At the special LMCs conference on 30 January, delegates voted for the GPC to canvass GPs on their willingness to submit undated resignations unless the Government delivers a ‘rescue package’ for general practice within six months. But what does this actually involve for you?
What is an undated resignation?
An undated letter of resignation means what it says – a GP giving notice of intention to cease providing primary medical services to a given population, but not determining the date when this action will be initiated.
The resignations are undated because it allows the GPC to date all resignations for the same date and enables them to be submitted simultaneously to NHS England.
What would trigger undated resignations?
The GPC is seeking contract negotiations at the moment. If an adequate new GP contract is not negotiated within the next six months then the profession would start a formal process to canvass GPs on their willingness to tender undated resignations. If successful, a move to mass resignation would follow shortly afterwards.
What if not every GP in the practice submits an undated resignation?
If only a small proportion of GPs at a particular practice submit their resignations then the remaining partners would remain responsible for ensuring the continued running of the practice, as per the partnership’s contractual obligations. However some practices will have clauses in their partnership contracts which say that if a certain number of GPs resign within a certain time period then the remaining partners will also submit their resignations to enable the handing back of the contract. Therefore, this has more impact if all partners in a practice resign together.
Why would the GPC want to use this strategy?
This is preferable to other methods of campaigning, as it is extremely difficult for independent contractors to undertake industrial action without falling foul of legislation. Similarly these GPs cannot technically strike as they will be found in breach of their contracts and are not protected by employment law. Salaried GPs could strike but only if they have a dispute with their employers (usually other GPs).
If the GPC cannot get the Government to urgently recognise the serious state of general practice, undated resignations give the negotiators backing to discuss with the profession whether they are prepared to consider resignation as the only option left.
Have undated resignations been used before?
Collective use of undated resignations was used successfully in 1966 to bring about a new contract, at a time when GPs found themselves in a similar position to today with unmanageable workloads, dwindling workforce and few resources.
In 1966 those resignations were never submitted. The mere threat was sufficient to force change. While not guaranteed, one would hope we could achieve the same outcome.
What are the risks and drawbacks of GPs preparing unsigned resignation letters?
Clearly this is a ‘nuclear option’. It places the resigning GP’s career at immediate risk with all the financial ramifications that come with closing a practice, such as making redundancy payments to staff.
If the Government did allow multiple practices to close simultaneously there would be chaos for those communities affected.
However, whether or not GPs agree to this strategy, many practices are at risk of closing anyway due to their decreasing financial viability, failure to retain and/or recruit doctors, and overwhelming workload.
Will this action need a minimum engagement?
That’s for the GPC to decide. But my instinct is that there would be no need for a majority of GPs to undertake this for it to be effective.
Even a small number of practice closures could have an effect. If 20 practices scattered across England closed, NHS England could probably cope with that. But if 20 practices with 15,000 patients closed, that might be a different matter. If those 20 practices were all in a small area of the country, say all within South Buckinghamshire, this would probably be sufficient to result in the complete collapse of the health service in that area.
How should I broach the possibility of preparing unsigned resignations with partner colleagues, and non-partner colleagues?
Ask colleagues if they can manage the stresses of general practice today, ask if they are prepared for the exponential rise in patient demand predicted over the next decade, ask how they would manage if the practice next door closes and they are expected to pick up the care of displaced patients, ask if they have any faith in the Government’s current strategy for sustaining services over the next decade.
Then ask them to consider the rationale of threatened mass resignation as a way of forcing the Government to take immediate and drastic action to avert the major crisis ahead.
Dr James Murphy is a GP in Buckinghamshire who proposed the motion for undated resignations at the LMCs conference