Health chiefs in the dark over industrial action by Bristol region’s GPs

Health chiefs have admitted they have little idea what industrial action by GPs in the Bristol region will look like, when it will happen or quite what the impact will be. Many family doctors across England began work-to-rule action in August in a dispute over funding from government.

Their union, the British Medical Association (BMA), has given surgeries a range of ten options to pick and choose from, including capping the number of patients to 25 a day, ignoring “rationing” guidelines on the number of referrals and treatments, and refusing to carry out tests and assessments for hospitals. The BMA has said the action could bring the NHS to a “standstill very quickly” while NHS England warned it could cause significant disruption affecting more than just GP services, such as adding to the number of people attending A&E and delaying discharges.

But one big problem for the local health authority – Bristol, North Somerset and South Gloucestershire Integrated Care Board (BNSSG ICB) – in preparing for this is that the decision over which measures, if any, to take is down to each individual practice, and they are not required to tell them in advance. Another is that because family surgeries are effectively independent businesses, so are not employed directly by the NHS, the action does not constitute formal industrial action.

This means that, unlike previous traditional strikes by groups of medics including junior doctors and consultants where dates and duration have to be announced ahead of a walkout, GPs can continue with work-to-rule indefinitely, so some of the action could become permanent and could change at any point. More than 8,500 family doctors voted earlier this year on whether to take collective action, with 98.3 per cent in favour.

The row is over a new GP contract offered by the previous Conservative government which would give a rise of only 1.9 per cent funding for services in 2024/25, which the BMA said would leave many practices struggling to remain financially viable. BNSSG ICB chief delivery officer David Jarrett told South Gloucestershire Council health scrutiny committee: “This is very different to the junior doctors’ and consultants’ industrial action which we saw a year or so ago.

“The impact of that was immediate and was time constricted, so we knew what was happening, when it was happening and the impact it had. We’re in a very different scenario with this.

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“We’re not sure what’s going to happen, where, when or for how long. So the impact is very different because it will build and grow and our response will have to adapt and flex to that.

“It’s a very different impact and response to the industrial action we saw last year.” BNSSG ICB head of primary care Beverley Haworth told councillors that there was “significant unrest across general practice” because of the contract offer, which GPs regarded as an imposed contract.

She said the ICB was holding weekly meetings to assess the risks of all the possible actions and decide what mitigations to put in place. She said Avon Local Medical Committee had given the ICB guidance on the options preferred by the area’s GPs which had helped it prioritise its next steps.

But Ms Haworth said: “There are still a lot of unknowns. We don’t know what our practices are doing at the moment or what they’re planning to do.

“We have worked with the LMC and our GP collaborative board to develop a survey to ask for support from practices to let us know which actions they will be taking and when. This is in full agreement with the LMC and our GP collaborative board.

“It’s important for us to feed this information back to NHS England around what the challenges are, so they understand what’s happening operationally but also to help us prioritise our work and manage system relationships. It’s not mandated, though. Practices don’t have to respond. Some may not, and some may not take any action at all.

“We are only aware at the moment of a handful of practices that have started action but they’re all doing different things. It’s really important that we maintain relationships because this is a significant amount of work in terms of prioritising pathway work.”

She told the meeting on Wednesday, October 9, that there was a high likelihood of impact on patients and to the delivery of services across the local health system. In a letter to GPs in August, Secretary of State for Health and Social Care Wes Streeting said general practice had been “neglected for too long”.

The government has accepted the recommendation of the pay review bodies to increase the wages of salaried and partner GPs by six per cent, but that is separate to the 1.9 per cent increase in funding for practice running costs which sparked the collective action. NHS England has urged patients to continue seeking treatment from their GP as normal.