LMCs call for BMA to re-enter GP collective action over 10-year plan

Exclusive GPs across a large area in England are calling on the BMA to re-enter formal dispute with the Government over the 10-year plan, Pulse can reveal.

Berkshire, Buckinghamshire and Oxfordshire (BBO) LMCs said that 87% of GPs in their area believe the union’s GP committee should ‘urgently return to formal dispute with the Government’ over changes announced in the plan.

A survey of their members also found that 87.8% see the plan ‘as a threat’ and that 83.4% believe the Government has ‘no intention of delivering a wholesale new practice-based contract’.

It comes after the GPC was asked to consider re-entering dispute with the Government ‘with immediate effect’ at a meeting last month, which Pulse understands was taken as a reference, although they did leave the door open for further disputes.

The GPC’s previous dispute with the Government over pay and conditions ended in March, following a written commitment from the Government to negotiate a wholesale new GMS contract within this Parliament.

However, the 10-year plan does not mention a new GMS contract for general practice, only two new contracts for neighbourhood services which ICBs will be able to award to other providers, including NHS trusts.

BBO LMCs said: ‘Responsibility for negotiation with the Government to adapt the 10-year plan for the benefit of general practice, oppose the harm it poses, and the use of any and all levers necessary to secure the required safeguards and assurances within the 10-year plan for the profession, sits squarely with GPC England.

‘The expectation of constituents of BBO LMCs expressed within this survey is for GPC England to act to defend against this threat.

‘The overwhelming majority (83.4%) believe the Government has no intention of delivering a “wholesale new practice-based contract”.

‘Further to this, based on the fact that GPC’s acceptance of the 2025/26 GMS contract, and accompanying withdrawal from formal dispute, was predicated upon assurance of delivery of such an aforementioned wholesale new contract, and given the lack of progress toward, nor mention of any new GMS contract in the 10-year plan, 87.1% of respondents believe GPC England should urgently return to formal dispute with the Government.’

The survey found that 82.7% of respondents expressed a likelihood to engage in ‘escalation of collective action’ to protect the independence of their practice ‘if led and coordinated’ by the BMA.

One GP responding to the survey told the LMC: ‘This is a deeply depressing document. I am grateful that the LMC sees the threat inherent in the plan and is being proactive to flag the threat to practices.

‘We are all so downtrodden and disillusioned, I fear some practices may gladly hand over the keys such is their level of despondency.’

The survey results

In total 149 constituents responded to the survey. In terms of breakdown by contractual status: 74.5% of respondents were partners, 20.8% were salaried, 3.4% were locums, and 1.3% were registrars.

87.8% see the 10-year as a threat, with two thirds of that number seeing it as a ‘significant threat’; 5% were indifferent; 7.2% saw it as an opportunity, with only 0.67% seeing it as a ‘significant opportunity’
83.4% believe that the Government ‘has no intention of delivering a wholesale new practice-based contract to replace 2004 GMS’
87.1% believe that ‘GPC should urgently return to formal dispute with the Government’
82.7% expressed a likelihood ‘to engage in escalation of collective action to protect the independence of [their] practice if led and coordinated by the GPC/BMA’ with two thirds of these being ‘very likely’

Respondents were also asked to rank the following by preference from most preferable to least preferable:
i. The 10-year plan isn’t implemented at all, due to unfeasibility or change in Government
ii. Practices being vertically integrated into trusts
iii. Practices being horizontally integrated into a single primary care provider such as a federation
iv. GPs and practices move out of the NHS to set up independent practice privately similar to dentists
v. Practices combine into Super-Partnerships to become Single Neighbourhood Providers in their own right

When first preference outcomes are ranked, the 10-year plan either failing to be implemented, or being scrapped by a change of Government is preferred overwhelmingly by constituents as an outcome, with 57.2% of respondents selecting this as the number one preferred outcome.

Source: BBO LMCs

The LMCs said that the ‘most unacceptable outcome’ of the plan is possible at-scale contract provision held by NHS trusts.

GPs and experts told Pulse that the proposals could mean that funding will mostly be channelled into larg-scale providers and that traditional practices will be left with fewer resources.

And one large ICB has already chosen a number of hospital trusts to oversee the new ‘neighbourhood health service’ across its footprint, announcing that the trusts will also hold the funding.

‘Based on the clear will of the profession from this survey, LMC advice to practices is to resist any attempt to impose a trust-led outcome to this 10-year plan,’ the LMCs said.

Another GP told the LMC: ‘I am scared for my business and my patients. I have seen the predatory nature of some large trusts and cannot see how we can possibly upscale our businesses fast enough to stop their juggernauts.’

BBO LMCs chief executive Dr Matt Mayer told Pulse that the 10-year plan is ‘antithetical’ to the Government’s manifesto promise to ‘bring back the family doctor’.

He said: ‘The overwhelming view of GPs across all five of our areas is that the Government has broken its promise to negotiate a wholesale new GMS contract, and has no intention of meeting the condition upon which the profession left dispute at the beginning of this year.

‘Furthermore, this 10-year plan is antithetical to the Government’s manifesto promise to “bring back the family doctor” and instead sacrifices personal general practice and continuity of care on the altar of corporate medicine at ever increasing scale with scant evidence in support.

‘This Government seems hell-bent on dismantling 77 years of NHS general practice and we implore GPC England to call this plan out for what it truly is, which is the beginning of the end of the NHS GP.’

GPC England chair Dr Katie Bramall said the committee ‘remains resolute in pressing for urgent action’.

She added: ‘We will continue to develop a set of clear, deliverable demands—including restoring core funding—and we are actively listening to our members as we consider the next steps.

‘GPC England is clear. Government must listen to the genuine concerns of GPs if they have any hope of their plan succeeding in meeting the three national objectives: transforming investment from hospitals to the community; analogue to digital; and sickness to prevention.

‘GPs can support those objectives whilst pointing to where the plan fails in its described implementation. There is a growing consensus across the profession that the current trajectory threatens the survival of the independent contractor model and, with it, the trusted family-doctor relationship our patients rely on and want to protect.’

Pulse has contacted the Department of Health and Social Care for comment.

Last week the GPC laid out a list of demands for the Government to avoid further GP collective action, including moving ARRS money to practice-level reimbursements and ‘explicit’ preferences for GPs to run neighbourhood services, amid serious concerns that the plan threatens the survival of independent practices.

The GPC has also has called for ‘clear financial arrangements’ to underpin the new neighbourhood care models proposed by the Government.