The impact of industrial action by GPs will not be as tangible, or as clearcut, as that of strikes by junior doctors. Hospital data is collected centrally, so that any increase in waiting lists or cancellations is quickly known. Information from primary care is not collated in the same way. But there is no doubt that capping appointments at 25 per day – as some GPs will do following this week’s vote – will mean a reduction in access to healthcare. With the NHS already under huge pressure, people who rely on their GPs for support will be justifiably anxious.
Yet GPs, who between them provided more than 25 million appointments in England in December (figures for Northern Ireland, Scotland and Wales are gathered separately), clearly feel they have no choice but to try to force ministers’ hands. This is not about pay, as the junior doctors’ dispute was. The GPs’ complaint is that the overall resources allocated by the previous government to primary care are insufficient. More than 98% of the 8,500 family doctors who took part in the ballot voted in favour, on the grounds that this year’s 1.9% budget increase is not enough.
About this, the GPs are right. Primary care receives less than 10% of the overall NHS budget in England, and a similar proportion in the other nations of the UK. But while the overall NHS budget has risen in recent years – though not by enough to meet inflationary and demographic changes – the proportion of spending on primary care in England has shrunk by more than two percentage points in less than a decade. Repeated pledges by the previous government to increase the number of GPs have been broken. Instead, numbers have been falling – from 29,364 full-time equivalents in 2015 to 27,670 in June this year.
In the light of these facts and figures, and others including the rising number of physical threats and attacks in local surgeries, it is no wonder that frustration has boiled over. A decision on Wednesday to relax budget rules to enable busy practices to hire more doctors came too late to make any difference.
There is no single template that GPs who restrict their work from this week will adopt. The British Medical Association has proposed a range of options from which they can select. Since some of these relate to software and data sharing, it may be that patients are relatively insulated.
But whatever the impact on the frontline – which is likely to include a rise in the number of people seeking treatment in A&E departments – the current year’s budget is unlikely to change. If the industrial action by GPs succeeds in having an effect on policy, it is more probable that it will do so by influencing parts of the review of the NHS that Wes Streeting, the health secretary, has commissioned from Prof Ara Darzi, who is due to report in September, and in the government’s departmental spending announcements in October’s budget.
Mr Streeting has already indicated his intention to alter the balance of NHS resources in primary care’s favour. Most health policy experts believe this is the right course, given the importance of prevention in areas from diet to ageing and the rising burden of chronic disease. But the size of the overall NHS budget is also at issue, and about this the GPs are right to be concerned, given the government’s emphasis on fiscal restraint. This industrial action is an indictment of years of broken promises, and signals desperation.
