GP patient cap could have ‘catastrophic’ impact on emergency departments, says NHS chief | GPs

Industrial action by GPs could have a “catastrophic” impact on emergency services, the 111 telephone advice service and mental health care, a senior NHS official has told the Guardian.

Family doctors who run GP practices across England are set to complete a vote on cutting the care they provide – including limiting the number of patients they see to 25 a day – in protest at the previous government increasing their budget by just 1.9% this year.

The British Medical Association’s (BMA) general practice partners’ ballot closes on Monday, with the results due shortly afterwards. They are expected to vote in favour of industrial action – but not strike action – starting on Thursday.

The outcome of the vote could pose a new headache for Wes Streeting, the health secretary, who is holding talks with junior doctors in a bid to resolve their long-running pay dispute in which they have struck 11 times in the past 17 months to secure a 35% pay rise.

In his first major policy announcement since replacing Victoria Atkins on July 5, Streeting pledged to increase the proportion of the NHS budget spent on general practice.

Speaking about the prospect of GP industrial action, a source close to Streeting said: “This is just the latest example of the mess the Tories have left. We are determined to work with the profession to rebuild general practice, which is essential to ensure the NHS is fit for the future.”

“We will gradually increase the share of resources devoted to primary health care and help solve the problems faced by general practitioners.”

The NHS fears that GPs’ limiting their patient contacts to 25 a day could cause significant disruption, with family doctors referring more patients than usual to already overstretched hospitals, another tactic to force NHS England and ministers to rethink their strategy. NHS leaders also worry it could lengthen waiting times for diagnostic tests and non-urgent hospital care.

“If all GPs implemented the cap on patient numbers it could have a catastrophic effect on the whole healthcare system,” said Matthew Taylor, chief executive of the NHS Confederation.

“General practice is now seeing more patients than before the Covid pandemic, so any reduction in their activity will put more pressure on other services, particularly emergency departments.”

Primary care leaders, speaking on condition of anonymity, estimate that up to 3 million doctor consultations a month could be lost if family doctors decide to cut the number of patients they see from 50 to just 25 a day. The cap is one of nine strike options offered to GPs by the BMA.

GPs could also use other tactics, such as referring patients directly to hospital instead of continuing to self-manage their conditions after discussing them with hospital doctors, and no longer rationing the number of people they send to hospital for diagnostic tests or specialist admissions. Both of these measures would increase the workload on hospitals, many of which are facing levels of demand for care that they usually only see in winter, forcing some to recently declare a “critical incident”.

Senior primary care officials say industrial action could lead to the sudden disappearance of 30% of GP appointments, leaving patients with no choice but to seek care elsewhere.

Last week, NHS England wrote to health service chiefs warning that a reduction in GPs’ usual working methods could have “system-wide impacts” that could also lead to more people calling 999 or seeking help at walk-in clinics.

The BMA has advised GP partners to use the non-statutory vote to support industrial action. “We need all GP contractors/partners to vote Yes to send a message to government that we are prepared to stand up for a better service for our patients and protect our practices,” it told them.

Dr Katie Bramall-Stainer, chair of the BMA’s GP committee, told Streeting in a letter earlier this month that “general practice, the most effective and productive part of the NHS, is collapsing” due to underfunding, the closure of 2,000 practices since 2010, a relentless rise in demand for care and the fact that each GP is caring for a caseload of more than 2,300 patients.

In its letter, NHS England warned that a slowdown in GP activity could lead to “short, medium and long term changes in patient flows between primary care, 999, 111 and emergency treatment centres/minor injuries units. Planning should also seek to understand the potential impacts on diagnostic and elective activity.”

The “secondary impacts and consequences” of GP action could also affect the availability of mental health services, including care for people in crisis, and lead to “potential pressure/congestion on urgent and emergency care, elective and discharge pathways”, it added.

Ruth Rankine, director of the NHS Confederation’s primary care network, said GPs felt general practice had received an “unfair deal” as inflation, NHS pay deals and hiring extra staff had pushed up their costs. They also felt hospitals had received favourable financial treatment in recent years, even though GP services account for 90% of all patient contacts with the NHS.

NHS England said: “We continue to work with GPs, the BMA and the government to avoid any potential action, but in the meantime the NHS has a duty to prepare for any potential disruption and ensure services continue to be provided to patients. We will therefore continue to work with local systems to help them plan in the event that industrial action does occur.”