Dr Katie Bramall-Stainer is the current Chair of the BMA’s GP Committee in England, and has led the negotiations on this year’s contract.  It is her first year in the role, and she has been much more visible than many of her predecessors.  Recently she gave an interview on the Talking General Practice podcast, where there were some very interesting insights into the recent contract negotiations.

The first is that on numerous occasions she referred to the reason for the underfunding of the core GP contract and the refusal to consider cost neutral suggestions as “ideological”.  At different points in the interview she stated that it was “not logical” and the decisions were “intentional and predetermined”, that there was a “perverse ideology behind it”, and that it was an “ideological dismantling” of the profession.

So something  more than just a lack of available of funding is going on, although frustratingly there was no further probing on the exact nature of this different ideology.  It is, however, hard to think that this is anything other than a belief that general practice should operate at a larger scale as a full part of the NHS, and that the partnership model (despite being the most productive part of the NHS) has somehow run its course.

The second insight was that there is much more hope nationally that the DDRB (Doctors and Dentists Review Body) will recommend a positive uplift for general practice.  Dr Bramall-Stainer reported that they were able to put forward a very cogent case for the 8.7% uplift the GPC has calculated as being necessary to return the profession to 2019 funding levels, and that this was well received.

The caveat on this is that the DDRB recommendations are not made until the end of June, and even if these are positive they then rely on the government accepting them, which it may not be inclined to do given the competing priorities for government funds in the run up to a general election.

However, if sufficient noise is generated by the result of the current referendum, along with any media coverage of the LMCs conference and GPC face to face roadshows planned for early in the new financial year, then the government may be more open to the DDRB recommendations.  As Dr Bramall-Stainer herself explains, the strategy is to give the government every opportunity to change the course this is moving without the need for industrial action.

But industrial action is on the cards, and what Dr Bramall-Stainer also gave was an insight into what this would entail.  She acknowledges that industrial action is difficult for GP practices, who rely upon a trusting relationship with their patients.  Damaging this trust in the pursuit of additional funding is a pill many practices would find hard to swallow, and so she is at pains to say that any action must be designed to hurt NHS England and the government, not the patients practices serve.

But this is a hard balance to strike, because ultimately if the changes do not affect patients then they do not affect the government.  What the GPC are clearly leaning towards is a mass movement across practices of only treating a safe number of patients a day.  They hope that if this is backed up by a clear enough campaign that stresses that practices are only seeing the patients that they can with the number of GPs and nurses they have then practices will be protected from any backlash, and that any ire will be directed nationally rather than locally.

Is this enough that the prospect of it will deter the government from continuing on the current course of underfunding the profession, and is it possible to enact and at the same time protect practices from any backlash?   The GPC knows it has to be prepared for its bluff to be called and to be able to follow through, so it has to get this balance right.  Understanding this is why the GPC wants to engage the profession as far as it can in designing the final shape of the industrial action it ultimately puts forward.