In his speech to the RCGP Secretary of State for Health Wes Streeting called again last week for general practice to end its collective action.  Should general practice simply ignore him and continue down the path it is currently on, and if it does what risks is it taking?

The new government is clearly keen to end the existing disputes with the NHS.  They have managed to come to a speedy resolution with both the junior doctors and the Consultants, and they are clearly keen to add GPs to this list.  Their belief is that the dispute general practice has is with the previous government, and that by meeting the recommendation of the DDRB and providing £82M to ensure the employment of newly qualified GPs, as well as stating that funding for primary and community care will rise as a percentage of total NHS spend every year for the next 10 years, they have done more than enough to at least be given a chance.

In his speech to the RCGP Wes Streeting instead asked for GPs “to work with us to rebuild the NHS together”.  He seems genuine enough, and so while I don’t think it was intended as a threat (i.e. if you don’t stop collective action then you won’t have the opportunity to work us), the voice of general practice is unlikely to be strong in the discussions as to what will end up in the 10 year plan if collective action continues.

Worse, the overall sense that general practice in its current form is “difficult to do business with” is reinforced by its seeming intransigence over collective action.  There is clearly a debate as to the future of the independent contractor model, and whether such a model is compatible with the government’s stated priority of shifting care from hospitals into the community.  A key part of the collective action is focusing only on core contract activity and stopping any work for the system, which of course will reinforce the view that it is having a core contract at all that is the problem.

That is not to say the collective action should necessarily be paused.  While the 6% uplift and the new ARRS contract for GPs are welcome, they do not end the challenges to practices caused by 3 years of disinvestment (and in the case of the scheme for new GPs will probably end up costing practices money).

While the government may want to do business with general practice, there has been no hint of any inclination by NHS England to do the same, who instead seem set on limiting any new money to the service (the failure to uplift the ARRS budget to accommodate the pay awards being the latest example).  The NHS is in dire financial straits, and general practice continues to be regarded as an easy option when it comes to making savings.  If the threat of collective action is taken away things could easily end up becoming even worse.

Collective action, as the GPC regularly point out, is a mechanism by which practices can start to control their workload given the cards that they have currently been dealt.  With no offer of additional in-year funding or support many practices feel that there is no alternative but to take matters into their own hands.

The problem is that the reasons to continue collective action are short term, and focus on what is happening now.  What is important it that the long terms risks general practice is taking by continuing collective action are understood – that it may alienate itself from discussions and reduce its ability to influence the forthcoming 10 year plan for the NHS (despite the key role that primary and community care will need to play in it), and that it may make fundamental change to the independent contractor model more likely as that becomes seen as the problem.  If collective action is to continue then these longer term risks need to be mitigated, to ensure that this short term measure does not end up inadvertently inflicting lasting damage on the profession.