Phase one of collective action involves different possible actions, which will impact or might involve GP registrars in different ways. GP registrars are advised to support the choice of their host practice.

The actions most likely to involve GP registrars

• Limit daily patient contacts per clinician to the internationally  recommended safe maximum of 25 . Divert patients to local urgent care settings once daily maximum capacity has been reached.
• Stop engaging with the e-Referral Advice & Guidance pathway .
• See patients face to face as a default, unless there is a compelling reason not to do so.
• Stop rationing referrals and admissions
• Refer, investigate or admit your patient for specialist care when it is clinically appropriate to do so.
• Refer via eRS for two-week wait (2WW) appointments, but outside of that write a professional referral letter in place of any locally imposed proformas or referral forms where this is preferable. It is not contractual to use a local referral form/proforma – quote our guidance and sample wording
• Stop rationing investigations. Refer your patient for specialist diagnostic investigations when it is clinically appropriate to do so.
• Stop unsafe risk-holding to protect the system over the patient. Admit your patient to the local Emergency Department when it is clinically appropriate to do so via a written referral letter to the admitting team.

If your practice has decided the practice will be participating in collective action

1. Partners or contractors should instruct GP registrars which action(s) the practice will be taking  

If your practice decides to undertake any of the above actions, you should discuss with your trainer how your work might change and how you can support the collective action. 

For collective action to be effective, it is imperative that contractors or partners who participate in collective action must instruct the GP registrars working at their practice to take the same action. Collective action will be most effective when the changes to working are adopted by the entire clinical team, including GP registrars. You should not see any increase in your workload as a result of collective action. General practice must be united to make change.

2. Any collective action which will significantly change ways of working needs to be clearly communicated, ideally in writing, to GP registrars 

If the collective action that your partner/partners or contractor decides to take will significantly change ways of working at the practice, and therefore your working day, this should be clearly communicated to you, preferably in writing. The changes made to how you work and the anticipated duration of these changes should be clearly explained, preferably in writing, to ensure shared understanding and clarity.  Any further changes to working patterns, for example if your practice ‘adds’ actions, should be communicated at least a week before implementation and with explanatory notes provided to staff. 

3. If collective action will change ways of working, changes to the GP registrar’s agreed work schedule should be made by mutual agreement 

Partners and contractors should hold discussions with their GP Registrar staff to clarify the proposed changes to work patterns as a result of collective action. Only by mutual agreement should changes be made to the GP registrar’s job plan, in particular given the contractual protections in place for GP registrars.

It should be clarified whether the changes are time limited (i.e. only for a period of collective action) or a permanent change. In particular, we expect the adoption of safe working principles to continue after the collective action period and become a permanent positive change for all of general practice. 

If the change is time limited, this should be outlined in the agreed work schedule and a date set for a proposed work schedule review. 

It is important for GP Registrars to feel able to be engaged in and supportive of collective action and this can be achieved by practices making concerted efforts to include all practice staff in conversations about the campaign, aims and desired outcomes. 

What to do if your practice/partners are not taking part in collective action

If your host organisation has not instructed you to work differently, you should continue to work as outlined in your contract and existing work schedule. 

It is important to note that GP partners and contractors are in dispute with Government but are not currently planning to strike or undertake other action that would breach their contracts. Accordingly, the collective action being called for now does not amount to industrial action governed by the Trade Union & Labour Relations (Consolidation) Act 1992 (TULRCA). GP partners and contractors can direct their staff to work in certain ways in order to take part in collective action. However, if a GP registrar takes part in collective action and this is not at the instruction of the host organisation, they could breach their employment contract and face disciplinary action or dismissal. Please ensure that before you take any action that this has been agreed with the partner or contractor at your practice.

What to do if your practice/partners are taking part in collective action but as a GP registrar you do not want to or you are unable to

As per usual practice working, GP registrars must follow the reasonable instructions of their practice in order to avoid being in breach of their contract. Changes to your job plan should only be implemented by mutual agreement. Where the action involves clinical judgement, however, normal Good Medical Practice principles apply and it is the individual’s responsibility to determine whether they can deliver safe patient care. 

If ultimately, the GP or GP registrar determines that specific action is against their clinical judgement, they must be able to demonstrate they have made the clinical decision in the patient’s best interest. If the individual has concerns about the safe delivery of patient care during the period of collective action, they should follow the GMC’s guidance on raising and acting on concerns about patient safety.

We would also highlight that, for GP registrars or resident doctors working within a GP setting employed by the Armed Forces, this would not be termed as actions they would be prohibited from undertaking as part of the actions currently set out. Should though we progress to other forms of actions, we will look to ensure that we inform these affected members as to whether any future action would constitute actions they would be prohibited from undertaking. 

Will undertaking collective action impact on GP registrar pay?

No. These actions are regarding the delivery of services as directed by the partners at each practice. This should not have any impact on the terms and conditions of GP registrars. If your host practice says they are having to change your employment conditions due to their participation in the action, please contact the BMA for advice.