GPs could cap appointments in work-to-rule

GPs across England will start capping the number of patients they are willing to see, after the British Medical Association (BMA) announced an immediate work-to-rule action.

The BMA has told its members they can limit appointments to 25 a day – some GPs see more than 40 at times – in a dispute over funding levels.

In a ballot, 98% of GP members backed taking action, with the union saying a lack of funding is putting practices at risk.

NHS England has warned the action could cause significant disruption beyond just GP services.

In a letter to senior NHS managers last month it said this could include increasing pressure and waits in A&E, slowing down the discharge of patients to hospital, and disrupting referrals into hospital for planned treatments, like hip and knee operations.

It warned that, as with other disputes, “maintaining services for patients with urgent needs, such as deteriorating conditions” was key.

But NHS England national director for primary care Dr Amanda Doyle said if a patient needs to see a GP they should “continue to come forward for care as practices will remain open”.

The BMA is suggesting a range of different actions could be taken by GPs, but it will be up to GPs themselves to decide what they want to do.

One option is to limit the number of patients they see to 25 a day – which the BMA deems to be the safe level. If every GP stuck to that it would reduce the number of appointments by a third, but it is unclear how many will follow the work-to-rule.

Not all GPs are BMA members and turnout in the ballot was just under 70%. The BMA said the impact is likely to be a “slow burn” rather than a “big bang”.

GPs could also refuse to carry out tests and assessments for hospitals pre or post-treatment, and could ignore guidelines on rationing treatments that are put in place to allow the NHS to prioritise the most in-need patients.

The BMA believes none of this action will put GPs in breach of their contract. GP practices are essentially independent businesses, so they are paid a lump sum by the NHS to deliver care and therefore are not directly employed.

BMA GP leader Dr Katie Bramall-Stainer said: “GPs are at the end of their tether. This is an act of desperation. For too long, we’ve been unable to provide the care we want to.

“We’re witnessing general practice being broken. The era of the family doctor has been wiped out by consecutive governments and our patients are suffering as a result.”

The action being taken does not count as formal industrial action and therefore the union can carry on with the work-to-rule indefinitely.

Louise Ansari, chief executive of patient watchdog Healthwatch England, said she was worried about the action, given the difficulties patients already face getting access to GPs.

“Without proactive communications to patients, the work-to-rule action could exacerbate access problems or even deter people from seeking help altogether.

“Patient safety must be paramount. We strongly urge all GP practices to inform their patients if and when they are taking part in the action and where to go for alternative help.

“Ultimately, it’s essential that the BMA and NHS England work with urgency to resolve the GP contract dispute.”

Health Secretary Wes Streeting expressed disappointment too. “I can totally understand why GPs would want to punish the previous Conservative government, but this action, if it goes ahead, will only punish patients.

“The Conservatives already got their kicking at the general election and we now have a Labour government that’s really committed to working with GPs to rebuild general practice so that people can get a GP appointment when they need one.”