England LMCs have voted for an industrial action ballot of GPs to take place once the outcome of contract negotiations is known.
This formed part of a motion to reiterate existing conference policy, and was strongly supported by GPC chair Dr Katie Bramall-Stainer, who said the profession’s negotiating power would be ‘highly dependent’ on whether GPs are willing to take ‘once-in-a generation’ collective action.
She told the LMC conference: ‘The strength of the profession’s negotiating position is going to be highly dependent on both the government in power and also the willingness of GPs themselves, of all contractual status, to consider the possibility of taking a once-in-a-generation step towards collective action.’
But she added: ‘If that’s what you wish. Because conference, as ever, I’m going to be in your hands.’
The conference passed the part of the motion, with a 68% majority, which said the BMA should ‘formally ballot members once the outcome of negotiations for the new contract with NHSEI / DHSC are known’.
Other existing policy that was reinforced via the motion included negotiating for:
- an activity-based contract
- PCN into core
- flexibility for GPs to provide services privately to patients that NHS cannot provide
However, existing policy to give up home visiting was not reinforced, with a vote narrowly lost with 54% of delegates voting against.
Dr Zishan Syed from Kent LMC, proposing the motion, said ‘surgeries are feeling that they are going to go bankrupt’.
‘Patients have spoken and they want to see doctors. Funds need to be reinvested into the core contract so that we can recruit doctors.’
And, with regards to industrial action, he said: ‘It’s about reasserting our autonomy and self-respect’
‘I’m tired of sitting in so-called negotiations with abusive NHS England and increasingly frustrated general practice… If the profession needs to strike, so be it.’
‘Whatever happens we need to be united’ and show that ‘we GPs, are a force to be reckoned with, he concluded.
Anthony O’Brien from Devon LMC, speaking against the motion, said: ‘This motion doesn’t change any policy, it is there to help up prioritise what to include in negotiations. I am not convinced any of these are things we really want to prioritise.’
And he argued that ‘we don’t want to constrain people to have a ballot if we don’t need to have one’.
Speaking in favour, Dr Mark Green from Berkshire LMC said: ‘GMS has been underfunded for year. I consider the GMS contract to be more or less dead without additional funding…. It actually shackles us. In any other business you can increase your own prices, or reduce workload.
‘So we need a contract that allows us the flexibility to maintain if not improve our business.’
‘An activity-based contract could give us back some control,’ he added.
Dr Annie Farrell from Liverpool LMC, speaking against the motion, welcomed the opportunity to discuss these policy items again.
Dr Manu Agrawal, Staffordshire LMC chair, said the notion was a ‘no-brainer’ and that he hoped never to see these motions again, as they are already policy and should already have been negotiated into the contract by the GPC.
‘Hopefully we can put right some past mistakes, she said.
She went onto argue that home visits ‘are a core part of GP services and that if GPs were allowed to provide private services to their own patients, they could ‘end up like dentists’, offering a two-tier services, ‘if’ NHS services were ‘even available’.
‘These ideas will continue chipping away at general practice,’ she argued.
Tower Hamlets LMC’s Dr Jackie Applebee also spoke against private service offering and the end of home visiting.
She said: ‘Conference, do we really want to give home visiting over to someone else?’
‘What would that do to continuity of care?’ she questioned.
‘There’s a cost of living crisis, do we really want to add to people’s woes by bringing in charging?’ she also asked, suggesting it would amount to throwing less affluent patients ‘under a bus’.
‘Let’s fight for our profession,’ inspired by junior doctors and consultants, and ‘let’s go on strike’, she added.
Dr Bramall-Stainer went on to close the conference with a rousing speech, which she concluded by promising that the recently-elected GP Committee would do everything in their power to negotiate the best-possible contract for general practice.
Referring to the upcoming process – which includes a grassroots survey of the profession that will open next week and close 31 January – as the ‘war effort’, she urged all practices to take part.
She said: ‘We are listening to what you are telling us. We are looking to the future, and we are looking at contractual income dropping, and we are watching you suffer. And all I can say is that we are living and breathing this. It’s visceral for me, it is tribal.
‘And I give you my word, that Julius, Samira, David and I, supported by the elected by the GPC England, supported in turn by you – our conference body – we will do everything in our power to get the best deal we can for you. Or rather, it will be the most that they are willing to give.
‘And if that’s not enough, then conference, it will be in your hands. We will need to support each other.’
An emergency meeting of the GPC at the end of April voted to abandon any plans to ballot the profession over industrial action in protest over imposed contractual changes for the current year.
