The Guardian view on GPs working to power: GPs need bigger budgets | Editorial
TThe impact of industrial action by GPs will not be as tangible or as obvious as that of strikes by junior doctors. Hospital data is collected centrally, so any increase in waiting lists or cancellations is quickly known. Information from primary care is not collected in the same way. But there is no doubt that limiting appointments to 25 a day – as some GPs will do after this week’s vote – will lead to a reduction in access to healthcare. With the NHS already under enormous pressure, people who rely on their GPs for support will rightly be anxious.
However, it was general practitioners who provided care together more than 25 million appointments in England in December (figures for Northern Ireland, Scotland and Wales are collected separately), clearly feel they have no choice but to force ministers. This is not about pay, as is the dispute with junior doctors. The GPs’ complaint is that the overall funding allocated to primary care by the previous government is insufficient. More than 98% of the 8,500 GPs who took part in the vote voted in favour, on the grounds that this year’s 1.9% budget increase is not enough.
On this point, the GPs are right. Primary care receives less than 10% of the total NHS budget in England, and a similar percentage in the other UK countries. But while the total NHS budget has increased in recent years – although not by enough to cope with inflation and demographic change – the percentage of spending on primary care in England has has shrunk by more than two percentage points in less than a decade. Repeated promises by the previous government to increase the number of GPs have been broken. Instead, the numbers have have fallen – from 29,364 full-time equivalents in 2015 to 27,670 in June this year.
In light of these facts and figures, and others including the rising number of physical threats and attacks on local practices, it is no wonder that frustration has boiled over. A decision on Wednesday to relaxation of budget rules to enable busy practices to take on more doctors came too late to make any difference.
There is no single template that GPs who are restricting their work this week will adopt. The British Medical Association has suggested a range of options for them to choose from. As some of these involve software and data sharing, patients may be relatively isolated.
But whatever the impact on the frontline – which is likely to be a rise in the number of people seeking treatment in A&E departments – this year’s budget is unlikely to change. If the GP strike does manage to have an effect on policy, it is more likely to do so by influencing parts of the NHS review that Wes Streeting, the Health Secretary, has commissioned from Prof Ara Darzi, due to report in September, and in the government’s spending announcements in the October budget.
Mr Streeting has already indicated that he intends to change the balance of NHS resources in favour of primary care. Most health policy experts believe this is the right course, given the importance of prevention in areas from diet to ageing and the growing burden of chronic disease. But the size of the overall NHS budget is also a point of contention, and one that GPs are right to worry about, given the government’s emphasis on fiscal restraint. This strike is an indictment of years of broken promises and a sign of desperation.