A senior NHS leader told the Guardian that strikes by GPs could have a “catastrophic” impact on emergency services, the 111 telephone advice service and mental health services.
GPs running general practices across England are set to vote on whether to cut back on the care they provide, including limiting the number of patients they see to 25 per day, in protest at the previous government’s budget increase of just 1.9% this year.
The poll of GP partners being held by the British Medical Association (BMA) closes on Monday, with the results due shortly afterwards. They are expected to vote in favour of industrial action – but not strike action – which was due to begin on Thursday.
The vote could cause another headache for Wes Streeting, the health minister, who is in talks with junior doctors to resolve their long-running pay dispute. They have gone on strike 11 times in the past 17 months, demanding a 35% pay rise.
There are deep concerns in the NHS that GPs limiting their patient contacts to 25 a day would cause significant disruption, with GPs referring more patients than usual to already overstretched hospitals as another tactic to force NHS England and ministers to rethink. It could also increase waiting times for diagnostic tests and non-urgent hospital care, NHS chiefs fear.
“If all GPs were to implement the patient cap, it could have a catastrophic effect on the whole health system,” said Matthew Taylor, chief executive of the NHS Confederation.
“GP practices are now supporting more patients than before the Covid pandemic, so any reduction in their activity will put more pressure on other services, including emergency departments.”
Primary care leaders, who wish to remain anonymous, estimate that as many as 3 million GP appointments could disappear each month if GPs continue to reduce the number of patients they see from 50 a day to just 25. nine options for industrial actions proposed to GPs by the BMA.
Other tactics GPs could employ include referring patients directly to hospital rather than continuing to treat their illnesses themselves after consulting with hospital doctors, and no longer rationing the number of people they send to hospitals for diagnostic tests or admission for specialist care. Both would increase the workload of hospitals, many of which are dealing with demand for care they normally only see in the winter, leading some to recently declare a “critical incident”.
According to senior primary care officials, strikes could lead to as many as 30% of GP visits suddenly disappearing, leaving patients with no choice but to seek care elsewhere.
NHS England wrote health bosses warned last week that a reduction in usual working practices by GPs could have “system-wide implications”, including leading to more people calling 999 or seeking help at walk-in clinics.
The BMA has advised GP partners to use the non-statutory vote to support industry action. “We need all GP contractors/partners to vote Yes to send a message to government that we are ready to stand up for a better service for our patients and to protect our practices,” it has told them.
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Dr. Katie Bramhall-StainerThe chair of the BMA’s GP committee told Streeting in a letter earlier this month that “GP practices, the most efficient and productive part of the NHS, are collapsing” due to underfunding, the closure of 2,000 practices since 2010, a continued rise in demand for care and the fact that each GP treats a patient base of more than 2,300.
In its letter, NHS England warned that a delay in GPs could lead to “short, medium and long-term changes in patient flows between and across primary care, 999, 111 and emergency treatment centres/minor injuries departments. Planning should also seek to understand potential impacts on diagnostic and elective activities.”
The “secondary effects and consequences” of GP intervention could also impact the availability of mental health services, including care for people in crisis, and lead to “potential pressure/congestion on emergency departments and the elective and discharge pathways”, it added.
Ruth Rankine, director of the NHS Confederation’s primary care network, said GPs felt general practice had been given an “unfair deal” as inflation, NHS pay fixes and the hiring of extra staff had increased their costs. They also felt hospitals had been given a favourable treatment in their finances in recent years, even though GP services handle 90% of all patient contacts with the NHS.
NHS England said: “We continue to work with GPs, the BMA and government to anticipate potential measures, but in the meantime the NHS has a duty to plan for potential disruption and ensure services continue to be delivered for patients. That’s why we continue to work with local systems to help them plan for the eventuality that collective measures do go ahead.”