GPs threaten to cap number of patients they see every day (2024)

GPs have threatened to bring the NHS to a “standstill” by capping the number of patients they see every day.

Family doctors across England are being balloted by the British Medical Association (BMA) on whether they are in favour of staging collective action amid a row over the new contract for GP services in England. It would be the first mass action from GPs in six decades.

The result is expected anytime from Monday afternoon after the ballot closes at midday. If, as expected, BMA members support collective action GPs may limit the number of patients they will see each day to 25. The Department of Health and Social Care said it is planning “for all contingencies”.

Many GPs have said they now have more than 40 or 50 patient contacts a day as demand soars. There were 2,294 patients per GP as of April 2024, an increase of 7.2 per cent since 2019, according to the latest figures from the Royal College of GPs.

Other action could include choosing to stop performing work GPs are not formally contracted to do, and they could potentially ignore “rationing” restrictions by “prescribing whatever is in the patient’s best interest”.

One of the country’s top GPs said the move could bring the NHS to a “standstill very quickly”. Any further disruption to primary care is likely to have a knock-on effect on secondary care with more people expected to turn up to hospitals if it becomes even harder to see a GP, according to NHS England.

Medics, however, have said they do not want to make patients a “piggy in the middle” and are directing the action at NHS England and the health department. Any action they take could begin as early as Thursday.

It will be another key political test for Health Secretary Wes Streeting, who met union leaders on 18 July, as he continues negotiations with junior doctors in England over a pay deal. Labour has also promised to reform the primary care system due to the difficulties people have in seeing a GP.

GPs have not staged collective action since 1964 when family doctors collectively handed in undated resignations to the Wilson government, leading to reform including the Family Doctor Charter of 1965. In June 2012, GPs in Englandrefused all non-urgent care for a day to protest against the government’s planned shake-up of their pensions.

Dr Katie Bramall-Stainer, chairwoman of the BMA’s England General Practitioners Committee, said she aspires to talk to the current Government about a Family Doctor Charter 2025 – 60 years on from the original.

“We have moved on so much since then, but I think we need to again agree a set of principles if you want the NHS to be free at the point of use, universal to all, funded through central taxation,” she said. “In a free at the point of use service, you have got to have a really effective, emboldened, resourced gatekeeper. And your gatekeeper is the GP.

“The GP model is why the NHS has lasted as long as it has done and when you try and break the GP model, you break the gatekeeper, and when you break the gatekeeper, you break the NHS. I think that is what we’re seeing on a macro level.”

On the industrial action, she said: “We’re not going on strike. This is collective, premeditated, disruptive action. It is industrial action, but the target isn’t patients. The target is NHS England, department of health.”

Dr Bramall-Stainer said: “If it’s done effectively, it’s done collectively and it’s done well, it will bring the NHS to a standstill very quickly.”

The BMA has said the new GP service contract, which will see services given a 1.9 per cent funding increase for 2024-25, means many surgeries will struggle to stay financially viable. GPs launched a formal dispute over the issue in April after a referendum carried out by the union found 99 per cent of 19,000 GPs rejected the contract.

Dr Bramall-Stainer added said there appears to be a “desire to break general practice”, adding there have been “three successive contracts impositions over the past three years”.

If the ballot is successful then GPs have a suite of measures which they can deploy as part of the action, including disregarding “rationing” restrictions put in place by local NHS bodies.

“We’re just going to ignore the ‘computer says no’ mentality,” she said. “All the time systems are asking GPs to be the rationer, to be the gatekeeper to finance, not just the gatekeeper to activity. Actually we are going to prescribe whatever is in the patient’s best interest.”

GPs may also opt-out of local data-sharing agreements which are not needed for direct patient care.

Integrated care boards and trusts have been told to develop plans to deal with the potential “whole system” impact of their industrial action, with NHS England asking health leaders to mitigate “risks to patients”.

It said in a letter last week: “It remains our hope that action will be averted. However, whilst discussions take place it is important we plan for all contingencies to keep patients safe – as we have in other periods of industrial action.”

But Dr Bramall-Stainer insisted “patients won’t come to harm from this”.

She said: “We don’t want to put patients as piggy in the middle – we live in our communities with our patients, there are no barriers between us.

“We get a lot of the flak from the failings of the NHS and we agree with our patients and it’s quite exhausting. The last thing we want to do is pitch patients against us. I don’t think patients will really notice very much difference at all. And that’s the plan.”

She said the union has some “cost-neutral solutions and suggestions that can make a big difference” to the working lives of GPs around England.

One such solution could be giving GP surgeries the freedom to use a staff funding pot to employ more GPs and additional practice nurses. The Additional Roles Reimbursem*nt Scheme is a £1.4bn fund designed to boost GP practice staff including physician associates and pharmacists, but not GPs or practice nurses.

Others could include tailoring incentive schemes including those aimed at boosting childhood vaccination rates and reinstating the amount practices are paid per vaccination for delivering Covid-19 jabs.

Earlier this month Dr Bramall-Stainer set out a number of asks of the Government, including the new Family Doctor Charter; a “minimum investment standard” for general practice; an ask to build “real-terms reinvestment into general practice”; and a call for “GP-to-patient list size ratios”.

Mr Streeting’s first official visit in his new role was to a London GP surgery on 8 July, where he pledged to “bring back the family doctor” and “fix the front door to the NHS”.

A Department of Health and Social Care spokesperson said: “The Health and Social Care Secretary has met with the chair of the BMA’s GP committee to discuss their priorities ahead of their ballot closing on 29 July. However, it is important we plan for all contingencies, in every eventuality, to keep patients safe”.