Threat of mass resignation underpins GP protest
GPs are currently voting on action against the contract imposed in England this year, with the action, at first, involving not undertaking tasks that are not in the contract.
Now the conference of local medical committees has voted to include the ‘threat’ of mass resignation, which has been used in the past, in the action. Doctors sign letters of resignation which are collected by the British Medical Association – to be handed in collectively if talks fail.
Dr Katie Bramall-Stainer, chair of the BMA’s GP committee for England, told the conference: ‘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. 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.’
GP numbers increase in England
April saw a sharp increase in GP numbers in England, but experts say it was not enough to solve the crisis in primary care.
The number of fully qualified GPs in April, standing at 37,476, was 77 more than in March, and 2.8% more than a year earlier, according to the latest NHS England data. Normally the numbers decline between March and April while practices wait for doctors to complete their training. Practices also had 4.7% more direct patient care staff than a year earlier and 1.8% more administrative staff. There was also an annual increase of 1.4% in the workforce of fully qualified GPs, measured as full-time equivalents, with an increase of 32 full-time post equivalents between March and April.
Ruth Rankine, director of primary care at the NHS Confederation, said: ‘There have been some increases to the general practice workforce in the last month, but there are still not enough to keep up with what patients need and deserve. With general practice only receiving a 1.9% uplift in this year’s contract, practices do not have enough funding to recruit more staff and we are in an unfortunate position where a vote is now being put to GPs on whether to stage “collective action” in opposition to this decision.’
First election primary care pledge
The first primary care pledge of the election campaign saw a promise to recruit 8,000 extra doctors within five years.
The Liberal Democrats claimed this could deliver patients a legal right to see a GP within a week of requesting an appointment and to get an appointment within 24 hours in the case of urgent need. The party said it will improve numbers by measures such as retaining experienced GPs, encouraging experienced doctors and nurses to return to the NHS, and increasing training places.
The Royal College of GPs said it had concerns about setting mandates for practice appointment times. Chair Professor Kamila Hawthorne said: ‘The reality is that we don’t have enough GPs to meet increasing patient need for our care, and introducing arbitrary targets will not help. Mandates for practices to ensure that all appointments are delivered within a set time frame would simply pile on pressure to an already struggling service and be fraught with unintended consequences to patient care – not least the prioritisation of speedy access over continuity of care, which we know has benefits for patients and the health service.’
She continued, ‘Now that a general election has been called, we expect to hear lots of promises from all political parties about improving access to general practice services – but providing the investment we need to boost the GP workforce, and resource our service to deliver the care our patients need, is the only way to ensure a GP service fit for the future.’
Satisfaction improves in Scotland
Patient satisfaction with general practice is improving in Scotland but is still well behind the period before the pandemic, according to a major new survey.
According to the national Health and Care Experience survey, which is undertaken every two years, 69% of patients reported their experience of general practice in Scotland as good or excellent in the last year. This is compared with 67% in 2021-22 and 79% in the year before the pandemic. The survey also showed a big increase in the proportion of face-to-face appointments in the last two years, with 62% of patients saying they had in-person appointments, compared with 37% in 2021-22 and 87% pre-pandemic.
Scottish Health Secretary Neil Gray said: ‘The Scottish Government published the General Practice Access Principles report in November. This sets out a clear framework for the core principles of how GP services should be delivered. We expect everyone who needs a face-to-face appointment with their GP to get one as soon as possible.’
Call for toughened action against violent patients
Patients who are violent towards practice staff should face toughened sanctions, GPs have said, while the conference of local medical committees also called for an expansion of violent patient schemes, with a reduced threshold for including patients. The scheme, known as a special allocation service, provides primary care services in a secure environment, but has been argued to be inadequate.
Reported by the BMJ, Dr Sally Tyrer from North Yorkshire said: ‘The providers on the whole lack funding, training opportunities, and adequate security. Many of the patients on the scheme have significant vulnerabilities and complex health needs. Above all we need a strong, unequivocal message that violence against primary care is unacceptable.’
Dr Alan McCubbin, from Newcastle and North Tyneside, told the conference how a patient was fined a few hundred pounds after knocking his practice manager to the floor upon being told he could not see a GP immediately. The system, he said, ‘sends a clear message to patients that they can do anything they like to GP practice staff with no meaningful consequences.’
Trainee doctors to resume strike
It has been announced that doctors in training are to resume strike action from 27 June to 1 July, which the BMA says has been timed to take place in the run up to the general election, after the failure of mediation talks.
Doctors’ unions and the Government have been in talks for three months in an effort to end the long-running dispute, but Dr Robert Laurenson and Dr Vivek Trivedi, co-chairs of the BMA junior doctors’ committee, said: ‘When we entered mediation with government this month, we did so under the impression that we had a functioning government that would soon be making an offer. Clearly no offer is now forthcoming. Junior doctors are fed up and out of patience.
‘Even at this late stage Mr Sunak has the opportunity to show that he cares about the NHS and its workers. It is finally time for him to make a concrete commitment to restore doctors’ pay.’
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