First do no harm: a mandate for industrial action in general practice

Carter Singh is a GP in Nottinghamshire. He is the chairman of the Nottinghamshire LMC and a national council member of the RCGP.

The decision to take industrial action is always a last resort and is not taken lightly by the British Medical Association.¹

The decision to take industrial action is always a last resort and is not taken lightly by the British Medical Association.¹

For those who quote “patient harm” as an ethical/moral reason for not taking industrial action; what about the quantum of patient harm occurring due to systemic failures including the lack of investment?²

The harm occurring not just during the days when industrial action is taking place, which is broadcast ad-nauseum via the media outlets, but the harm occurring day-in day-out every week, month, year and decade due to an exodus of GPs, leaving the profession or the country?³

.The harm caused by low levels of recruitment into the profession therefore, piling more work onto dwindling workforce who are in some cases working beyond safe limits trying to right the wrongs not of their own making.⁴

The harm that is occurring due to the shift of un-resourced work from secondary/social care into general practice.⁵

The harm occurring due to taking GPs away from the front-line and tying them up with administrative tasks.⁶

The harm occurring due to 2187 less full-time GPs since 2015⁷ serving a population which has grown by 4%⁸ during the same period.

The harm occurring to GPs due to stress, burnout, depression and sadly the increased rates of death by suicide.⁹

Harm is what GPs are trying to prevent by safeguarding and protecting General Practice.

I would urge those who speak of harm to heed caution before selectively playing the ‘harm card’ to try and demonise and vilify GPs to create anti-GP rhetoric and engineer division between GPs and their patients.

GPs and patients are the best allies, but the relentless negative media narrative denigrates GPs by dividing and conquering.¹⁰ This is manifested in the low GP satisfaction ratings and the increase in abuse and complaints made against GPs.  Perhaps now is the time to flip this narrative and shift the focus of accountability onto the MPs rather than the GPs?

Industrial action is always an action of last resort and is never taken lightly, and although it is a crude and non-specific form of negotiation, it is often used when all other reasonable methods of negotiation have sadly failed.  It is rarely a choice but rather a cry for help.

Deputy editor’s note: see also

• Khan N, November 2022, https://bjgplife.com/healthcare-workers-balloting-for-strike-action-no-easy-choice/
• Sykes P, November 2015, https://bjgplife.com/junior-doctors-dispute-learning-from-previous-experience/

References

1. BMA, Doctors in England announce four days of joint strikes this autumn as juniors vote for six more months of industrial action, 31st August 2023,  https://www.bma.org.uk/bma-media-centre/doctors-in-england-announce-four-days-of-joint-strikes-this-autumn-as-juniors-vote-for-six-more-months-of-industrial-action
2. Essex R, Brophy S A, Sriram V. Strikes, patient outcomes, and the cost of failing to act, BMJ 2023; 380 :e072719 doi:10.1136/bmj-2022-072719
3. Khan N, Taking stock of the GP workforce crisis in the UK – a call to action, BJGPLife, 2022, https://bjgplife.com/taking-stock-of-the-gp-workforce-crisis-in-the-uk-a-call-to-action/
4. Shemtob L et al, Is it me or GP? Notes for a profession in difficulty, BJGPLife, 2022, https://bjgplife.com/is-it-me-or-gp-notes-for-a-profession-in-difficulty/
5. Rimmer A (2017) BMA, GPs must push back against work dumped on them by hospitals, says BMA. http://careers.bmj.com/careers/advice/GPs_must_push_back_against_work_dumped_on_them_by_hospitals_says BMA (accessed 20/9/23)
6. Gibson J, Checkland K, Coleman A, et al. Eighth national GP worklife survey2015www.population-health.manchester.ac.uk/healtheconomics/research/Reports/EighthNationalGPWorklifeSurveyreport/EighthNationalGPWorklifeSurveyreport.pdf(accessed 20/9/23)
7. https://digital.nhs.uk/data-and-information/publications/statistical/general-and-personal-medical-services
8. https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/articles/overviewoftheukpopulation/2020#uk-population-data
9. Gerada C. Doctors and suicide. Br J Gen Pract. 2018 Apr;68(669):168-169. DOI: https://doi.org/10.3399/bjgp18X695345
10. Barry E, Greenhalgh T. General practice in UK newspapers: an empirical analysis of over 400 articles. Br J Gen Pract. 2019 Feb;69(679):e146-e153. https://doi.org/10.3399/bjgp19X700757

Featured photo by Ehimetalor Akhere Unuabona on Unsplash