GP action already starting to be felt, NHS England board hears

The NHS ‘is already starting to see tension’ as a result of GP practices ‘pulling back’ from doing discretionary work, NHS England’s board heard today.

The comments, made by the organisation’s only GP board member Professor Helen Stokes-Lampard, come as a ballot of GP partners regarding collective action is due to close on Monday next week.

However, the BMA has already advised practices on action they can begin to take in the meantime to reduce workload and protest against this year’s imposed GP contract.

Speaking at NHS England’s board meeting today, Professor Stokes-Lampard said regarding the ‘looming industrial action’ in primary care: ‘We are already starting to see tension as general practice is pulling back from doing all the discretionary stuff.’

Earlier this week, NHS England instructed ICBs to prepare for a ‘reasonable worst-case scenario’ impact of GP action, and to keep lines of communications open with GP practices and LMCs to stay informed of what work was ceasing.

It said ICBs should prepare for a ‘whole system impact’, although it was still hoping to avert the action taking place.

However, Professor Stokes-Lampard warned it may be difficult to know what impact of collective action in general practice is having.

She said: ‘I think that’s one thing we need to watch and it will be interesting to see the statistics involved for that as well. I think it’s going to be quite difficult to disentangle those statistics, because it’s so nuanced and difficult to pull out – it’s difficult to measure.’

Professor Stokes-Lampard, the former chair of the RCGP, is due to leave her NHS England role in the next months to take on a role as New Zealand’s national chief medical officer (CMO).

The BMA’s GP Committee England has sought to assure practices that any collective action would not breach their core contract, and that the ‘menu’ of potential action is ‘already permissible’.

GPs have been urged to begin some actions ahead of the ballot result, such as ceasing engagement with advice and guidance pathways, which the GPCE advised from the start of June.

BMA GPCE collective action options

Limit daily patient contacts per clinician to the UEMO recommended safe maximum of 25. Divert patients to local urgent care settings once daily maximum capacity has been reached.
Stop engaging with the e-Referral Advice & Guidance pathway – unless it is a timely and clinically helpful process for you in your professional role.
Stop supporting the system at the expense of your business and staff – serve notice on any voluntary services currently undertaken that plug local commissioning gaps.
Stop rationing referrals, investigations, and admissions
- Refer, investigate or admit your patient for specialist care when it is clinically appropriate to do so.
- Refer via eRS for two week wait (2WW) appointments, but outside of that write a professional referral letter where this is preferable. It is not contractual to use a local referral form/proforma – quote our guidance and sample wording.
Switch off GPConnect functionality to permit the entry of coding into the GP clinical record by third-party providers.
Withdraw permission for data sharing agreements which exclusively use data for secondary purposes (i.e. not direct care). Read our guidance on GP data sharing and GP data controllership.
Freeze sign-up to any new data sharing agreements or local system data sharing platforms. Read our guidance on GP data sharing and GP data controllership.
Switch off Medicines Optimisation Software embedded by the local ICB for the purposes of system financial savings and/or rationing, rather than the clinical benefit of your patients.
Practices should defer signing declarations of completion for “better digital telephony” and “simpler online requests” until further GPC England guidance. 
- Defer signing off “Better digital telephony”: do not agree yet to share your call volume data metrics with NHS England.
- Defer signing off “Simpler online requests”: do not agree yet to keep your online triage tools on throughout core practice opening hours, even when you have reached your maximum safe capacity.
- Read BMA guidance on this.
Defer making any decisions to accept local or national NHSE Pilot programmes during the proposed period of action.