The government announced pay awards worth 4.5% for doctors and a 4.75% overall uplift to NHS staff pay on 19 July 2022. The awards sparked widespread anger because they fall far short of inflation currently above the 9% mark – and because the government has refused to offer additional funding to cover the cost of the increases.
Junior doctors signalled that the awards had brought industrial action from the medical profession closer – and action is forecast to take place in spring 2023. If GPs take part, some of the forms of action the profession could take are below.
GPs could close their lists on the grounds of patient safety, which would be a perfectly legal action. It also has the advantage of lending itself to collective action and to being very effective, very swiftly.
BMA GP committee member and Doctors in Unite chair Dr Jackie Applebee said the move ‘would only take 24 hours to make an impact’.
GP contract regulations say practices can choose not to register new patients if they have ‘reasonable and non-discriminatory grounds for doing so’ – for example to safeguard the quality of patient services.
The BMA encouraged GP practices last year to close their lists in response to a government ‘support package’ for general practice that doctors said would increase workload.
Non-co-operation is another potential tool in doctors’ armoury. GPs could decline to comply with CQC inspections and decline to co-operate with appraisals.
However, these methods lack the force of collective action because they can only be deployed by practices that happen to be in line for inspection by the CQC, or by doctors who are due an appraisal.
An indicative ballot in 2021 by the BMA found that 87% of GP practices were prepared to refuse to comply with a contractual requirement for GPs to declare their income if it was over £150,000.
This requirement was suspended because of the COVID-19 pandemic, but could be brought back.
GP surgeries could opt out of PCNs. Doctors’ leaders voted earlier this year for the BMA to withdraw practices from PCNs by 2023. NHS England has rejected BMA calls for an extra opt-out window later this year – but practices will be able to pull out without breaching their contracts next April.
Another tactic used by GPs in the past is to sign undated letters of resignation. In Northern Ireland, the BMA GP committee began collecting undated letters from practices in 2016 after the collapse of the government left the profession in crisis, with no prospect of a funding rescue package that doctors’ leaders had been pushing for.