Dr Katie Bramall-Stainer: ‘We need to prepare for undated resignations’

The BMA’s GP Committee England chair gave a rousing speech at the UK LMCs conference, in which she argued GPs need to threaten to leave the NHS

I’m speaking capacity as chair of GPC, England so I hope devolved nation colleagues will forgive my focus on national matters over the next couple of minutes.

We are witnessing the constructive dismissal of our profession on a national scale. This is intentional, it is premeditated, it is planned. It is funded at the expense of our businesses.

What does constructive dismissal look like? It looks like 1,300 practices gone. But behind that headline, there’s far more than 1,300 lives changed forever. Dreams abandoned and obliterated by toxic pervasive narratives against our livelihoods, against our staff and against ultimately our patients.

It’s the loss of over 10,000 GPs in the past decade in the context of 8 million more registered patients. When I trained as a GP, the accepted number of patients per full time equivalent was 1,800. It’s now almost 2,300 – 500 patients more. It’s the toxic oxymoron of thousands of GPs out of work in a workforce crisis. It’s starving evidence-based care, eroding quality outcomes, and then blaming us for the lack of access to a GP.

What’s the future? What’s going to change with a new UK Government? Well, if we continue to run with full Fullerisation, with ‘modern general practice access’, with what is basically the enshittification of general practice, then, no, nothing’s going to change already. There’s £2m over two years for pilots to do Fuller across seven ICBs and colleagues in this room, colleagues sat here, are engaging with it. Stop it, stop it now.

Because the cavalry is not coming. You are the cavalry. Your destiny is a choice. Do not leave it to chance.

DDRB is going to drop mid ballot. That was always the plan because it’s intentional. And what are they going to give you: 2%, 3%? How about 4%? So 4% on top of your 1.9% is 5.9% – which is what they gave you last year.

What was last year? It was an absolute car crash and that’s what I told [primary care minister] Andrea Leadsom three weeks ago and the colour drained from her face. Now will Labour suddenly double that amount? No, of course they’re not going to.

So what is 6%? It is £660m less than in 2018-19. If you want to be on a level to where you were five years ago, you need 12%. Who’s going to deliver that for you?

Nobody is, no matter what party they are. They’re not going to do it until they have to and they’re not going to agree to anything once they’re in government.

Now is the window of opportunity, and this is why we have to get every political party to agree to terms for a new contract in England because otherwise we’re on a hiding to nothing.

GMS has been broken. And that’s why we have to do this. That’s why collective action is so important.

And actually, yes, there’s an evidence base. In 1964, James Cameron led collective action in the form of undated resignations to the Wilson government. It was effective and led to the family doctor charter of 1965: the Red Book contract.

APMS reprocurement costs tens of thousands of pounds per contract. No government can afford to procure 70% of contracts with a unified date of termination. It sends a powerful message, it empowers your representatives.

But before we even start to consider undated resignations, we have to take action now. We have to vote in the ballot. Now our voting and our plans and our action must be sequenced. They must be strategic. We have got to protect our practices to protect our patients. we have got to take action to save general practice. The time is now.

Dr Katie Bramall-Stainer is chair of the BMA’s England GP Committee

Editor’s note: this originally said the Fuller pilots were offering £10bn over two years. This was, of course, £2m over two years, which is significantly different!