GP locums and registrars must take part in collective action for it to be as effective as possible, the BMA has said in recent guidance.
It is ‘imperative’ that GP partners who decide to take collective action encourage locum GPs and registrars to take part in the same action, the guidance said.
Collective actions that practices can take include declining non-contractual work, refusing to engage in advice and guidance, limiting patient contacts to 25-a-day per GP and declining to sign new contracts with NHS England or the local ICB.
The BMA guidance for GP locums said: ‘For collective action to be effective, it is imperative that contractors or partners who participate in collective action invite locum GPs to participate in the same action, as the actions will be most effective when the changes to working are adopted by the entire clinical team, including sessional GPs.
‘You should not see any increase in your workload as a result of collective action nor expect any change in remuneration. General practice must be united to make change.
‘If the practice in which you are engaged decides to undertake any of the actions, they may suggest changes to your terms of engagement, for example instituting safe working principles such as 15 minutes appointments and a maximum of 25 consultations per day.’
Locum GPs should discuss with the practice what action they are taking and the expectations of the practice for the anticipated duration of collective action, it added.
They should ensure that they have ‘clear cancellation terms and timeframes’ within their contract, to ensure that they are not unduly affected if faced with a short notice cancellation.
The union also said that it is ‘important’ for GP registrars to feel able to be engaged in and supportive of collective action and this can be achieved by practices making ‘concerted’ efforts to include all practice staff in conversations about the campaign, aims and desired outcomes.
The guidance for GP registrars pointed out that if the collective action that GP partners take ‘significantly change ways of working’ at the practice, this should be clearly communicated to registrars, preferably in writing.
‘The changes made to how you work and the anticipated duration of these changes should be clearly explained, preferably in writing, to ensure shared understanding and clarity,’ the BMA added.
It also added that GP registrars must follow the ‘reasonable instructions’ of their practice during collective action in order to avoid being in breach of their contract.
Collective action options likely to involve GP registrars
- Limit daily patient contacts per clinician to the internationally 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
- See patients face to face as a default, unless there is a compelling reason not to do so
- Stop rationing referrals 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 appointments, but outside of that write a professional referral letter in place of any locally imposed proformas or referral forms where this is preferable. It is not contractual to use a local referral form/proforma – quote our guidance and sample wording
- Stop rationing investigations – refer your patient for specialist diagnostic investigations when it is clinically appropriate to do so
- Stop unsafe risk-holding to protect the system over the patient – admit your patient to the local Emergency Department when it is clinically appropriate to do so via a written referral letter to the admitting team
Source: BMA
Collective action began on 1 August after GP partners voted in favour of taking action in protest against contractual terms and funding.
Two weeks in, Pulse exclusively revealed that almost half of England’s GP practices are already taking some form of collective action, with the most popular option being limiting the number of daily patient contacts.
After the BMA announced the results of its non-statutory ballot, which saw 98.3% of GP partners voting in favour of taking collective action, NHS England said that ICBs should make sure that practices are continuing to meet contractual requirements during the action.
Health secretary Wes Streeting recently asked GPs to stand down collective action, as he said that it is ‘in no doubt shutting the door on patients’ and that their care ‘will suffer’.
And some GP practices have refused to complete this years’ NHS England staff survey as part of collective action.
I am not sure exactly how Registrars fare, but as a locum, I think there is very little that I could do to go against the control the Partners have to limit my patient contact numbers, non-contractual (GMS) work, and use of Referral/A&G routes.
I would be happy to support my Partner colleagues by following any instructions they give about the ‘collective actions’ while I am engaged by them, but there is really very little control I have over functions of the Admin team and IT at practices.
It would be more of a showing of moral support vicariously, I think.
Too little, too late? And to be honest given how hard it is to get any sort of appointment with any flavour of health care professional” at GP surgeries these days will the general public notice this 40% collective action?. To be honest its pointless and it’s come at the wrong time why start now given the recent change of government? There lies the answer the problem has been and still is with the political flavour of the GP leadership. 14 years ago Annual LMC’s representative’s committee voted virtually unanimously for industrial action and the motion was passed. GPC at time took the vote under advisement and decided instead to work “constructively” with their Tory friends in government to get a “far better deal” working behind the scenes. Well that worked well didn’t it? BMA’s GPC are to blame for the current dire state of General Practice as a result of their back room deals during the Tory years.