ICBs estimate average £2m cost of GP collective action

Exclusive GP collective action has been estimated to cost on average £2m to each ICB, according to new data gathered by Pulse.

An FOI requests to all 42 ICBs revealed that collective action by GPs is expected to impact prescribing costs, as well as creating commissioning gaps where practices have decided to serve notice on underfunded services.

This follows five months of GP collective action during which practices have been able to choose from a list of nine options recommended by the BMA.

As revealed by Pulse, collective actions that practices can take include declining non-contractual work, switching off medicine optimisation software, refusing to engage in advice and guidance and limiting patient contacts to 25 a day per GP.

The FOI data showed that on average ICBs are reporting that collective action is expected to cost £2m. Out of 10 ICBs who said they had identified risks and possible financial impact, six ICBs have disclosed specific costs related to prescribing, practices refusing to engage in advice and guidance, and commissioning gaps, for a total of £12.2m.

But the overall national financial impact is likely to be much higher, as 19 ICBs declared they had not yet carried out a specific financial assessment, and the remaining ICBs said that they had not found any quantifiable financial impact of the action, or that it was difficult to determine at this stage (see box).

On prescribing costs, Staffordshire ICB calculated that the loss of savings in relation to GP prescribing are estimated to be in the region of £2.1m for 2024/25.

The ICB said: ‘This is in relation to cost improvement programmes whereby an external healthcare company would deploy clinical pharmacists to assist GP practices in making cost reducing drug switches.

‘However, through lack of GP participation as a result of the collective action these programmes were postponed.’

In Gloucestershire, the ICB estimated that GP collective action could cost around £4.6m, including ‘significant’ financial risks to prescribing savings (£1.1m) and costs related to GPs stopping advice and guidance (£3.5m).

Buckinghamshire, Oxfordshire and Berkshire West ICB also reported a shortfall of £3.6m specifically in prescribing savings, ‘primarily attributed to the potential impacts of GP industrial action’.

Pulse previously revealed that a Berks, Bucks & Oxon LMCs survey of practices showed that 94.1% of practices in the area are ‘engaging in some form of collective action’.  

Practices have taken action serving notice on any underfunded services, which has produced a financial impact in some areas, including Humber and Yorkshire, where both local ICBs said they had to provide an extra £1.6m to mitigate against practices servicing notice on LESs.

Frimley ICB also identified commissioning gaps created by practices serving notice on any voluntary services currently undertaken.

‘It is estimated that resolving this commissioning gap will cost £0.3m per annum, with an in-year cost of £95k anticipated for 2024/25,’ it added.

The most popular action put in place by practices has been limiting patient contacts, with more than four in 10 GP surgeries in England taking this action as of September last year.

As a result of this, in Coventry and Warwickshire, the ICB predicted a potential reduction of between 19% (47,000) and 26% (72,000) appointments per month due to collective action.

It said that if 10% of these are diverted to secondary care, it could mean between 235 and 360 additional attendances per working day and that this could cause ‘a building impact’.

Bristol, North Somerset and South Gloucestershire ICB said that there are ‘significant financial risks’ related to GP collective action, which could bring impact in the future, including:

• Additional costs in community, mental health and secondary care related to increased activity
• Additional costs to increase capacity in urgent care services should it be needed
• Expected medicines optimisation savings not being realised
• Additional expenditure on newly commissioned or extended services in primary care to provide activity practices have ceased, or plan to cease if not funded

The BMA said that while the ‘ultimate’ financial impact of GP collective action is currently not known, action by practices has prompted actual or proposed funding uplifts for a combined total of nearly £1.37bn.

A spokesperson told Pulse: ‘While we don’t know the ultimate financial impact of collective action, we do know that it has prompted actual or proposed funding uplifts for 2024/25 and 2025/26 of a combined total of nearly £1.37bn.

‘This is over five times more than the previous government invested in April 2024, which will be the first step on the journey to restoring general practice services to the levels patients deserve within this Parliament.’

A Department of Health and Social Care spokesperson said: ‘GP services are buckling after years of neglect but through our Plan for Change we will fix the NHS’s front door and shift the focus of healthcare from hospital to community.

‘We are hiring an extra 1,000 GPs, so patients can get the care they need, and have proposed the biggest boost to GP funding in years – an extra £889m.’  

NHS England has declined to comment on this data.

Collective action began on 1 August last year after GP partners voted in favour of taking action in protest against contractual terms and funding.

At the LMC conference in November, local GP leaders called on the BMA to ballot the GP profession on taking ‘more significant’ industrial action. This will be discussed at a special LMC conference next month.