English hospitals brace for ‘alarming’ disruption as GPs go on strike

The NHS faces “alarming” and “dangerous” disruption until Christmas and potentially into 2025, health leaders have said, after GPs went on their first strike in 60 years amid a major dispute over funding.

Hospitals, A&E departments and mental health services are already under huge pressure. They are now being prepared for a surge in demand from thousands of patients turning to them for help after GPs in England launched a ‘work-to-rule’ campaign on Thursday.

A letter seen by the Guardian, sent to senior NHS leaders by the national director of primary care, Dr Amanda Doyle, says the NHS is preparing for a “worst-case scenario” and that 999 services could be affected.

A separate analysis found that overburdened hospitals could face a 10% increase in referrals and up to 200,000 extra patients a month if GPs stopped consulting specialists before referring patients.

Speaking to the Guardian, Matthew Taylor, the chief executive of NHS Confederation, said the strike was likely to have a significant immediate impact. “In some areas, patients may take longer to get an appointment with their GP, or they may have to go elsewhere for something that was previously provided in a GP practice.

“This will put more pressure on A&E, mental health and other frontline services, where waiting times could increase significantly. This is an alarming situation, especially after everything the NHS has been through in recent years, and one that health leaders understand GPs will not take lightly.”

In a vote held by the British Medical Association (BMA), GPs voted overwhelmingly in favour of taking industrial action in protest at the previous government which increased their budget by just 1.9% this year. More than 8,500 GPs took part, with 98.3% supporting immediate action.

The government has pledged to increase its budget to 6% for 2024-25. Health Secretary Wes Streeting also announced plans, just hours before the vote was announced, to cut red tape to allow GP practices in England to recruit more doctors.

Streeting said he wanted to build a “new relationship” with GPs. In a letter to them posted on X, he described general practice as the “heart” of the NHS but said it had been “neglected for too long”.

Taylor said the funding to recruit GPs was a helpful start, but the problems required longer-term and more far-reaching measures. “With winter approaching, the NHS faces dangerous disruption through to Christmas and into 2025 unless the BMA and government can find a way forward,” he added.

Doyle’s letter to senior NHS leaders said that every region in England should take steps to prepare for “potential impacts and risks to patients”. They should consider the possibility of disruption to emergency departments, elective treatments, mental health and community services, children and young people’s services and midwifery. There could also be short, medium and long-term impacts on 999 and 111 services, she added.

GP’s partners will choose what form of action they take from a selection of 10 measures drawn up by the BMA, the Guardian understands.

One option is to limit the number of patients GPs see per day to 25. They could choose to stop doing work for which they are not formally contracted, and could ignore the constraints of ‘rationing’ by ‘prescribing what is in the best interests of the patient’.

Hospitals could receive 10% more referrals – a “crippling” effort to clear the backlog of care built up during the Covid-19 pandemic – if GPs stop referring some of their patients for “specialist advice and guidance”, the Health Service Journal reported.

In England, an average of 200,000 referrals per month have been prevented over the past year through ‘specialist advice and guidance’, where GPs consult a specialist before making a referral, with the aim of preventing more patients from ending up on the waiting list.

The industrial action has caused Streeting a huge headache, just three days after he resolved a long-running pay dispute with junior doctors. The last time GPs took ‘industrial action’ was in 1964, when GPs collectively submitted their undated resignations to the Wilson government.

Dr Katie Bramall-Stainer, chair of the BMA GP committee, said: “We’ve had a huge response to this vote and the results are clear: GPs are at their wits’ end. This is an act of desperation. We’ve been unable to provide the care we want for too long.”

However, patient groups said the strikes were “selfish” and that GPs risked harming those who needed care and losing public support.

The Royal College of GPs said the vote showed the “strength of feeling” among GPs in England. Its chair, Prof Kamila Hawthorne, said: “No GP will want to reduce the services they provide to their patients – and it must be clear that GPs and their teams will still be working.

“But there are many aspects of what GPs deliver that go well beyond the contractual requirements they have to meet, and this additional workload and the goodwill of the GPs who deliver it have been taken for granted for too long.”

NHS England urged the public to come forward for care as usual, with practices still required to be open from 8am to 6.30pm Monday to Friday.

In a statement, Doyle praised GPs as the “bedrock of the NHS” and pledged to work with ministers to find a way to end the strike. “Our message to the public remains the same – they should continue to come forward for care during this industrial action, as GP surgeries remain open,” she said.

The NHS advises patients to call 111 for urgent medical help if their GP surgery is unavailable and, in the event of a serious or life-threatening emergency, to call 999.