Since then, a controversial vote of no confidence took place against then-GPC chair Dr Farah Jameel, who was replaced by Dr Bramall-Stainer in elections in August.
Motion in full
That conference calls on GPC England to:
(i) include in its negotiations with NHSEI / DHSC that existing conference policy of an activity-based contract is part of the new contract – PASSED (77% in favour)
(ii) include in its negotiations with NHSEI / DHSC that existing conference policy of PCN into core is part of the new contract – PASSED (71% in favour)
(iii) include in its negotiations with NHSEI / DHSC that existing conference policy of more flexibility for private services the NHS cannot provide is part of the new contract – PASSED (69%)
(iv) include in its negotiations with NHSEI/DHSC that existing conference policy of the removal of home visits from core contract work is part of the new contract – NOT PASSED (54% against)
(v) formally ballot members once the outcome of negotiations for the new contract with NHSEI / DHSC are known. PASSED (68% in favour)
READERS' COMMENTS [8]
Please note, only GPs are permitted to add comments to articles
? G.Ps—-? collective industrial action—-all together now—–1—2—-3—–”and the band played believe it if you like”
Activity based contract will kill general practice. The hospitals are drowning in debt due to being paid by activity. The government are never going to pay a fair price for what we do and it will never work.
Plus do practices have the resources to log and claim for every small thing they do? It will never work. Just negotiate for a decent GMS settlement.
Most GPs don’t do visits anymore. They are fine by arrs staff. Why would our colleagues vote against its removal from the contract ? Jesus wept. We really are ate own worst enemy and have ourselves to blame. With not passing the removal or any urgent demand, we have destroyed any chance of workload decrease. You only have yourselves to blame and should now stop moaning…..forever.
It is 100% clear that GPs are not going to be, as a group, as organised, determined or united as the consultant or junior doctors groups. But there is a significant number who will be willing to take some action.
So the answer is simple:
– Not full industrial action, but steps short of industrial action that individual GPs or practices can opt in or out of in part or in full.
– Picking changes which have high impact on costs
– But picking things which do not necessarily cost individual practices who decide to take action.
– And ideally steps which do not harm or inconvenience patients
The recommendation to limit workload to 25 decisions is a good start, but fails the last test, it impacts patients, so is not widely adopted by GPs. Opting out of the PCN ES affects practices and maybe patients so is not widely adopted.
Appropriate examples might be related to referrals or prescribing:
– just 30% of practices prescribing liptor instead of atorvastatin would cost the taxpayer 40 million per month or half a billion a year. The same might apply to clopidogrel, ramipril and so on.
– refusing to take part in work to reduce prescribing costs harms nobody and costs a lot of money.
– I read Japanese bus drivers still went to work but refused to collect fairs during their strike action. The BMA equivalent might be that we prescribe paracetamol emmolients and other otc treatments every time it is appropriate.
– opting out of using referral forms and insisting that hospitals do their own pre-referral work up.
– insisiting the Type 2 diabetics and COPD patients get the specialist care they deserve (and used to get)
It just takes some innovative thinking from the BMA.
What is never going to work is:
– full on strike action
– Opting out of vital funding.
– Opting out of services which can be provided elsewhere.
Fee for service is widely utilised in other countries and does rely on accurate coding and claiming but this is not a significant impediment. It’s the only way ever increasing secondary care workload dumping will be addressed. If the fee offered by the NHS for any service is not adequate then we decline to undertake that service. The ability to be able charge patients directly for aspects of care not adequately funded is key.
This may be our last chance to stop general practices as we know it from falling apart. Over the last 25 years, they have been several points where GPs should’ve taken a stand. This is the line in the sand that we must not cross.
The NHS has failed; time to leave the building before the roof falls in.
GPs are a disparate group, an uneasy rag tag alliance of partners, salaried and locums , all of whom view the other with suspicion and jealousy.
Even within their own grouping there are whispers of “us & them”, as……..
– partners in one area could be earning far more than partners down the road
– some locums have plentiful well paid work, others are fighting for the scraps.
– many salaried GPs have secure rewarding posts, but others are exploited and undervalued.
We’re more divided now than ever before. Even Pulse itself is littered with Partner vs Locum gripes.
All of this makes any joined up cohesive industrial action nigh on impossible. Remember the embarrassing farce of the Pension Strikes? And the public have been indoctrinated into thinking we’re all massively overpaid part-time golfers, so don’t expect any sympathy there.
Unless the profession can truly unite under one banner (errrr, no, not the useless wet blankets at the BMA, GPC or RCGP), then all of this “strike” guff is empty rhetoric.