OPINION: Dr Cristina Ramos of Rother Street Medical Centre explains why GPs have reluctantly taken industrial action
GPs have voted overwhelmingly in favour of taking collective action. This has been a really challenging decision for them. More than 8,500 took part in the ballot and 98.3 per cent voted to take action.
Many people will feel a sense of despair that yet another part of the NHS is taking industrial action after the many months of disruption caused by the consultant and junior doctor strikes. This has a massive impact on patient care especially the waiting times for appointments and procedures.
Health care practitioners struggle with taking industrial action. It takes a lot to push GPs to support collective action. Earlier this year they voted to reject the 2024-25 contract; despite this, the last government implemented the contract anyway. The sense of frustration and despair has continued to grow.
Demand is increasing in general practice and across the whole of healthcare. An average of 1.43 million appointments were booked per day in general practice in the year ending in June 2024. GPs delivered 44.6 per cent of those appointments. Increased demand isn’t just about the increase in the number of patients needing help, it’s also about the increased complexity of the patients we care for. People are living longer, with more complex medical problems and with more treatment options available. The potential to help people is greater, but that needs the right infrastructure and workforce to deliver the care.
In February 2020 the government committed funding to recruit an additional 6,000 GPs by 2024. The reality doesn’t reflect that. Since the end of 2019, there has been an increase of 2,523 FTE (full- time equivalent) doctors including trainees and locums. It’s not hard to see why the profession feels under pressure. GPs and patients are on the same page, we want to provide good quality, easily accessible care in practices that are fit for purpose. This has been increasingly difficult to do with the chronic under-funding of services and estates, as well as the workforce challenges.
Practices are essentially small business delivering health care in an increasingly bureaucratic system. Practices only get six per cent guaranteed funding. All the other funding requires practices to deliver different services under multiple different arrangements and contracts. Practices often deliver services that are unfunded because it supports the care they provide for their patients. For example, GPs are not contracted to do ECGs (a trace of your heart to check for an irregular heartbeat or a heart attack). Many practices do them anyway because they feel it helps with the management of patients with heart problems, but this is unfunded activity. There are many examples of this sort of activity which practices and GPs have carried because of goodwill and wanting to do the right thing. The challenge is that the chronic under-funding of the sector, combined with often very negative press coverage, has left general practice feeling a little battered and bruised.
GPs are incredibly resilient and able to adapt and adjust to constant change but there has to be a recognition that the current situation is not sustainable. In the last year alone, nearly 99 practices closed in England. This is a significant increase considering 200 closed between 2018 and 2022. Collective action is not what we want but we recognise that dialogue with the previous government brought about no change and no support. We are hopeful that the British Medical Association will be able to negotiate a quick resolution with the new government and find a way of supporting general practice to recover and grow.
In the meantime, individual practices will choose from a list of ten actions which include capping the number of patients seen by individual GPs, refusing to share patient data unless it’s in the best interests of the patient and referring patients directly to specialist care rather than following more complex NHS processes.
Patients have an important role to play in supporting their practices. Work with the partners and staff and engage with your patient participation groups , to better understand the challenges your practice is facing and which options they are choosing to implement. Patient support will strengthen the message that goes back to central government and will hopefully bring about better investment in general practice to deliver the best possible care in our communities.
