally managed.   
In some instances, HSC Trusts unilaterally change a GP referral for a face-to-face appointment to a request for advice and guidance, effectively discharging the patient with advice on local management. GPs are often left to facilitate and communicate this to the patient, despite it conflicting with their clinical decision that referral for face-to-face secondary care is advisable.  
Unless the guidance on local management is either specifically requested, or is otherwise timely and clinically helpful, GPs should write back to the HSC Trust, re-referring the patient and insisting on appropriate specialist provision. When writing back, the GP should insist that the Trust communicate directly with the patient, rather than via the GP.

Cease completion of unfunded paperwork

GPs currently complete large volumes of paperwork which is not required by their contracts but plugs gaps in the wider health and care system. Often this is unfunded and has no direct link to patient outcomes. Where this is the case, requests to complete paperwork may be redirected to the other appropriate agencies. 
There is an assumption that in order to access other statutory services a letter or note from a GP is required. However, this is rarely the case and furthermore is it not resourced. Certain GP paperwork can be required to ensure patients can access other statutory services, however this is not resourced.

Switch off Medicines Optimisation Software

Switch off medicines optimisation software via EMIS.  
This software often produces nuisance pop-ups on the screen during patient consultations and when issuing acute and repeat medications. These pop-up suggestions may not be in the patient’s best interest.

Source: BMA NI