GPs told to refuse shared care agreements in collective action escalation

GPs across England have been told to refuse new shared care agreements as part of collective action organised by the BMA.

The union’s latest escalation of collective action against this year’s imposed GP contract involves refusing any ‘informal requests’ for hospital specialist treatment to be transferred from specialists to GPs.

The BMA said that too often, practices are expected to ‘automatically’ take on the responsibilities for prescribing and monitoring specialist treatment, without any recognition of the clinical safety, accountability, workload and modelling that is needed prior to such a pathway being agreed between ICBs and practices.  

As part of collective action, GPs have already been asked to remove or ignore any non-contractual medicines optimisation software for new prescriptions, and to notify their ICB that they are stopping voluntarily sharing data using a template letter provided by the union’s GP committee. 

From today, practices will also be asked to:  

• Refuse to accept any informal requests for new shared care agreements. 
• Accept only those new agreements which are appropriately resourced and safe. 
• Ensure a formal agreement is in place before prescribing and monitoring begins, which confirms specialist support will continue to be available to the patient and clear responsibilities set out between the hospital specialist and their GP surgery.  

The GPC added that it is ‘negligent’ for commissioners to place unresourced additional responsibilities on GPs who are struggling with capacity.

GPC England chair Dr Katie Bramall said: ‘This next phase of collective action is about GPs rejecting the transfer of additional work from hospitals to practices – beyond their existing contractual arrangements with the NHS – that is too often unsafe and unfunded. 

‘Practices may choose to take on additional work, if the additional workload has been calculated and costed to ensure other services do not become unreasonably stretched.

‘The profession must take a stand against the ICBs which oversee this, else the demand on practices will continue to grow pushing them ever closer to closure.

‘The BMA recognises that both specialist hospital and GP services are stretched too thin across the NHS. This is why we want to see a long-term solution that gives patients with complex care needs the reassurance that their long-term care can be managed closer to home and safely by both specialists and GPs.

‘However, if there is no additional resource to cover the additional workload and time GPs and their practices need to take on the additional ask, services for other patients suffer and practice staff become even more overworked than they are now. GPs should not be expected to fill commissioning gaps at a cost to their own practice’s long-term survival.

‘For the sake of safe patient care, and keeping local GP surgeries open and viable, practices will therefore refuse any new requests for shared care, if these are inappropriately resourced.

‘Once commissioners have drawn up formal proposals which are safe and sustainable, GP practices with capacity may be able to take on more specialist prescribing and deliver more care closer to home for their patients.’

Earlier this year, the committee said it would announce new actions to escalate the dispute each month, should the Government fail to provide ‘sufficient concessions’ on the imposed contract.

A Department of Health and Social Care spokesperson said: ‘GPs play a pivotal role in the NHS, and we remain committed to working with the BMA to resolve outstanding issues and avoid escalation.

‘We expect all providers of NHS care to act in the best interests of patients, make responsible use of public funds, and work in line with established clinical guidance and local prescribing arrangements.

‘We don’t anticipate a significant impact on patient services, and patients should continue to contact their GP as usual.’