The plan, intended to balance practices’ books in the face of a pay freeze while protecting patient services and honouring staff pay commitments, stops short of a formal protest.
‘At the moment we don’t believe there is an appetite for industrial action. Some practices may consider they are doing it as a protest and that is up to them,’ said GPC chairman Dr Hamish Meldrum. ‘It is a clear message that practices should be doing what everyone else has done, live within their budgets.’
In its damage-limitation advice ‘Safeguarding Patient Services, Maintaining Cost-Effectiveness’, the GPC last week told practices to stick to the letter of their contracts and reject any new work foisted on them by hospitals without enough money.
‘GPs refusing non-contractual new work should make it clear that it is being refused on the grounds of financial pressure,’ the latest GPC guidance says.
Staff and GP colleagues should be trained to say ‘no’ and any attempts by primary care organisations to go beyond reasonable persuasion into ‘intimidation and bullying’ reported to the GPC.
Practices should review the cost — workload — service balance of all enhanced services and ditch any that are underfunded.
GPs in England should also decide if they want to boycott the access and Choose and Book direct enhanced services, whose funding ceased at the end of March.
The guidance said that ‘many GPs will evaluate their involvement in Choose and Book over the next year, particularly where they feel the use of the software offers no real benefit for patients and takes up too much time.’
In some areas PCTs abuse the system by restricting access to services by removing them from the Choose and Book menu.
Practices should also consider moving to closed or open-but-full lists if taking on new patients becomes uneconomic.
But practices are warned that closing practice lists can open up opportunities for alternative providers to move in.
The GPC encourages practices in England to engage with practice-based commissioning (PBC) to make money as well as exert more control over local services and says it is ‘vital’ that practices demand their entitlements to management resources and freed up cash as well as their right to provide new services without going to tender.
‘Non-co-operation with PBC will reduce the role GPs play in the local health service,’ it says.
Practices should ensure that they are charging enough for non-NHS work outside their contracts or under the collaborative arrangements that cover local authorities’ work in public health, social services and education.