More implied threats of industrial action will only lead to inaction, argues Jaimie Kaffash
We are not currently the BMA’s favourite publication. Our reports on motions and leaked WhatsApp messages have understandably left negotiators angry, as the quote from the England GP Committee deputy chair yesterday suggests. Indeed, we have become the ‘Daily Mail’ of the GP publishing world.
From Pulse’s point of view, we do believe that these stories are in the public interest – the GPC is negotiating for the benefit of grassroots GPs, and they deserve to know what action is being taken by their elected representatives about the current contract that they are subject to and has been imposed on them.
But you know what? I have sympathy for negotiators’ frustration at us and at these discussions becoming public. It would be easier for their strategy if they were able to discuss it without this fear.
The problem with this is that the GPC’s strategy is flawed. Their press release threatened ‘industrial action if “disastrous” changes to their working contract… are not reviewed in the coming months’. This was widely interpreted as strike action, or closure for the day – including by our (ahem) sister title, the Daily Mail. And I have no doubt this was the intention, especially in the current climate where other parts of the BMA membership are taking strike action.
Yet this is an empty threat – GPs will simply never take strike action. As I have argued before, unlike with nurses, junior doctors, paramedics or teachers, postal workers and railway staff, GPs closing for the day doesn’t have an obvious impact – especially as they will certainly continue to offer urgent appointments. A day of closure just makes a terrible system that bit worse.
On top of this, the headlines will no doubt revolve around no one noticing they are shut, and there are legal and financial issues – for partners, this isn’t just a lost day of their own earnings, they will still need to pay their staff.
I have sympathy for those pushing for strike action, because they are desperate for change. But the truth is, this will never be on the table and this was confirmed at the GPC meeting last week.
If I wasn’t already annoying enough to GPC negotiators, I am going to make myself even more annoying. Because while I am pointing out why their strategy is flawed, I am not offering any solutions. Once again, I have sympathy – the GPC is a collection of 70-odd GPs with 71 opinions. To get a consensus is hard enough, even when there is an obvious solution.
But there does need to be more realism here. Threaten ‘industrial action’, but at least be clear what this means. Could it be withdrawal from PCNs? Or creative solutions, such as referring, say, all diabetes patients to secondary care? Or will they yet again consider undated resignations? Or working to rule?
These strategies all have flaws, but they will at least pave out some concrete steps that can provide some hope to GPs who are at the end of their tether. Because the fudge of a motion and the following press release could simply be ignored by the Government. As a product of a specially convened meeting, it represented a waste of time and was in fact a restatement of existing policy.
There needs to be another way, because more implied threats of days of action will only have the effect of complete inaction.
Jaimie Kaffash is editor of Pulse. Follow him on Twitter @jkaffash or email him at editor@pulsetoday.co.uk
Work to rule, clearly. Ie in at 8.30, home at 6pm 15 min appts, do the best to keep patients safe and well and then compile waiting lists of patients waiting for appts and BMA can publish that weekly as the league table instead of F2F rates. I don’t even care if they are actual league tables just point out this is not an indication of our success or failure but that of the government in their 13 years of underfunding and lack of planning and lack of support and deliberate undermining and the right wing hostility campaign that lost us even more staff.
The advantage of this is:
1. It transparently shows through waiting lists how back the backlog/ unachievable workload is.
2. If communicated effectively it will make clear this is down to the government and no one else and only they can fix it
3. It won’t affect contractual issues that a strike would. staff still in and paid. May affect qof down the line but as things implode deal with that. Re the new BS first contact resolution thing; just have a couple on reception redirecting everyone who does not seem urgent same day to 111 who can retriage it back to us if needed. (contractually allowed; if it crashes 111, who cares, it is a totally crap chocolate teapot service anyway for which the process of us offloading the triaging of patients our reception don’t think need urgently triaging seems the most effective use of that service I’ve ever heard of. And I work for 111/out of hours loads, so I am correct on this.
4. by working fixed hours, with fixed numbers of appts we protect ourselves, probably give about the best fudge of patient care we can and actually may help a bit with our stress. It clearly delineates
ates where the excess workload is. ie everything beyond the 15 min appts 8.30-6 (+/- those other hours they signed us up to); ie scheduled, and everything else on the ever expanding waiting list data we can give the govt and get published weekly.
All this government ever seems to do is hunt or bang on about data. Give them some.
