The imposition of the 2024/25 GP contract on 1 April, giving practices a funding uplift of about 1.9%, was resoundingly rejected by GPs in a British Medical Association (BMA) referendum.
Now, the BMA general practitioners committee England (GPCE) has announced a non-statutory ballot, from 17 June to 29 July, asking GP partners whether they are prepared to take collective action against the contract.
This article examines some of the key issues behind GPs’ negative reactions towards the contract and discusses arrangements for the BMA ballot and potential collective action. Now that the general election is confirmed for 4 July, will that affect the plans?
Sense of injustice over sub-inflation pay rise
A major issue for GPs is that the 1.9% uplift to funding in the 2024/25 contract, described as ‘derisory’ by BMA leaders, is seen as a further real-terms funding cut that will lead to practice closures and a reduction in patient services.
Dr Steve Taylor, GP spokesperson for Doctors Association UK (DAUK), has warned that: “GPs will be looking at the government finally offering pay increases to SAS doctors and consultants with a sense of injustice.” He said, “Despite it being the only part of the NHS doing more than 2019, the government has ignored pleas from GPs to provide the funding needed to continue to provide the care patients need and deserve.”
The government has so far refused to negotiate, saying that extra funding could come after the Doctors and Dentists Review Body (DDRB) issues its recommendations.
However, with the general election now scheduled to take place around the time the DDRB is expected to issue its advice, GPs are concerned that a decision will come too late to stop more practices closing.
Dr Taylor said, “With GPs facing significant issues on funding that need urgent attention, DAUK hope that MPs will not delay decisions on funding and make it a priority on the resumption of parliament.”
Does the contract ‘cut bureaucracy’?
Another key issue is the bureaucracy that many GPs feel is overwhelming their ability to focus on patient care.
While NHS England has emphasised that the 2024/25 GP contract is intended to cut bureaucracy – “the biggest reduction of unnecessary and burdensome bureaucracy in 20 years” – GP leaders have rejected this claim.
GPs have argued that there is more bureaucracy than ever, including:
- Completing complex forms and clinical tests to refer patients to hospital
- Writing referrals for patients from other providers
- Filling out sick certificates and prescriptions on behalf of other providers
- Supervising Additional Roles Reimbursement Scheme (ARRS) staff and registrars
- Working with primary care networks and integrated care boards.
The GP unemployment crisis
A further big issue is GP unemployment. Despite rising demand for GP appointments, and falling numbers of full-time equivalent GPs, thousands of sessional and locum GPs have reported struggling to find work, while GP registrars fear that there will be no work for them when they qualify.
The BMA called for an urgent government review, warning that many practices cannot afford to recruit GPs due to funding cuts and inflexibilities in ARRS funding.
Professor Kamila Hawthorne, Chair of the Royal College of GPs (RCGP), also expressed her frustration: “The College has been calling on the Government to allow practices to use ARRS funding to recruit more GPs and to increase the overall funding for general practice so we can recruit all the staff we need to meet patients growing levels of demand.”
BMA ballot for collective action by GPs
Given the overwhelming rejection of the 2024/25 contract by GPs, the BMA GPCE voted on 16 May to conduct an online ballot, from 17 June to 29 July, in which GP partners will be asked whether they are willing to take ‘safe and legal action’ to protect their practices and their patients.
Dr Katie Bramall-Stainer, chair of the BMA GPCE, called this “phase one” of the response to the BMA referendum. Despite the general election being held on 4 July, she confirmed that the ballot will go ahead and “does not change our plans for GP action”.
GP leaders hope that the ballot will help to put general practice funding on the agenda for discussion during the political campaigns and put pressure on politicians to find solutions that will avert the need for action. 
However, if the ballot outcome is in favour, collective action could start from 1 August, just three weeks after the new government is installed.
Actions that GP partners may be asked to take will not breach GP contracts. They may include limiting daily appointments to 25 patients per GP in line with BMA safe working advice, and stopping or reducing non-contract work.
The BMA promises a series of roadshows, webinars, and resources to explain the plans to healthcare professionals, as well as a public campaign.
Public support for prioritising GP funding
In polling, 72% of GP respondents previously said they were prepared to take industrial action. Even so, many expressed their discomfort with the idea and their concern about the public response.
However, it seems that prioritising investment in primary care is a key issue for the public too. Findings of the Rebuild General Practice campaign in 2023 found that 52% of respondents wanted the government to prioritise general practice in allocating NHS funding. Recent research by the Health Foundation and Ipos UK also demonstrated widespread support for prioritising community-based services, including general practice.
With the general election just weeks away, prospective MPs will no doubt be tested on their understanding of the issues facing GPs and their patients in provision of primary care services. Their plans to address these issues may well be an important factor in how the public vote.
If you have questions about how the proposed collective action could affect your practice and medico-legal responsibilities, our advisory team is here to help at Medical Defense Society.
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