GPs put pressure on ICB with joint approach to collective action

Dorset GPs have come together to warn the ICB they will stop providing a number of services, in the first noted instance of a joint local approach to collective action.

In a letter to Dorset ICB, the local GP Alliance and Wessex LMCs laid out regional plans for collective action with the aim of allowing the ICB to ‘plan alternative provisions’ to ensure patients are not ‘adversely impacted’. 

It gave the ICB three months’ ‘advance notification’ on a series of actions planned for January, including ‘stopping all shared care areas where there is not adequate funding’, such as DMARDs, Denosumab, PSA monitoring and INRs. 

In order to ‘ease the unacceptable demands’ placed on GP practices, local leaders called on the ICB to:

• Increase practice overflow capacity immediately;
• Commission an infectious disease outbreak service and respiratory hubs within three months;
• Change/fund the basket of services and local enhanced services to realistic activity based contracts by April 2025.

Since receiving the letter in mid-September, the ICB has agreed with local GP leaders to negotiate an interim support payment for shared care areas, in order to safeguard patient care. 

Dorset GP Alliance deputy chair Dr Simone Yule told Pulse that their recent survey revealed that three quarters of local practices ‘wanted some form of collaborative collective action’. 

Despite this united approach, the local GP leaders emphasised that individual practices are ‘still free to undertake any of the actions suggested by the BMA’.

Dr Yule told Pulse that Dorset GPs are ‘focusing’ on tackling unfunded work, which aligns with the BMA’s recommendation for practices to ‘serve notice on any voluntary services that plug local commissioning gaps’. 

This work includes MGUS monitoring, shared care for ADHD medications, monitoring for bariatric surgery and for eating disorders, as well as gender dysphoria support and medications, according to Dr Yule. 

She said: ‘It’s all of those things that we’re actually pushing back on and saying we’re not going to be taking on any new patients.

‘And actually, unless we can negotiate some better funding streams, we will hand back our current patients from the 1 January. We’ve given them three months’ notice.’

Dr Yule told Pulse that collective action has ‘really made [them] focus’ on ‘what’s value for money’, claiming that there has been ‘so much mission creep from secondary care’.

‘I think we’ve got some really positive stories about how as an Alliance we’ve supported practices with collective action, which is actually bringing the ICB to the table to negotiate,’ she added.

The letter, seen by Pulse, said that neither the Alliance nor Wessex LMCs is ‘recommending that any action is or is not undertaken as that remains a practice decision’, but said they ‘have agreed to support practices in any way they can during these challenging times’. 

It continued: ‘As part of this ongoing support and discussion, we have agreed to share with NHS Dorset the collective action that Dorset Practices have deemed appropriate to undertake.

‘This is to allow NHS Dorset to plan alternative provisions where needed to ensure that patients are not adversely impacted as part of these actions. Overflow capacity would seem to be a key commissioning priority.’

The letter recognised the ‘difficult financial position that Dorset is in’ and so offered to work with the ICB to ‘help to commission the extra services in the most cost-effective manner’. 

A spokesperson for NHS Dorset ICB said they are looking to boost investment in GP practices over the winter, including via shared care agreements. 

They said: ‘We are working with general practices and representatives of our hospitals and community services to ensure that patients are able to continue to access the care that they need.

‘As part of plans for winter we are seeking to further invest in general practice services which will support access to care during this difficult time, including the provision of current shared care arrangements with other providers.’

Pulse exclusively revealed earlier this month that more than four in 10 GP practices are now limiting appointments as part of collective action, while 70% of England’s GPs are currently taking some form of action.

England’s LMC leaders will vote next week on whether the BMA should ramp up collective action based on concern that it is ‘not having enough impact’.