Buckinghamshire, Oxfordshire and Berkshire West (BOB) ICB has warned it may lose £4.2m this year due to GP collective action.
BOB ICB said that collective action by GPs in its area represents a ‘high-risk factor’ as it could ‘significantly increase’ GP prescribing costs.
And a Berks, Bucks & Oxon LMCs survey of practices in the area, seen by our sister title Pulse, showed that 94.1% of respondent practices in BOB are ‘engaging in some form of collective action’.
A finance report published by the ICB said a ‘high-risk factor’ is ‘the potential impact of GP industrial action, which could significantly increase GP prescribing costs and hinder the delivery of [cost improvement programmes]’.
A table predicting the cost impact from this said it could cost the ICB £4.2m in one year, adding that the likelihood for this was at a ‘medium’ level.
The report, published last month, suggested there was still a chance of GP action ‘not occurring’.
‘The key opportunities include […] a 50% chance of GP action either not occurring, or potential for cost reimbursement,’ it said.
However Berks, Bucks & Oxon LMCs’ survey of practices suggested the majority of GP practices are taking the collective action option which would impact prescribing costs.
This is described by the BMA as switching off the medicines optimisation software, which is embedded in GP systems by the local ICBs ‘for the purposes of system financial savings and/or rationing rather than the clinical benefit of your patients’.
Of the local practices that responded to the LMC’s survey, 65% of practices said they were currently taking this action.
It is up to practices to decide what action to take from a menu of options created by the BMA, which also includes declining non-contractual work, refusing to engage in advice and guidance, limiting patient contacts to 25 a day per GP and declining to sign new contracts with NHS England or the local ICB.
According to the LMC survey, which received responses from 84 practices looking after 1.2m patients in total, 70.2% are taking action by limiting the number of patients they see.
On average, local practices are putting in place five out of the 10 actions recommended by the BMA.
The LMC said part of the reason it undertook the survey was that ‘many practices have expressed frustration’ at ‘the lack of any data, advice, or feedback’ from the BMA, with some practices having ‘expressed a reluctance to engage in or escalate their action’ due to this.
The LMC said: ‘In the absence of any meaningful data or support from the BMA organisationally, and given our unique relationship with constituent practices, the LMC composed our own survey.
‘The overwhelming majority of respondent practices are engaged in some form of collective action under BMA guidance.
‘These results, representative of practices serving a patient population of over 1.2 million, should reassure practices that action truly is “collective,” and they are not alone, by any means.’
The LMC also warned that as time progresses, practices ‘will have little choice’ but to escalate actions which will divert ‘significant’ clinical and administrative burden to the rest of the system, such as trusts.
It added: ‘Practices should be reassured that commissioners have this action on their risk registers. Furthermore, the LMC maintains close dialogue with secondary care leaders. Practices should therefore feel confident and unhindered in engaging in and escalating such action.’
LMC chief executive Dr Matt Mayer said: ‘General practice is the only part of the NHS system that never runs at a deficit, because any deficit is borne by contractors.
‘However, the wider system constantly expects GP practices to balance the NHS books by dumping unfunded work onto underfunded practices.
‘As per BMA advice on collective action, GPs are rightly prioritising the safe care of their patients over ever-shifting prescribing targets set by the system.
‘GPs will always base their prescribing decisions, of when and what to prescribe, on the needs of the patient in front of them, and not on what is literally box ticking requested by the system.
‘Any consequent cost implications for the system are symptomatic of a chronically underfunded NHS, and any attempt to blame GPs for such commissioning gaps will only prove the necessity for continued action.’
BMA GP committee chair for England Dr Katie Bramall-Stainer said: ‘We are very grateful to the team at Berks, Bucks, and Oxon LMCs (BBO LMCs) for producing such a quick turnaround of data across their patch. This snapshot show how practices are getting involved at a grassroots level.
‘This week we’re conducting October’s monthly action tracker survey, asking GPs to tell us what actions their practice is taking. We are so grateful to those local organisations like BBO who continue to build and complement on the all-important details so we can build this into a national picture.
‘The BMA will be producing more materials to help practices understand what individual actions mean and help them to take steps their peers and neighbouring practices are taking, and how it’s working for them.’
Our sister title Pulse has approached BOB ICB for comment but according to a report by interim CEO Dr Nick Broughton, the ICB has established an ‘incident management team’ to ‘support oversight, escalation and management’ of any issues associated with GP collective action.
Collective action began on 1 August after GP partners voted in favour of taking action in protest against contractual terms and funding.
After the BMA announced the results of its non-statutory ballot, which saw 98.3% of GP partners voting in favour of taking collective action, NHS England said that ICBs should make sure that practices are continuing to meet contractual requirements during the action.
Last week, the BMA set out a list of demands for the Government to meet in order to bring collective action to an end.
The union said that to end the dispute the profession needs investment to ‘stop the collapse of GP practices’, as well as ‘a cast-iron commitment’ from the Government to agree and implement a new, national GP contract within this parliament.
A version of this story was first published on our sister title Pulse.
