What kind of industrial action do GPs want?

We asked Pulse readers what kind of industrial action they would want to see if BMA members do vote against the contract in England in the current referendum. We received a number of great suggestions, and here is a selection, ranging from going private to focusing on QOF and stopping all training. If you have any more suggestions get in touch with the editor at editor@pulsetoday.co.uk

Go private

The BMA should fully work up and distribute a credible plan for going dentist (a modern day ‘Guernsey’ option). This should be paired with undated resignations and we should be willing to go through with it.

The general public don’t understand quite how things are because a smaller number of GPs keep pedalling fast and faster, keeping the service going at the cost of their own sanity.

Dr AP is a GP in Berkshire

I think we should ‘do a dentist’. Strikes won’t work, as all we are doing is making things worse for ourselves by shifting our workload – the weeks after the strike would be utterly miserable.

We are drowning in workload and a fee at the point of use is the only way I see to stem the tide. I appreciate that, on an ideological basis, this will not appeal to everyone. But I spend my days apologising for the state of the NHS and trying to paper over the cracks and keep patients safe.

I think we are about to split into a ‘free and see a PA’ vs ‘pay and see a GP’ service; that is clearly what is wanted by the Government and I see no point in continuing to practise on the margins, with our necks in the noose if and when things go wrong.

Dr Alexis Manning is a locum in Cardiff

Spend a week on QOF

If GP partners strike, we still have to pay our staff and expenses etc.

We could stay open and have a week to book in all our QOF reviews. This would show the public we are continuing with chronic care, which is our expertise, but anything acute will have to go to the hospital or walk in centres. It would have to be a week or so as a few days will not have any impact. It also means we are within our contractual obligations.

Dr Komal Raj is a GP partner in Derby

Subcontract on-the-day appointments to out of hours

Close doors except for pre-booked appointments, continue all booked in advance appointments with nurses only (thereby fulfilling all obligations of the phlebotomy LES, QOF, extended hours etc).

Limit doctors to a maximum of 26 appointments a day, no visits except nursing homes, with an ambulance called for all other visits call an ambulance.

The 26 pre-booked appointments should be only for routine stuff: medication reviews, minor surgery, coils, implants, procedures, paperwork, review of bloods, results, letters, etc, plus cover for nursing homes (only to take the stress off out-of-hours cover).

We should subcontract all urgent on-the-day appts to OOH, so commissioners cannot say there is no cover. Ideally coordinate this action for at least three working days, the longer the better.

Anonymous GP in the West Midlands

Stop taking responsibility for others

We are so limited to what we can do but doing nothing is what the Government expect.

Could we stop taking responsibility for everyone else for at least a month?

We could start with no medical students and no GP trainees. This might be a small drop in income and GP trainees can do online learning modules from the RCGP.

How about no prescribing on behalf of others including community services, ARRS staff, acute prescriptions from secondary care? Maybe no ordering tests on behalf of others? Any clinician who cannot prescribe, order tests or needs supervision would either not be able to work, would be restricted to cases where these wouldn’t be needed or have to find a supervising clinician in secondary care.

We would then be able to crack on with our job and hopefully not be in breach of contract. If it has no impact on patient care, it would suggest other roles like ARRS are not needed. If it has an impact, it shows all the additional work we do.

Dr M Sayed is a GP partner in the North West

Mass resignations

I think Labour would be more likely to settle were they in government in the autumn – at a time when industrial action might be planned to occur. However, I think we should nonetheless prepare for industrial action and, in my view, this should entail the use of undated mass resignations of GPs, together with the contingency for GPs to ‘take back control’ and restore agency to the medical profession.

All our options for partial concessions to an all-out strike nevertheless primarily hit the hard edge of patient care. Such disruption would affect patients more significantly than the Government, who would be quick to capitalise on any inconvenience or harms to patients, whipping up a Gov-fest of adverse GP publicity. In contrast to work-to-rule or strikes, undated mass resignations are a technical solution and less impactful on patients. Threat of resignations would also entail planning for a major change to sustain the future of effective general practice.

Whilst abundant measures of distress across the NHS system have deteriorated to an extreme, patients have no voice and we have been repeatedly ignored. Small gains by striking doctors have driven some hard bargains to get fair treatment. We need decisive change.

Once was a Red Book, now there’s NHSE…

Dr Nick Mann is a GP locum and specialty doctor in London

Decline all non-direct care work

We must not do anything which further diminishes access/services to patients. I believe the Government’s intention is precisely to goad us into striking, further diminishing our currency with the public, so carefully crafted since Covid by their proxies in the media.

What we can do is to decline all activity which is not direct care to the patient. Appraisal, CQC, e-consulting, all work transfer from hospitals, all reports, all non-clinical meetings. The list of possible such actions is endless. We’ll have more time, patient care will improve. Please, let’s make sure we punch up and not down. Losing our patients’ goodwill is the Government’s intended outcome, facilitating the demise of GP led primary care.”

Dr David Marshall is a GP partner in Wiltshire

Continue NHS work

Industrial action seems simple – we continue all NHS work,

First, we refuse to do all non-contractual work where possible or ‘go-slow’ (DVLA, insurance, PIP reports etc. all ‘medicals’).

Then we send standard email or text to affected patients with an explanation to direct their anger correctly. (The government propaganda machine will be difficult to overcome, but I’ve never had a problem in advising patients to not read the Daily Mail or Express as part of health promotion).

The message should include a link to the email addresses of the health secretary, shadow health secretary and the local MP to allow patients to communicate directly with those who have power.

We have a democratic footprint like no other group in society – it should be used to the maximum with no pulled punches

Dr David Polkinghorn is a GP partner in Sheffield

Use the 2% uplift as a PR weapon

GPs are sadly unable to co-ordinate effective industrial action. We are a confusing cornucopia of partners/salaried/locum doctors with no unifying representative body and diverse opinions.

This is best illustrated by the embarrassing farce that was the pension strike, where a few surgeries closed, several reduced activities, but the majority continued with business as usual. Any further industrial action would be a similarly futile act, damaging our reputation with patients with zero chance of any meaningful change of government heart.

My suggestion is that we brandish the 2% as a weapon to whip up public sympathy. Posters plastered over surgeries, hand-wringing media articles, patient participation groups empowered to lobby MPs, and decrying every handed-back contract as evidence of primary care collapse.

This would then become a major issue in the forthcoming election, with parties competing in promising how much they will invest in general practice, hopefully leading to a genuinely game-changing favourable 2025 contract, similar to 2004.

Dr Chris Pattullo is a GP partner in St Helens

Wait for the referendum

Let’s wait and see what the referendum says, what the Government offer after the DDRB reports in July and then what the BMA legal team have decided is possible under contract law.

First things first, see if GPs will unite to give a mandate to BMA to take things further.

BMA should not (and I guess will not) show their cards until after they have a legal mandate under trade union law. And if they do show them too early, the Government can always legislate to outlaw what may be planned.

Timelines suggest this will be for the next government to sort (or not).

Dr David Jenner is a salaried GP in Devon