GPC Collective Action
GPC England Non-Statutory Ballot Outcome: 1st August 2024
Following the third consecutive NHS England contractual imposition the BMA launched a non-statutory ballot which closed on 29th July 2024. BMA Member GP Contractors were asked to vote on the question: ‘Are you prepared to undertake one or more examples of collective action as outlines in the BMA campaign to Protect your Patients, Protect your Practice?’
98.3% of you have voted YES (1.7% voting No, with a Turnout of 67.7%)
Hear from Dr Katie Bramall-Stainer, Chair GPC England, about the ballot outcome
Next Steps for Practices undertaking collective action
There are a number of actions that practices can take to support a safe service for their patients and their practice team.
GPC England is not recommending which action(s) practices take. It is for each practice to pick and choose as they see fit and the actions you choose may depend on your patients.
You can choose to start slowly and build incrementally or do all of them from day one as you wish. You do not need permission to do any of these actions.
They are already permissible and will not result in contract breach.
The 10 options for collective action can be found here: Protect your patients, protect your GP practice (bma.org.uk).
Action is divided into Practice level, PCN level and National.
This is an opportunity for a collective professional reset, to draw a line in the sand and say 'no more'. It's not a strike, collective action is a marathon not a sprint and continues until our newly elected Government comes to the table and agrees a new contract that is safe for GP contractors / partners, their practices, and their patients.
In this recording of the BMA Roadshow held at BMA House in London on 18th July, hear directly from Dr Katie Bramall-Stainer, Chair of GPC England, about the collective action options and how these can be implemented IF NOT NOW…WHEN? Protect Your Practices, To Protect Your Patients. GPC England Officer Team Roadshow | Microsoft Teams
Communicating Collective Action to Patients: ‘GPs Are On Your Side’
The BMA recognise it is important that patients understand why GPs now fell they need to take action and have produced public facing campaign materials for their campaign – GPs are on your side. This is ready for practices to share with patients and the public
The messaging explains how the model of general practice has been broken. The materials include slides to present to your PPG, posters, social media graphics, animations for waiting room screens.
‘GPs are on Your Side’ badges, Lanyards, leaflets can be ordered for free from the BMA at BMA reps campaign materials (dotdigital-pages.com) (scroll down to the GP Materials page)
The Rebuild General Practice campaign Home | Rebuild General Practice (rebuildgp.co.uk) includes clear messaging that can be shared with patients and describes the aim of keeping patients safe and protecting the NHS by rebuilding general practice.
Resources to support Practice Actions
Action 1:
Adopt BMA Safe Working and limit daily patient contacts per clinician to the UEMO recommended safe maximum of 25.
Measurement of workload: NHSE (NHS England) measures GP workload based on appointment data. This gives an incomplete picture of GP activity and fails to reflect the huge number of non-appointment patient contacts. The BMA encourages all practices to account for patient contacts within their appointment books as a way of recording this workload. When accounting for workload, work performed in relation to repeat prescriptions and documents can be counted separately to direct patient contact. This data is not currently collected by NHSE. By doing so, it is possible for practices to better measure and account for all patient contact. This includes even brief and informal types of contact like discussions with community teams regarding specific patients, calling patients about results, and home visits.
Accurate data allows practices to make informed decisions as to how best care for their patients. It also allows GPCE to discuss workload more effectively with NHSE. For guidance on how to map all activity to ensure it is counted in the NHSE GPAD data, please refer to the following NHS England » Improving GP appointment data
The BMA guidance on how to adopt and embed the safe working guidance can be found here Safe working in general practice (bma.org.uk)
Action 2:
Stop engaging with the e-Referral Advice & Guidance pathway - unless for you it is a timely and clinically helpful process in your professional role.
Action 3:
Serve notice on any voluntary services currently undertaken that plug local commissioning gaps and stop supporting the system at the expense of your business and staff
Practices choosing to serve notice on unfunded/non contractual work can use this template letter:
Action 4:
Stop rationing referrals, investigations, 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 (2WW) 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 – the BMA has produced this guidance and sample wording focus-on-proformas-and-referral-forms.pdf (bma.org.uk)
This template letter can be used to respond to any referral rejections: Response to Patient Referral Rejection Template
Action 5:
Switch off GPConnect Update Record functionality that permits the entry of coding into the GP clinical record by third-party providers.
