GPs have threatened to bring the NHS to a standstill with unprecedented industrial action that includes cutting the number of appointments by a third.
The British Medical Association is urging GPs to back the measure, the first in 60 years, in a vote that closes at midday today.
Patient groups last night branded the move “selfish” and warned that GPs risk harming those who need care and losing public support.
An NHS chief said the effect of a cap on appointment numbers could be “catastrophic”.
It is feared that up to 3 million GP appointments a month could disappear if all GPs were to comply with BMA demands to reduce the number to just 25 appointments a day. Some currently carry out 50, compared with the average being 37.
It is feared that up to 3 million GP consultations a month could disappear if all family doctors submit to BMA demands to reduce numbers to just 25 a day.
BMA representatives have previously met with Health Secretary Wes Streeting (pictured)
The action would begin this Thursday and would last ‘months’.
The union says GP funding is being cut and the terms of a new NHS contract mean “many surgeries will struggle to remain financially viable”.
But GP partners, who own their practices and make up the majority of family doctors, earn an average of £153,400 a year, despite only one in three working full-time.
If GPs support the vote, they will be asked to take part in up to nine forms of protest, including one that would limit the number of “daily contacts with patients”.
This includes in-person appointments, remote consultations and online messages.
The BMA says practices should limit these to 25 per GP per day, which is a third less than the current typical workload.
Dr Katie Bramall-Stainer, chair of the BMA’s general practice committee, said GPs would not be “striking” but would instead engage in “premeditated and disruptive collective action”.
GP workforce figures for May 2023 show there are 27,200 fully qualified GPs in England, down from 27,627 the previous year. The peak number of GPs was 29,537 in March 2016.
Separate figures show that only 68.3 percent of appointments were made in person in November, down from 80 percent before the pandemic. It is also the lowest figure so far this year.
The graph shows the ratio of general practitioner patients to consultations since 2015, with an average of 9,755 patients per consultation in May 2023.
He said the move was aimed at hitting NHS England and the Department of Health and Social Care, rather than patients.
But Dennis Reed, director of Silver Voices, which campaigns for over-60s, told the Mail: “Our members, who are already struggling to get medical appointments on time, will be baffled and angry at this premature action by GPs.
By failing to take any such disruptive measures during the five years of the last Government, despite broken promises about recruiting more doctors, they are not giving negotiations with the new Government a chance.
It is laughable to say that the measure is aimed at NHS England when it is the patients who will suffer the most restrictions on appointments.
‘The proposed action will only mean that more patients will be forced to overload accident and emergency departments.
‘Some older patients will be turned away from their GP surgery and return home, risking worsening symptoms.’
She added: ‘Silver Voices has supported the call for more resources for primary care and is sympathetic to GP workloads, but this self-serving move over the detailed terms of generous contracts risks losing public support for their cause.
“The way to solve these problems is through mature negotiations, not through threats.”
Matthew Taylor, chief executive of the NHS Confederation, told the Guardian: “If all GPs were to implement the patient cap, that could have a catastrophic effect on the entire healthcare system.
“General practice is now seeing more patients than it did before the Covid pandemic, so any reduction in activity will put further pressure on other services, including A&E.”
The vote, which opened on June 17, could potentially mean GPs also stop doing work they are not formally contracted to do; refuse to cooperate with local data-sharing arrangements; and ignore NHS “rationing” restrictions on medicines.
On Monday, NHS England told local health leaders to prepare for a “reasonable worst-case scenario” in relation to the GP strike, warning it could affect “the whole system”, including emergency services.
And Professor Helen Stokes-Lampard, former president of the Royal College of GPs, told NHS England’s board meeting on Thursday that the NHS was “already starting to see strain” as a result of GP practices “pulling back” from doing discretionary work.
GPs have not taken action since 1964, when family doctors collectively submitted their undated resignations to the Wilson government.
But the BMA has spearheaded recent strikes by junior doctors and consultants, hampering efforts to clear waiting lists that built up during the Covid-19 pandemic.
The BMA has said the new GP contract, which will see services receive a 1.9 per cent funding increase by 2024/25, means many surgeries will struggle to remain financially viable.
But official NHS Digital figures show that GP partners have seen their earnings (taken from practice profits) rise by 31 per cent in recent years.
Dr Bramall-Stainer revealed the move has been designed to be “easy, sustainable and effective”, adding: “If done effectively, done collectively and done well, it will cripple the NHS very quickly – but not for patients, but for the whole NHS management, the policy makers who have put these decisions in place that are not helping patients.”
GPs launched a formal dispute over the issue in April after a referendum held by the union found that 99 per cent of the 19,000 GPs rejected the contract.
Dr Bramall-Stainer said: ‘We don’t want to put patients in the middle like pigs – we live in our communities with our patients, there are no barriers between us.
“We get a lot of criticism for the failings of the NHS and we agree with our patients, and it’s quite exhausting. The last thing we want to do is turn patients against us.”
“I don’t think patients will notice much of a difference. And that’s the plan.”
Dr Bramall-Stainer met with Health Secretary Wes Streeting on 18 July and union leaders hope those talks will continue.
Earlier this month, she submitted a series of demands to the Government, including a new GP Charter; a “minimum investment standard” for general practice; a petition to create “real terms reinvestment” in general practice; and a call for “relations between GP list sizes and patient numbers”.
Mr Streeting’s first official visit in his new role was to a GP surgery in London on 8 July, where he pledged to “bring back the family doctor” and “fix the front door to the NHS”.
A Department of Health and Social Care spokesperson said: ‘The Health and Social Care Secretary met with the chair of the BMA’s GP committee to discuss his priorities ahead of the close of voting on 29 July.
“However, it is important that we plan for all contingencies, in any eventuality, to keep patients safe.”
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 plan for any potential disruption and ensure services continue to be delivered to patients, so we will continue to work with local systems to help them plan in case industrial action takes place.”