Pulse summarises May’s talking points – what does a general election mean for general practice, and what industrial action will the BMA partner ballot lead to
What does the election mean for general practice?
It was like something from a rom-com: the pouring rain; his finest suit; and asking people to just give him a chance. Replacing a schmaltzy soundtrack were the muffled cries of protestors and D:Ream’s ‘Things Can Only Get Better.’ Of course it was no rom-com; instead Rishi Sunak’s announcement that we are going to the polls on 4 July.
It has been a long time coming: years of damaging policies, underfunding and a global pandemic have brought the NHS – and general practice – to its knees. In the past 14 years the profession has had to address and adapt to: an ageing population with increasingly complex health problems; careening from a recruitment crisis to an employment one; being the workload dumping ground of the NHS; and huge numbers of practices closing just to name a few.
Things need to change to achieve a sustainable long-term future for general practice. But it isn’t clear what a Labour or Conservative government might do to ensure protection for the profession. Official manifestos have yet to be released, but we can look back at what both sides have previously said to gauge a direction.
Unless there is an upset of seismic proportions, we’ll have a Labour government for the next five years. The shadow health secretary has a history of clashing with GPs. In 2022, Wes Streeting criticised a ‘something for nothing’ culture in general practice, failing to recognise the workload GPs carried out, a lot of the time beyond their contractual remit. He also promised continuity of care, self-referring to specialist services, and cutting two-week wait appointments to see a GP. At the time, the BMA called his plans ‘divisive’ and ‘disappointing, pointing out that Streeting was failing to recognise the efforts of the workforce and not seeking solutions grounded in reality.
Last year, he said he would abolish the GP partnership model, opting for a salaried service instead. He did retract the statement, saying that he did recognise the value of the current model, but it showed a fundamental lack of understanding for the structure and organisation of primary care – a worrying prospect if we are to assume he will be heading up the DHSC soon.
In terms of funding, earlier this week Rachel Reeves, shadow chancellor, introduced a fiscal lock to ‘bring economic security back to family finances by empowering the Office of Budget Responsibility (OBR).’ Committing to this, as well as labelling themselves as the party of ‘economic stability’, means that they will not be able to increase public spending upon entering office. Streeting compounded this in an LBC interview: when asked if he would give the NHS more funding, he said insinuating that ‘it would take some time’ for Labour to turn around the damage the Conservatives wreaked on the NHS – implying that any immediate NHS funding will have to come from cuts of other areas. Last year, he did say that ‘any available funding‘ in a Labour government would go to GPs over hospitals, and that over time he would shift more money over to primary care.
As for the Conservatives, the first point to make is LOOK AT THE CURRENT STATE OF GENERAL PRACTICE AND THE NHS. But for a more detailed analysis, a very optimistic reading of their policies is that the recent re-delegation of fit notes with the WorkWell pilots does in theory ease GP workload. But it is obvious that general practice was not the motivation for the reform. And its attempts to focus on the biggest issue in general practice in the past 14 years – the recruitment crisis, almost entirely of its own making – led to the long-term workforce plan last year. Recognising the drastic shortfall of FTE GPs, the plan laid out more medical school places and training positions. However, a Pulse analysis poked holes in the aims, pointing out that there was no: forecasting or commitment to increase training capacity; no plan to address the shortage of trainers; nor the lack of infrastructure to name a few.
There has been little said about what would be done for general practice if the Conservatives were re-elected. In a recent op-ed for Pulse, primary care minister Andrea Leadsom said she was committed to reducing admin and streamlining finances. GPCE chair Dr Katie Bramall-Stainer responded to Leadsom after the BMA was accused of misrepresenting the GP 2024/25 contract changes as final. Dr Bramall-Stainer said that the 1.9% uplift – even if not the final figure pending DDRB – was insufficient due to the way that general practices operate. She warned that it could result in practices having to hand contracts back. Leadsom did announce that she was calling a Taskforce on the Future of General Practice over the Spring and Summer, but this seems doubly redundant now given that A) we have an early election, and B) Leadsom has since announced she is standing down as an MP anyway.
There’s only one thing for certain and it has already been said: On 5 July, either Rishi Sunak or Keir Starmer will be prime minister, and GPs won’t exactly be excited either way.
What kind of industrial action will GPs be taking?
It’s a date! Not just the election, but also potential GP collective action, which will start on 1 August according to the BMA.
It has been a long journey to get to this point. One could argue it has been years in the making: in 2001 the BMA threatened a walkout over excessive workloads; there was (unsuccessful) doctor-wide walkouts in 2012 over pension reform; in 2016 GPs voted in favour of industrial action over an ‘inadequate’ rescue package. And that’s only this side of the 21st century…
This iteration of collective action talks started in March, when 99% of GPs voted ‘no’ in a BMA referendum: ‘Do you accept the 2024/25 GMS contract for general practice from Government and NHS England?’ Though not a formal trade union ballot, the ‘temperature check’ of the profession set the wheels in motion for considering further steps with the offered 1.9% funding uplift deemed insulting and insufficient by many. The BMA then released a proposed timeline, with any action originally proposed to begin in November. Though this date has now been brought forward by a few months, it was done so before the general election was announced, and GPCE chair Dr Katie Bramall-Stainer said that early election did not change their new timeline. In April, the GPCE confirmed it was ‘in dispute’ with NHS England.
And now we are at the ballot stage. From Monday 17 June to Monday 29 July there will be an online ballot for GP partners on industrial action. Dr Bramall-Stainer has said that the ‘non-statutory’ ballot will draft a menu of potential actions that could be taken – none of which will go against GP contracts. Depending on the outcome of the results, action will then commence three days later on the Thursday. The union will also be doing a series of roadshows in June across 10 regions in England for GPs to discuss the ballot and means of collective action.
We know, and have known for a while, that industrial action will not see surgeries close their doors to patients – even though some may think that any action less than this does nothing for the cause. But what will it actually consist of?
Though nothing has been publicly stated, a slide shared with delegates at a contract webinar in March suggested measures regarding: how GPs refer via e-Rs; engagement levels with A&G; switching off data-sharing agreements; giving a notice on all shared care agreements, citing no capacity to deliver; only see 25 patients a day and give them a ‘platinum level’ service; and no proformas.
At present, the BMA has hinted that some measures of collective action might include stopping fit notes, prescriptions or investigations ‘which should have taken place in the hospital setting.’ The fit note point is an interesting one – it is something that GPs are already prepared to do less of since the proposed welfare reforms. The WorkWell pilot has only been launched in 15 out of 42 ICBs, so stopping fit notes would still have a material impact and make a sufficient statement. Refusing to issue prescriptions on behalf of others (community services, ARRS staff, secondary care), as well as halting work on investigations that should have happened in hospitals would simultaneously relieve the burden of workload dump, and show how the value of the work that GPs already provide beyond their contracts.
Something that will be important is getting the public onside – or at least not completely alienating them. Since March, Dr Bramall-Stainer has reiterated how icing out patients will do nothing to serve GPs’ cause. The GPCE has mentioned it will produce public-facing campaign materials alongside collective action. Using these, and the miserly 1.9% uplift as a PR tool, the public might get behind collective action, making politicians more likely to sit up and take notice. Maybe that’s overly-optimistic but one can dream…
