Now that the British Medical Association (BMA) has opened its ballot for collective action among General Practitioners (GPs) in England, in protest at the imposition of the latest GP contract, Practice Index has asked a number of Practice Managers how they feel about any upcoming action.

From now until midday on Monday 29th July, GP members of the BMA who run their surgeries will vote on whether to support the organisation’s call for collective action. This decision follows the BMA’s member referendum on the 2024/25 General Medical Services (GMS) contract changes in which over 99% of members who responded (that’s more than 19,000 GPs and GP trainees) rejected the Government and NHS England’s 2024/25 GP contract changes.

After months of inharmonious negotiations between the BMA and NHS England, the 2024/25 GP contract has been imposed on the profession – the third year in a row that this has happened. The new contract has not been well received in the medical profession, with the BMA stating it “does absolutely nothing to improve what is fast becoming an irreparable situation for practices and their patients up and down the country”.

One of the union’s concerns is that the contract ignores calls for additional support to help practices meet rising costs. The BMA’s GP leaders requested an uplift of 8.7% to bring practices back to the financial position of 2018/19 following years of sub-inflationary contract rises. However, the imposed contract only offered a 1.9% uplift, which in real terms is yet another funding cut.

Following the referendum, Dr Katie Bramall-Stainer, Chair of the BMA’s General Practitioners Committee in England, stated: “We want to provide patients with a quality service, but it’s increasingly clear, and our patients can see for themselves – we simply cannot do that without sufficient investment and more GPs in our surgeries.

“GPs and their patients want the same thing. We want patients to be able to see their family doctor, quickly and easily, in a practice that is local to them, well-staffed and resourced, and safe. This contract imposition will do untold damage to our profession, making it harder for surgeries to stay open and give the care our patients need.”

Supportive of collective action

While collective action is not the same as strike action, it could see GPs prioritising their patients’ needs over local NHS system wants, pulling out of data-sharing agreements or pushing back against NHS England to offer face-to-face appointments as a default. Discussions are ongoing, and all plans being explored are subject to change.

Despite this concrete roadmap for action, Practice Managers are clearly aware that trouble may be on the horizon, especially considering the impactful strikes undertaken by other staff groups in the NHS. PMs do, on the whole, appear to be supportive of action (not all were before the latest contract imposition).

One PM at a large practice in south-west London told Practice Index: “I’ve always been reluctant to back any form of strike or collective action, but enough is enough. The main thing we need is investment and we simply can’t accept another cut to our funding. It’s time for action, especially with a new Government probably on its way.

“Covid is often blamed for the uptick in pressure on practices, but the problem pre-dates the pandemic. For the past decade, we’ve tried all ways to increase revenue and cut costs, and there’s nothing more we can do to survive other than cutting staff and services.

“One example is ear wax removal. Where we are, patients don’t have access to the service anywhere across the ICB because we simply don’t have the capacity. That’s leading to an increase in people damaging their ears after trying self-removal or reporting with more serious problems that probably cost more to deal with in the long term.

“The real-term funding cuts have serious consequences and, if the conversations I’m having are accurate, practices will have no choice but to close. We’re at breaking point with the rising costs we’re having to cope with.”

Justified demands

Another PM, from rural Cumbria, added: “I believe the doctors’ demands are completely justified. We’ve been facing a significant lack of investment, and the pressure on us is immense, so I support action. It’s not a full-on strike, and it will be interesting to see what the BMA decides to do, but we need to start making a noise in general practice. Demand has surged dramatically, especially following the stress of Covid and I don’t know any practice in this area where partners aren’t considering leaving. Many GPs have already decided to leave the profession or take up positions overseas.”

Another PM echoed these thoughts, saying: “One of the main areas of concern the BMA has raised is the ongoing difficulties GPs face in recruiting more family doctors. Practices have access to a funding pot for hiring more staff, but not GPs, which is what we actually need and is what our patients want. The contract could have addressed this issue, potentially alleviating cases of Locum and Salaried Doctor unemployment across the country.

“I read recently that a Locum was working for Tesco. That’s a complete under-utilisation of talent and expertise and a sorry indictment of where we’re at in primary care.”

One of the BMA’s concerns is that it feels the contract is ignoring calls for any extra support to help practices meet the rising costs of keeping practices open. That’s only part of the story, though, according to a Nottingham-based PM.

“Yes, funding is a big problem, but it goes hand in hand with successive contracts introducing more bureaucracy and arbitrary targets that only set practices up to fail and take GPs away from direct patient care.

“To only focus on funding would be a mistake. I know from my GP Partners and the work the practice management team is doing here that we joined a very different NHS years ago. It was one where delivery of patient care came first, rather than feeling like it’s secondary to the paperwork. For me, the ICB makes the matter worse, so I would like the BMA to target local commissioners, the Government and NHS England in their fight – and be really clear about what they’re asking for and why.

“I also think there needs to be a clear distinction between this action and that which Junior Doctors etc. are taking. The public have witnessed a lot of strike action across the NHS over the past few years and I think there’s a danger they’ve become a little blind to what’s going on.”

Communication will be key

While supportive of collective action, one PM expressed a note of caution, building on the comment above: “It’s worth remembering that our practice teams are the ones on the front line, who will be answering queries from patients, delivering the news that certain services won’t be available and, of course, dealing with Mr and Mrs Angry. As PMs, we’ll have to ensure that our preparation is in order so that everybody knows what to say.

“I think that whatever collective action the BMA takes must be carefully positioned to avoid providing ammunition to those who might struggle to get an appointment on short notice, who will then claim GPs as ‘lazy’ and so on. Whatever action the BMA takes, it must be specifically targeted, clearly communicated, and must not disrupt care for patients genuinely in need.”

In what has become a highly confrontational time for the health service, with different staff groups clashing with the Government and leading to multiple strikes or collective action, it looks very much like the next battleground will be in general practice. While we don’t know what the BMA’s proposed action will entail, it looks like Practice Managers need to brace themselves for an ‘interesting’ few months ahead.

We would love to hear your thoughts on the potential BMA collective action. Are you in favour or against? What concerns you? What do you think the action will look like? How will you prepare your practice? Let us know by commenting below or take it to the Forum.