GPs in several areas serve collective notice to ICBs on ‘unfunded work’

GPs in several areas are coming together to serve notice to their ICBs on ‘unfunded work’ as part of collective action. 

ICBs across the country have been warned that, unless funding improves, GPs will withdraw various services and shared care arrangements, including PSA monitoring, phlebotomy, ring pessaries and ECGs.

LMC leaders told Pulse that serving notice in a collective way has had some success, with one ICB agreeing to conduct a full review of all local enhanced services before the next financial year. 

Gloucestershire LMC told Pulse that of their 64 practices, almost 90% have served notice on ring pessaries from 1 February 2025, while 82% have served notice on MGUS and CLL monitoring from 1 March. 

The LMC coordinated this action by balloting practices to gauge appetite, and decided to focus on these services because they had been raised with Gloucestershire ICB prior to collective action but had been ‘sitting on the table’ with no progress.

LMC member Dr Rachel Rutter said: ‘The ICB are in agreement that the work is unfunded and we are hoping to progress discussions towards an agreed [enhanced service] for both pieces of work which we feel sit most appropriately within general practice in terms of ease of access for patients and efficiency, but which clearly need resourcing to enable GPs to provide the appropriate quality of care and monitoring.’

Meanwhile in North Yorkshire and York, around 50 local practices (65%) have given notice on one or more enhanced service, with a variety of notice periods. 

North Yorkshire LMC chair Dr Sally Tyrer told Pulse: ‘Many practices (40+) have given notice on several enhanced services simultaneously. Several practices have given notice on all their enhanced services which is in excess of 10.’

Practices have ‘worked together in their specific localities’ which has ‘helped them gain confidence’ to take this form of collective action, according to Dr Tyrer. 

The services involved included anticoagulation, ring pessaries, minor injuries, spirometry, Mirena coil for non-contraceptive purposes, DVT management, among others. 

Dr Tyrer said this approach to collective action, which has been ‘replicated’ across Humberside, has elicited a response from Humber and North Yorkshire (HNY) ICB.

Since practices served notice, the ICB offered – and GPs accepted – a ‘financial interim offer’ with a request to extend notice periods to 31 March 2025, which was ‘essentially to buy time to review the situation’, Dr Tyrer told Pulse. 

She said the ICB has also agreed to ‘rapidly conduct an ICB-wide full LES review’ with a view to this being completed and new enhanced service offers in place by April this year. 

In Bath, North East Somerset, Swindon and Wiltshire (BSW), around two thirds of local GP practices signed up to serve notice from 1 April on ‘any non-commissioned unfunded services’, according to the LMC. 

LMC vice-chair Dr Julia Gregg said that BMA collective action ‘coincided with a LES review across the whole patch’, and she suggested that the ICB’s ‘insulting’ findings encouraged GPs to get on board with action.

Speaking at the England LMCs conference at the end of November, Dr Gregg said: ‘The ICB were meant to be doing a levelling up process, but lo and behold, it wasn’t. 

‘It was, quite frankly insulting – trying to give us block contracts for things that were basically going to make it just non-viable to go ahead with these services. So that really got everybody sort of standing up and listening.’

Dr Gregg said the LMC ‘felt really strongly’ that it needed to ‘be taking some leadership with collective action locally’, despite not being a trade union. 

She continued: ‘So we instructed our medical director and the staff to be coordinating responses across the area, to be gathering information about what people wanted to be doing.

‘And lo and behold, we managed to get probably about two thirds of our area so far to sign up to send letters to the ICB to say they’re serving notice from the 1 April on any non-commissioned unfunded services, things like ECGs, phlebotomy, basic things like that.’

The ICB started ‘listening within two weeks’, Dr Gregg said, with the chief executive agreeing to attend the LMC’s next meeting. 

In response, the ICB told Pulse that it has ‘successfully engaged’ with all PCNs and is ‘currently finalizing [their] joint commissioning intentions’.

A spokesperson continued: ‘A follow-up meeting with our GPs is scheduled to confirm the final position, and we are confident that all concerns raised in the letters will be fully addressed, with comprehensive mitigation plans in place to ensure continuity of care for our population.’

The BMA’s menu of nine actions advises practices to ‘serve notice on any voluntary services’ which ‘plug local commissioning gaps’ and to ‘stop supporting the system at the expense of your business and staff’.

GP Committee England chair Dr Katie Bramall-Stainer said they ‘fully support the coordination of collective action by LMCs and the sharing of best practices’.

She continued: ‘This action highlights that practices cannot continue undertaking work that is un-resourced. Sufficient funding is crucial for delivering more effective services and ensuring safer and high-quality patient care by the surgery team.

‘The BMA has enhanced its guidance on individual actions, providing a range of template letters to support and empower practices in taking collective action.’

In response to local action from practices, a spokesperson for NHS Humber and North Yorkshire said: ‘The ICB is working collaboratively with LMCs to mitigate the impact of collective action on patients, which includes extending notice periods.

‘We will continue to work with LMCs to address other challenges faced by general practice.’

Hertfordshire and West Essex ICB confirmed that the LMC had ‘notified’ them of their approach, which ‘advised practices to serve three months’ notice to the ICB to allow sufficient time’ to agree ‘alternative arrangements for affected patients’.

A spokesperson continued: ‘The safety and wellbeing of our patients is of paramount importance and we are working with local hospital trusts and our cancer clinical leads to establish an alternative approach to ensure patients diagnosed with cancer have appropriate blood monitoring as outlined in national and local guidance.’

Pulse has also approached Gloucestershire ICB for comment. 

In November, Pulse reported on the collective approach of Dorset GPs, who came together to warn the ICB they will stop providing a number of services due to inadequate funding.

LMC leaders in several areas have also asked GPs to pull out of shared-care agreements for ADHD as part of collective action. 

At the LMC conference in November, local GP leaders called on the BMA to ballot the GP profession on taking ‘more significant’ industrial action.