The ballot is now open and will close on 29 July.
Read our full guidance on taking part in the ballot here.
We need all GP contractors/partners to vote YES to send a message to the Government that we are ready to stand up for a better service for our patients, and to protect our practices. Download our 'Every vote counts' graphic and promote the ballot to your network on social media.
If you're a non-GP Partner working within a GMS or PMS GP practice, show your support by signing our form.
The ballot is taking place online and eligible members will have received an email from [email protected]. Your link to vote is unique and should not be forwarded as it can only be used once. Please note that the deadline has passed for requesting replacement ballots.
Disputing the 2024/25 GP contract changes
Developments
Katie Bramall-Stainer has written to the new Secretary of State detailing how he can work together with GPs to rebuild general practice in England. We intend to develop a constructive relationship with the new government, but will remain organised to ensure GPs can secure the contract that patients and staff deserve.
We have now published our vision for the future of general practice in England and shared this with the Secretary of State.
What will action by GPs look like?
If our ballot is successful, we will be inviting GP contactors/partner BMA members to determine the actions they will be willing to take. They should enact these actions across the whole practice team working with their practice managers. LMCs will also be vital in supporting practices and advising on the locally commissioned services and ICB asks which are not supporting the sustainability of local GP practices . Each of these actions is outlined below in our GP practice survival toolkit.
GP practice survival toolkit
Below are ten actions for practices to choose from. The actions you choose may depend on your patients, your local contracts and your LMC’s feedback. 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.
- Limit daily patient contacts per clinician to the UEMO recommended safe maximum of 25.Divert patients to local urgent care settings once daily maximum capacity has been reached.
- Stop engaging with the e-Referral Advice & Guidance pathway - unless it is a timely and clinically helpful process for you in your professional role.
- Stop supporting the system at the expense of your business and staff - serve notice on any voluntary services currently undertaken that plug local commissioning gaps.
- 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 – quote our guidance and sample wording - Switch off GPConnect Update Record functionality to permit the entry of coding into the GP clinical record by third-party providers.
- Withdraw permission for data sharing agreements which exclusively use data for secondary purposes (i.e. not direct care). Read our guidance on GP data sharing and GP data controllership.
- Freeze sign-up to any new data sharing agreements or local system data sharing platforms. Read our guidance on GP data sharing and GP data controllership.
- 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.
- Practices should defer signing declarations of completion for “better digital telephony” and “simpler online requests” until further GPC England guidance.
- Defer signing off ”Better digital telephony”: do not agree yet to share your call volume data metrics with NHS England.
- Defer signing off “Simpler online requests”: do not agree yet to keep your online triage tools on throughout core practice opening hours, even when you have reached your maximum safe capacity.
- Read our guidance on this -
Defer making any decisions to accept local or national NHSE Pilot programmes during the proposed period of action.
Choose which action to take
GPC England is not recommending which action(s) practices take. It is for each practice to pick and choose as they see fit. You may decide to add to your choices over the days, weeks, and months ahead. This is a marathon, not a sprint.
Some of these actions can be permanent changes – professional, collective and a single opportunity to embrace sustainable and safe change. Others may be de-escalated following negotiations with the new Government.
Will any of these actions potentially result in a breach notice to my practice?
GPCE is not currently calling on GP contractors / partners to take any action that will place GP contractors in breach of their contract. Therefore, GPCE does not expect participating practices to be issued with breach notices.
This is instead an opportunity for a collective professional reset, to draw a line in the sand and say 'no more'. It's not a strike, it's not a crash diet - this is more a lifestyle modification. It's going to continue this way; it's not just for the summer. It is until the next Government comes to the table and agrees a new contract that is safe for GP contractors / partners, their practices, and their patients.
Patient information campaign: GPs are on your side
You can also download campaign materials to display to patients here.
Our asks of Government will be summarised in our vision document ‘Safety, Stability & Hope: How to Rebuild General Practice' being launched at the BMA House roadshow on Thursday 18 July.
The outcome of this ballot will inform our collective next steps. The BMA will direct practices to choose one or more suggested actions from the menu listed on this page above from 1 August 2024. Please note, this menu of suggested actions is subject to revision..
In the meantime, members are strongly encouraged to review the BMA advice and guidance – available here, discuss within your practice teams and start implementing measures to improve the safety of patient care and staff working conditions.
We hope we never get there, and the new Government listens to our reasonable proposals, but further steps could involve escalation to contract breach actions, e.g. action short of strike or strike action. This may include Salaried GP members, GP Registrar members or other practice clinical staff. GPs who exclusively locum are unlikely to be directed to refuse to take on new work, which would leave them without any income.
When GPCE refers to collective action it means concerted action taken together by GP contractors/partners, which does not breach their contracts, to apply pressure to the Government to negotiate positive changes to the GP contract and/or agree a new substantive national GMS (General Medical Services) contract across the next Parliament.
Eligibility to vote
You are eligible to vote if you are:
- a BMA member and joined before 23 July 2024
- practising in England
- a GP contractor/partner
- you/your partnership holds a General Medical Services or Personal Medical Services service contract with the NHS
The APMS (alternative provider medical services) contract holders have been excluded because APMS contracts are held by limited companies, not unlimited liability partnerships. APMS contracts were developed in 2016 to be short-term commercial contracts whilst a longer-term GMS solution was found. The priority remains ensuring GP contractors / partnerships can obtain a GMS contract from the local commissioner where General Practice services are required.