Hand back the baton
suggest a read of this from Ben Gowland at Ockham
Cant be sure Labour will behave fairly either as Wes Streeting seems to be populist
The National Influence of General Practice
Posted by Ben Gowland The General Practice Blog
General Practice is in a difficult place. Worse is that politically it is being backed into a corner, and without action things are likely to become more difficult still. What influence does general practice have, and can it impact national decisions about its own future?
In 2019 a five year deal was agreed including above inflation increases in funding for the service, alongside significant new investment via PCNs. All was fine until inflation skyrocketed beyond 10% and what seemed like a reasonable deal in 2019 with hindsight now looks like a very bad deal indeed.
The GPC arm of the BMA tried to negotiate further increases to match the inflationary pressure, but the government/NHS England response was simply to impose the terms of the previously agreed contract. This happened in 2022/23, and then again this year for 2023/24. Last year there was no concrete reaction from the profession, and so far this year there has equally been zero response.
2023/24 marks the final year of the 5 year deal agreed in 2019. NHS England has already made it clear that should no new deal be agreed then the terms of this current deal will simply be carried forward. Would the service be able to survive taking a real terms cut of over 5% for a third consecutive year?
Which begs the question of whether a new deal can be agreed. The behaviour of NHS England and the government in years 4 and 5 of this contract should make the service extremely reticent to enter into another 5 year deal, but one suspects that is what will be on offer. Once again it will no doubt be front loaded to make the initial offering attractive (or at least more attractive than continuing with the current deal), but the pain will inevitably come as the time of the agreement progresses.
We know from the Fuller Report that the national direction is for PCNs to ‘evolve into’ Integrated Neighbourhood Teams. This carries with it the huge risk that the additional investment gained over the last 5 years into general practice through PCNs could be lost as that resource is shifted sideways into NHS trusts and out the control of practices. We also know from the Hewitt Review that the push is to move funding away from the national contract and into local contracts. More on why that will be ultimately detrimental to general practice can be found here.
So if the service would generally be against another 5 year deal, a shift of PCN resources out of general practice, and a move away from a national GP contract when we know all of these things are most likely on their way, what action is general practice taking nationally now? While we all hope that behind the scenes furious preparations are underway, at present there is no visible action in train.
What about on the NHS England and government side? Well, there is the national media campaign against general practice and the ‘inability’ to book a face to face appointment. Instead of backing the service the government is announcing rescue plans and ‘firm action’ which implicitly lays the blame at the feet of practices. As a result public support for general practice is at an all-time low.
Then there is the mandate for GPs to publish any earnings above £159,000. Why would this requirement, that was dropped 3 years ago, be reinstated now? It seems highly likely to be pre-emptive, so that any complaints the profession make against the proposed new deal when it comes can be countered with a point to whatever the number of declarations ends up being, ignoring the fact that huge numbers are earning less and that their earnings have gone down. It is not hard to see the government using the ‘greedy GPs simply wanting more’ argument in any public dispute (just look at how they are handling the dispute with the junior doctors).
There is also the insidious emerging national rhetoric that the national GP contract is ‘broken’ and no longer fit for purpose. It is not evidence based, but the NHS works by acting on whatever the perceived current wisdom is. It is not an accident that this rhetoric has become fashionable just as the current contract is coming to an end.
So NHS England and the government have been taking active steps to prepare, while it seems the service has not. There are plenty of actions the profession could be taking. There could be some visible protest action against this year’s imposed contract. Even if it doesn’t get anywhere it would be a marker in the sand for next year. There could be a collective refusal to publish the requested earnings information, because why would you give your political opponent a stick to beat you with. And there could be some form of concerted media campaign highlighting the growth in attendance numbers, the failure to increase the number of GPs, the impact of the imposed contract on practice staff (etc etc). These are just a few, and of course there are many more actions that could be in train.
Something has to change. General practice has to get its house in order nationally. What general practice is really crying out for is some strong national leadership. The service needs to unite behind a national figure, someone trusted by the profession and the public alike. At present this seems to be lacking, and unless this is rectified quickly there could be some very dark days ahead.
As the latest elections show it is Labour is who GPs need to be urgently talking to . The Conservatives quite deservedly are going to be wiped out at the next election – just a matter of when. Great editorial Jaimie
Referencing Douglas’s comment and the quote about there being an impartial national extremely well respected figure that can provide analytical skills and also has the public and doctor’s trust. I can think of someone who perfectly fits the bill – his name is Sir Robert Francis. Maybe the BMA could ask for his help