Is the GP strike the end of family healthcare as we know it?

General practitioners in England have voted overwhelmingly to take a form of industrial action in protest at a 1.9 per cent increase in public funding for surgeries. The GPs will be working to their contracts for the foreseeable future, and have thus created a major problem for the NHS in patient care, and for the new government in trying to fulfil its manifesto promises to reform, fund and fix the health service.
It’s the first such “national” action (albeit Scotland, Wales and Northern Ireland have their own devolved arrangements) and a substantial challenge to the authority of Wes Streeting, the health secretary.
The junior doctors in hospitals and clinics, employed as staff by the NHS, have indeed had their long-held claim settled (though not without the threat of further strikes). However, GPs are self-employed and their practices are effectively small (or not-so-small) businesses, with all the pressures that entails. It is an odd arrangement because their sole “customer” is the NHS, which agrees services with them but negotiates collectively on a national basis with the British Medical Association.
The anomalous arrangement goes back to the genesis of the NHS in 1948, when Nye Bevan, father of the service, said he had to “stuff their mouths with gold” and allow doctors their autonomy and freedom to take on private patients.
Inevitably. Although surgeries are still required to be open from 9am to 6pm, the number of patients that GPs will see in a day will decline, so the scramble for an appointment will be even more frenetic, and success entirely unrelated to clinical need. Some sick people will instead head to A&E, walk-in clinics and other facilities, adding to already intense pressures there. Others, a minority, may opt to go private, which further fractures the national system; a few will resort to pharmacies, as the previous government suggested. It will harm some people’s chances of an early diagnosis and worsen outcomes. How far this will happen remains to be seen.
Yes, because the practices cannot afford to take them on at the expected salary levels. Some extra funding is being made available for the temporary use of GPs to get waiting lists down over the next six months. But it is not a permanent answer. The advent of a new health professional, the physician associate, is supposed to offer a more cost-effective method of delivering primary care, and the General Medical Council is in favour of it, but the GPs as a whole are bitterly opposed and complain that it will compromise diagnosis and degrade patient care. GPs have also been concerned in the past about the limit of £1m for a tax-free pension pot. Some GP practices are closing because they are not viable, which is also making matters worse. It’s all about money, in the end.
It proves that merely electing a Labour government with a landslide majority doesn’t, in itself, solve anything. Precisely the same money troubles, backlogs and structural challenges are there as they were when the last Conservative health secretary, Victoria Atkins, left office almost a month ago. Certainly, despite the goodwill and Streeting’s often repeated keenness to get around the table and negotiate, it suggests that there may be as many, if not more, strikes during this administration than the last. The fact that the junior doctors’ dispute was rapidly ended with them securing a bumper pay rise after a series of quite disruptive and relatively long strikes may encourage other groups – as well as the GPs – to follow their (arguably) militant approach.
Talk and try to offer a better future but probably without much in the way of hard cash. The manifesto states: “We will train thousands more GPs, guarantee a face-to-face appointment for all those who want one and deliver a modern appointment booking system to end the 8am scramble. We will bring back the family doctor by incentivising GPs to see the same patient, so ongoing or complex conditions are dealt with effectively. Labour will also take the pressure off GP surgeries, by improving access to services and treatment through new routes. We will create a Community Pharmacist Prescribing Service, granting more pharmacists independent prescribing rights where clinically appropriate.” Behind the often violent partisan rhetoric, Labour’s approach is not so radically different from the last government’s, with the important exception of that junior doctors’ pay settlement.
Streeting wants to move the GPs out of their traditional partnerships and into the NHS salary structure, perhaps via the new Neighbourhood Health Centres. Labour says they will work by “bringing together existing services such as family doctors, district nurses, care workers, physiotherapists, palliative care and mental health specialists under one roof”. But the starting point is that GP partnerships are in decline and perhaps not sustainable. As Streeting mused last year: “I’m minded to phase out the whole system of GP partners altogether and look at salaried GPs working in modern practices alongside a range of other professionals.”
If Labour and Streeting fail to improve satisfaction with NHS care, critics on the right will claim that the NHS is no longer fit for purpose. Part of the improvement during the Blair-Brown years was down to a new and fairly generous GP contract, it is worth noting.
Reform UK is already advocating shrinking the service to one for the poor. At the moment, such ideas are unpopular but constant strikes and ever-lengthening waits will erode faith in the system. That, the BMA should realise, will not necessarily be of benefit to GPs.