GPs in Northern Ireland could potentially curb the number of patients they see in dispute with Department of Health says BMA figure
GPs in Northern Ireland look set to consider the "collective action" they can take over a dispute which has erupted with Department of Health.
This could involve, for instance, curbing the number of patients that are seen by a surgery each day.
Frances O'Hagan, chairwoman of the GP committee at the Northern Irish branch of the British Medical Association (BMA), told the News Letter that this is in response to what she said is the "incredible" disrespect shown by the health minister Mike Nesbitt this week.
The dispute stems from the annual update to the contract between GPs and the department.
Effectively, GPs' surgeries operate a bit like small businesses, with the the practice partners covering running costs, employing staff, and paying themselves.
Dr O'Hagan said that the funding stream breaks down roughly as follows.
About 60% of GPs' money comes from "core funding" – meaning a sum paid out for every patient on a surgery's books.
This varies from area to area, and she gave the rough range as being about £60 to £110 per head.
The remaining 40% of GPs' money comes from providing services like vaccinations, minor surgeries, or visits to care homes, for which they get a fee.
"After everything else that's paid, we get what's left," said Dr O'Hagan, adding that the amount that GPs individually earn can very from place to place and month to month.
She said the deal offered to GPs this year involved an extra £1m or so for the core funding budget (amounting to an extra "50p per patient per year", and coming with 17 conditions attached including letting patients book in at reception, and keeping a dedicated phone line free for the department to get through).
Added to that is £3.5m to cover the cost of Labour's National Insurance hike ("but that's cost-neutral – it's no actual funding in practices for us to do anything"), and a £5m subsidy to fund GPs' insurance costs (though Dr O'Hagan said that this does not cover locums – doctors who work freelance and are not tied specifically to any one surgery).
Dr O'Hagan said that this had been put to BMA members, and they voted resoundingly against it.
Despite this, Mr Nesbitt took the "seismic" decision on Monday to impose it anyway.
"It is incredible how disrespectful he had been," she said.
So what will happen next?
"GPs are going to look at all their options," she said.
"Some individual GPs will just say 'this isn't enough for me to keep the lights on and the doors open' and they will hand their contract back.
"We absolutely don't want that to happen, because that just is so unfair to patients, and also it's a real moral injury to those GPs as well."
Those quitting GPs could go to GB or the Republic where pay is better, or may become locums.
But what might the BMA do about it collectively?
Dr O'Hagan said that GP's contacts mean "technically we can't strike, because we're independent contractors".
"But there is action we can take that is short of strike action called 'collective action'.
"We need to get very clear advice on actions we can take but this has been done in England... GPs do an awful lot more than we're actually contracted to do.
"In England what they said was they will work to their contract, and not necessarily do things they're not contracted to do that are other people's jobs."
They also limited themselves to "seeing a safe number of patients per day".
It was put to her that this sounds like “work to rule”.
“I suppose, yes, you could, you could put it that way,” she said. “We prefer to call it ‘working safely’.”
In response to the BMA charge of “disrespect”, the department referred the News Letter to the minister’s statement of a day earlier when he said: “When I took up post, the last thing I was looking for was a fight. I have huge respect for the tens of thousands of wonderful colleagues who deliver excellent healthcare each and every day in Northern Ireland…
"I am not saying I am the best friend GPs could have hoped for as Minister of Health, because I am sure every Minister before me has cherished primary care. But I do hope they understand it is a key focus.
“That said, I did not come into post to make promises I could not keep or agree to demands that the budget cannot possibly satisfy.”
Speaking in the Assembly today, Mr Nesbitt was asked how many GPs have “handed back” their contracts in recent years (meaning how many surgeries have closed).
The minister said: “Regretably, there have been 16 handbacks since the financial year 2023/24 – 11 in 2023/24, five in 2024/25.”