Phase one of collective action involves different possible actions, which will impact salaried GPs in different ways. 

The actions which will directly impact salaried GPs are: 

• Limit daily patient contacts per clinician to the internationally recommended safe maximum of 25.(i) 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, investigations, 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. (ii)
• 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 employer has decided the practice will be participating in collective action

1. Partners or contractors should instruct salaried GPs what action the practice will be taking

If your practice decides to undertake any of the above actions, you should expect to be instructed by your employer to change your way of working.

For collective action to be effective, it is imperative that contractors or partners who participate in collective action to instruct the salaried GPs they employ to take the same action. Collective action will be most effective when the changes to working are adopted by the entire clinical team, including sessional GPs. 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 salaried GPs

If the collective action that your partner 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 salaried GP’s job plan should be made by mutual agreement

Partners and contractors should hold discussions with their salaried GP 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 salaried GP’s job plan. 

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, and this should be reflected in salaried GPs’ job plans. 

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

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

If your practice or partner is taking part in collective action but does not want you to

As per usual practice working, salaried GPs must follow the reasonable instructions of their employer in order to avoid being in breach of their contract. If your employer has not instructed you to work differently, you should continue to work as outlined in your contract and existing job plan. 

If the partners or contractors at your practice have decided to implement some actions to take part in GPC England’s organised campaign, but you are not being directed to work differently, this could be because they have opted for action which does not directly impact on sessional GPs.

For example: 

• Serve notice on any voluntary services currently undertaken which plug local commissioning gaps.
• Switch off Medicines Optimisation Software embedded by the local ICB for the purposes of system financial savings and/or rationing, rather than the clinical benefit of your patients.
• Switch off GPConnect (iii) functionality to permit the entry of coding into the GP clinical record by third-party providers.
• Withdraw permission for data sharing agreements which exclusively use data for secondary purposes (i.e. not direct care). Read our guidance on GP data sharing and GP data controllership.
• Freeze sign-up to any new data sharing agreements or local system data sharing platforms. Read our guidance on GP data sharing and GP data controllership.

Alternatively, if your employer has introduced collective action measures which should result in a change to the way salaried GPs in your practice work, such as the recommended safe maximum of 25 patient contacts, but has only enabled/instructed contractors or partners to work in this way, please contact the BMA for advice.

If your practice or partner is not taking part in collective action

If your employer has not instructed you to work differently, you should continue to work as outlined in your contract and existing job plan. 

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 salaried GP takes part in collective action and this is not at the instruction of the contractor or partner they work for, they could breach their employment contract and face disciplinary action or dismissal. 

If your practice or partner is taking part in collective action but you do not want to

As per usual practice working, salaried GPs must follow the reasonable instructions of their employer 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 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 on raising and acting on concerns about patient safety.

Will undertaking collective action impact on salaried GP 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 salaried GPs. If your employer says they are having to change your employment conditions (e.g. pay, working hours, etc.) due to their participation in the action, please contact the BMA for advice.