Now it's family doctors in York who will be taking industrial action

That’s the warning from a York GP as surgeries across the city begin to prepare for what will amount to a ‘work to rule’.

Family doctors in England voted overwhelmingly for ‘collective action’ starting from August 1 – though doctors union the British Medical Association (BMA) has said it will be a ‘slow burn’ rather than a ‘big bang’.

York GP Dr David Fair said different practices across York will be deciding for themselves what action to take.

York GP Dr David Fair (Image: Supplied)

But options include limiting the number of patients a GP sees each day; refusing to shop around to find the cheapest drugs to prescribe; and referring more patients directly to hospital rather than providing tests and checks in GP surgeries.

Dr Fair, a GP at York’s Jorvik Gillygate Practice, said the result would almost certainly be to increase waiting times in A&E – but also the number of patients on hospital waiting lists.

Dr Fair, who is not himself a member of the BMA but understands why GPs feel they must take action, said no GP wanted to take such steps.

Action by GPs will almost certainly lead to an increase in the number of patients on hospital waiting lists - and to an increase in wait times in A&E (Image: Nesquest)

But he said they felt they had no choice after years in which family doctors have seen their share of the NHS budget fall steadily. The straw that broke the camel’s back was when the previous Conservative government said it would be increasing GP funding by just 1.9 per cent this year, Dr Fair said – well below the rate of inflation.

The industrial action was a way of ‘flying a flag’ to say something had to change, he said.

He said that already, some GP practices – though not in York – were going bankrupt. Unless the share of funding GPs received increased, there was a real danger that family doctors would go the same way as dentistry – many patients now cannot see a dentist on the NHS.

GP practices are under pressure because the proportion of NHS funding that goes to them has been declining steadily

Dr Fair said: “We don’t want patients to feel frightened. No GP I know would intentionally disadvantage any of their patients.

“The industrial actions which GPs have voted for have been actions intended to send a clear message to the government that we are sticking up for our patients and we are concerned for the future of the role of general practice within the NHS.

“Without change, young doctors will choose not to work in UK general practice , or GPs will desert the NHS and patients would have to pay privately for GP services.”

The Labour government has now said that it will accept the recommendation of the independent pay review body for doctors and dentists to uplift GP pay by 6%.

The BMA has described this as a ‘small step in the right direction’. But a spokesperson added: “We still have hundreds of millions less resource to run our practices compared to even five years ago. Practices are still closing, so we have no choice but to move ahead with collective action.”

York Central MP Rachael Maskell (Image: Supplied)

York Central’s Labour MP Rachael Maskell said: “GPs are on their knees. I trust that this industrial action can be a moment when the Government recognises the challenges and opportunities of primary care and resources the system accordingly.”

Luke Charters, the recently-elected Labour MP for York Outer, added: “Under the previous government, the NHS was neglected and underfunded for 14 years.

“This Labour government has already resolved issues with junior doctors. I know that Wes Streeting will be having conversations with the relevant unions to seek a positive way forward (for GPs).”

York Outer MP Luke Charters (Image: Supplied)

What action might GPs take – and why?

York GP Dr David Fair said he knows of GPs who have been seeing 40 or more patients a day. One option for doctors taking industrial action will be to limit that to 25 patients a day.

Family doctors are also routinely expected to ‘shop around’ for the cheapest drug to prescribe. That takes time, Dr Fair said. GPs taking industrial action may decide to save time by simply prescribing the drug they think best for their patient – adding to the nation’s pharmacy bill.

GPs are also routinely vet, screen or test patients before referring them to hospital - and often write to consultants first before making a referral. Another option for GPs taking industrial action will be just to refer all patients directly to hospital clinics, without doing any of the ‘triage’ work first.

GP practices across York are making their own decisions about what form industrial action will take (Image: PA)

That will inevitably add to the number of patients on waiting lists to see hospital specialists.

GP practices are essentially small businesses with a single client – the NHS.

Out of the money paid to each practice, the partners have to decide how many receptionists, nurses, secretaries and cleaners to employ, and how much to pay them. They also have to pay all the running expenses of the practice such as rent, heating, cleaning and IT equipment.

The GP partners do not have a salary: what they earn depends on how much money is left after all the expenses have been paid.

Family doctors say the proportion of the total NHS pot given to GP practices rather than hospital services has fallen year on year, meaning many are struggling to make ends meet.

But it makes sense to invest in GP services, Dr Fair says. By catching and treating disease early, GPs can save lives, reduce patient suffering – and reduce the need for more expensive treatment further down the line, so saving the NHS money.

He said the industrial action was essentially a ‘rebellion against the government for shrinking the amount of money so much that ALL practices in the UK will be at risk of folding if the share going to general practice is not increased’.