The NHS faces “alarming” and “dangerous” disruption until Christmas and potentially into 2025, health chiefs have said, after GPs began their first industrial action in 60 years amid a major row over funding.
Hospitals, A&E units and mental health services are already under huge pressure. They are now braced for a surge in demand from thousands of patients turning to them for help after family doctors in England launched work-to-rule action on Thursday.
A letter seen by the Guardian that was sent to senior NHS managers from the national primary care director, Dr Amanda Doyle, said the NHS was preparing for a “worst-case scenario” and that 999 services could be affected.
Meanwhile, separate analysis suggests swamped hospitals could be set for a 10% increase in referrals and up to 200,000 extra patients every month if GPs stop consulting specialists before referring patients.
Speaking to the Guardian, Matthew Taylor, the chief executive of NHS Confederation, said the industrial action would probably have an immediate significant effect. “In some areas, it may take longer for patients to get an appointment with their GP, or they may have to go somewhere else for something that was previously provided in general practice.
“This will pile more pressure onto A&E, mental health and other frontline services where waiting times could grow considerably. This is an alarming situation to be in, particularly after everything the NHS has been through over the last few years, and one that health leaders understand GPs will not have entered lightly.”
In a ballot run by the British Medical Association (BMA), family doctors voted overwhelmingly in favour of taking collective action in protest at the previous government increasing their budget by only 1.9% this year. More than 8,500 GPs took part, with 98.3% supporting immediate action.
The government has pledged to increase their budget for 2024-25 to 6%. Wes Streeting, the health secretary, also announced plans just hours before the ballot result emerged to cut red tape to enable GP surgeries in England to hire more doctors.
Streeting said he wanted to build a “new relationship” with GPs. In a letter to them posted on X, he described general practice as the “heart” of the NHS, but said it “has been neglected for too long”.
Taylor said the funding to recruit GPs was a helpful start but the problems required longer-term and more far-reaching action. “With winter around the corner, the NHS faces dangerous disruption until Christmas and into 2025 unless the BMA and government can find a way forward,” he added.
The letter from Doyle to senior NHS managers said every region of England should take measures to prepare for “potential impacts and risks to patients”. They should plan for the possibility of disruption to urgent and emergency care, elective treatments, mental health and community services, children and young people’s services and midwifery. There may also be short-, medium- and longer-term effects on 999 and 111 services, she added.
GP partners will choose what form of industrial action to take from a selection of 10 measures set out by the BMA, the Guardian understands.
One option is to limit the number of patients GPs will see each day to 25. They may choose to stop performing work they are not formally contracted to undertake, and could ignore “rationing” restrictions by “prescribing whatever is in the patient’s best interest”.
Hospitals could receive 10% more referrals – “crippling” efforts to tackle the backlog of care built up during the Covid-19 pandemic – if GPs stop diverting some of their patients with “specialist advice and guidance”, the Health Service Journal reported.
On average, 200,000 referrals have been avoided each month in England in the past year through “specialist advice and guidance”, under which GPs consult a specialist before making a referral, with the aim of preventing additions to waiting lists.
The collective action poses an enormous headache for Streeting just three days after he resolved a long-running pay dispute with junior doctors. The last time GPs took “collective action” was in 1964, when family doctors collectively handed in undated resignations to the Wilson government.
Dr Katie Bramall-Stainer, the chair of the BMA’s GP committee, said: “We had a huge response to this ballot, and the results are clear – GPs are at the end of their tether. This is an act of desperation. For too long, we’ve been unable to provide the care we want to.”
But patient groups said industrial action was “selfish”, and that GPs risked harming those in need of care and losing public support.
The Royal College of GPs said the ballot result showed the “strength of feeling” among family doctors in England. Its chair, Prof Kamila Hawthorne, said: “No GP will want to restrict the services they provide for their patients – and it needs to be made clear that GPs and their teams will still be working.
“But there are many aspects of what GPs provide that go well beyond the contractual requirements they are under, and this additional workload and the goodwill of the GPs delivering it have been taken for granted for too long.”
NHS England urged the public to continue to come forward for care as normal. Practices will still be required to open between 8am to 6.30pm Monday to Friday.
In a statement, Doyle hailed GPs as the “bedrock of the NHS” and vowed to work with ministers to find a way to end the industrial action. “Our message to the public remains the same – they should continue to come forward for care during this collective action, as GP practices will remain open,” she said.
The NHS recommends patients use 111 for urgent medical help when their GP practice is unavailable and, if it is a serious or life-threatening emergency, to call 999.
• The headline of this article was amended on 2 August 2024 to correctly refer to GPs taking industrial action, rather than going “on strike” as an earlier version said.