GMS and PMS contracts are the only contracts which enable continuity of care for a list of registered patients, providing patients with certainty for the future, as well as assured collective national bargaining to protect patient services
The national GP contract was built on the foundation of the collective endeavour of GPs standing together to ensure the best contract for the profession, their staff, and their patients. Only by continuing to stand together will GPs as a branch of practice of the BMA, be able to collaborate, influence, and negotiate substantial improvements to the current contract and beyond.
Should any future balloting and subsequent industrial action be ordered by the membership, strict trade union laws apply around who can vote and the membership data we hold for them.
We’ve let poor national policies divide us for too long. The collective lobbying and individual benefits BMA membership provides members cannot be found elsewhere, and it’s time we strengthened and secured the best possible future for the next generation of GPs and their teams.
The referendum is being run independently by Civica. You will receive your email from [email protected]. Once the ballot has opened on 17 June 2024, if you have not received your voting email, please check your junk or spam folders. Also check you are a BMA member and that your membership subscription has not lapsed.
If you still don’t have the email, please complete this form to let us know and you will be sent a replacement voting link once we have checked your contact details. The ballot closes on 29 July 2024 at midday.
If you’ve done those things and still haven’t received your voting email, please ask for support via [email protected] and we will get back to you swiftly.
Salaried, locum and registrar GPs are not able to vote in this ballot.
This is phase one. It is necessary for contractors / partners who own and run practices to make the initial decisions necessary to ensure practices stop doing things they are not contractually obligated / resourced to do. All practice staff should be involved in these collective actions, as they are also negatively impacted by the lack of resource going to GP practices, and the moral injury caused.
Guidance on the imposed contract changes
The BMA GPCE has published advice and guidance to help you consider how best to approach the contract changes.
Why action by GPs is necessary
This is our one and only opportunity to come together as a profession to protect sustainable NHS GP services for our patients.
The Wilson Government heralded the 1965 Family Doctor Charter. We need a 2025 Family Doctor Charter fit for the following decades with a commitment to build up to a floor of 15% of NHS expenditure focused on the provision of excellent primary medical services to restore general practice as the jewel in the NHS crown and protect services, patient confidence, and NHS productivity.
Our aim is to get the Government back around the table to negotiate in good faith with GPCE. We want to deliver a new contract for the profession across England that provides the investment needed to transform, rebuild, and reinvigorate general practice. We need to fix our contract, not the model.
Non-GP practice partner support for collective action
As the non-statutory ballot is only open to BMA GP contractors/partner BMA members, we have created a form for non-GP Partners/Contractors to sign and show support for GPCE’s “Protect your patients, protect your GP practice” campaign.
GP ballot roadshows
The GPC England officer team is travelling across England in a series of roadshows, hosted by regional LMCs leaders. These events offer an opportunity to hear face to face about the GP campaign, understand the non-statutory ballot, and discuss and debate with your peers.
The events are open to all GP contractors/partners and practice managers, salaried GPs, GP registrars and practice nurses are also very welcome too.
Background to the GP contract dispute
The ballot and the referendum
Following March’s unequivocal referendum result, where 99.2% of BMA GP and GP registrar members returned a resounding vote AGAINST the 2024/25 GMS contract, we are now in dispute with NHS England. The responsibility to deliver the GMS / PMS (Personal Medical Services) contract is held by the GP contractor / partner(s) of the practice. They are not NHS employees, but independent GPs who contract with the NHS. Unlike other NHS employees in other branches of practice, such as resident (junior) doctors and consultants, GP contractors / partners are not subject to TULCRA legislation. The ballot is therefore indicative rather than a statutory one. It is a means of gathering momentum ahead of organised collective action, which will commence from 1 August. The BMA GPC England is asking members to vote YES to Protect Your Practice, Protect Your Patients.
Action by GPs
This will not be strike action. Services will not be withdrawn in this initial phase of the campaign, and contracts will not be breached. However, the impact on NHS England and ICB (integrated care board) budgets will be felt keenly. England general practice currently receives 6p in every NHS pound, and an average GMS ‘global sum’ per registered patient of £107.57 per annum. CPI erosion to the GMS contract since 2018/19 is worth £659 million – 6.6%. It is hardly surprising, therefore, that over 1,300 practices have either closed or merged in the past decade.
GPC England wrote to ICBs in April to request that systems add GP action to their risk registers to prepare to mitigate any such potential impact. Government, NHS England and the DHSC (Department of Health and Social Care) have known this would be the consequence of a third consecutive contract imposition for over a year. Each have had repeated opportunities to come to the table in good faith to negotiate a reasonable agreement, which would see a stop to practice closures and GP unemployment – but our pleas have fallen on deaf ears.
Practices facing shortfalls
The outgoing Government committed to honouring the 2024/25 DDRB (Doctors’ and Dentists’ Review Body) uplift in July 2024, but NHS England and the DHSC only provided a 1.9% uplift in the interim in April 2024 – a real-terms cut in funding. GPCE could not have stressed more, or evidenced better, how precarious practice finances are at the moment, and the General Election that has since been announced is only going to delay the vital funding boost many surgeries, often in deprived areas, need. As things stand, we are greatly concerned that some GP contractors / partners will have to hand back contracts and close their practice before the new Government can intervene.
The BMA DDRB Swingometer below shows that even if the newly elected Government were to more than quadruple the initial 1.9% uplift, which the GPCE thinks is highly unlikely, practices will still be facing a huge shortfall compared with 2018/19 at a time when running costs and staffing expenses are significantly higher. Funding hasn’t just stood still for the past five and a half years or so; it has reduced in value in terms of what it can pay for on behalf of patients.
Pressures in general practice data analysis
The BMA monitors data on GP workforce, working patterns, and appointment numbers, which illustrates the growing pressures on general practice.
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