Practices were advised to switch off GP Connect functionality in EMIS in June. Guidance on toggling off the functionality can be found here
Action 6:
Withdraw permission for data sharing agreements that exclusively use data for secondary purposes (i.e. not direct care). Read the BMA guidance on GP data sharing and GP data controllership.
GP practices must continue to participate in the following data collections:
- The National Diabetes Audit (GMS Regulation 74B, PMS Regulation 67B)
- Information relating to indicators no longer in the Quality and Outcomes Framework (GMS Regulation 74C, PMS Regulation 67C)
- Information relating to alcohol related risk reduction and dementia diagnosis and treatment (GMS Regulation 74D, PMS Regulation 67D)
- NHS England Workforce Collections (GMS Regulation 74E, PMS Regulation 67E)
- Data relating to appointments in general practice (GMS Regulation 74H, PMS Regulation 67H)
- Data concerning use of online consultation tools and video consultations (GMS Regulation 74I, PMS Regulation 67I)
Additionally, GP Practices must continue to submit the following:
- Information relating to overseas visitors to NHS England (GMS Regulation 74F, PMS Regulation 67F)
- Information to the MHRA (Medicines and Healthcare products Regulatory Agency) Central Alerting System on request (GMS Regulation 74G, PMS Regulation 67G)
- Information to NHS England as part of the annual return and review (GMS Regulation 77, PMS Regulation 70)
Any other data sharing is non contractual and permission can be withdrawn.
Action 7:
Freeze sign-up to any new data sharing agreements or local system data sharing platforms. Read the BMA guidance on GP data sharing and GP data controllership.
Action 8:
Switch off Medicines Optimisation Software embedded by the local ICB for the purposes of system financial savings and/or rationing (rather than the clinical benefit of your patients).
In Kent & Medway, MQIPP (Medicines Quality Innovation Productivity and Prevention, the replacement for MOS) is currently being negotiated, and once published it will be for practices to make a decision about how they wish to engage.
Action 9:
Defer signing declarations of completion for “better digital telephony” and “simpler online requests” until further GPC England guidance is available.
In the meantime:
- Defer signing off ”Better digital telephony” until after October 2024: do not agree to share your call volume data metrics with NHS England.
- Defer signing off “Simpler online requests” until Spring 2025: do not agree to keep your online triage tools on throughout core practice opening hours, even when you have reached your maximum safe capacity.
Action 10:
Defer making any decisions to accept local or national NHSE Pilot programmes whilst we explore opportunities with the new Government.
A statement from the BMA about the NHSE pilot programmes can be found here
Further Resources
Interface principles & template letter to reject inappropriate transfer of work from secondary care
This document has been developed collaboratively with hospital trusts, mental health trusts, community health trust, health care partnerships and the integrated care boards and endorsed by their lead Medical Director.
The document should help clarify responsibilities for coordinating patient care and help bridge the perceived boundaries between General Practice and other providers. The principles within the document are aligned with NHS contractual responsibilities and GMC Good medical practice ‘providing good clinical care’ duties as a Doctor.
We encourage GPs to review and discuss the document within their practices and consider its application to enhance patient care. For example, ensuring practices have robust systems in place for patients to receive results requested by General Practice. Or if there are instances where GPs are asked to follow up on investigations initiated by another provider, this document can be forwarded to the respective hospital clinician as a reminder of their responsibilities.
This document is available for reference on our website alongside other useful information on the Raising concerns – Primary to Secondary Care Interface section of our website. Additionally you may find BMA document BMA duty of care when test results and drugs are ordered by secondary care of help.
Please click on link below for a quick video explaining the document and how it can be used to help coordinate patient care and address interface related issues.
These template letters can be used by practices to respond to and reject the inappropriate transfer of work from secondary care providers to general practice.
This template letter can be used by practices to respond to and reject inappropriate prescribing requests from secondary care providers to general practice
NHS England Guidance
NHS England has published a letter outlining practice’s contractual responsibilities during collective action NHS England » Collective action by GPs: supporting guidance. Our view is that the letter is helpful in confirming much of the work currently carried out by practices is unfunded and outside core contractual responsibilities and we will provide further guidance to practices on how to respond to any requests for assurance they may receive.
GPC England's response to NHS England paper: Potential Collective Action by GPs supporting guidance