Classification: Official
Publication reference: PRN01446

To:

Integrated care boards:

• chief executives
• chief operating officers
• chairs
• chief people officers/HR directors
• medical directors/chief medical officers
• directors of nursing
• directors/heads of primary care
• directors of pharmacy/chief pharmacists

Trusts:

• chief executives  
• chief operating officers
• chief people officers/HR directors
• medical directors
• directors of nursing

cc.

NHS England regional teams:

• regional directors
• P&I directors
• medical directors
• chief pharmacists
• directors of nursing
• heads of EPRR
• directors of primary care
• primary care medical directors
• directors of commissioning

Dear Colleagues,

Planning for potential ‘collective action’ by general practice from 1 August 2024

This letter provides information on NHS England’s approach to pre-action self-assessment and reporting ahead of potential upcoming ‘collective action’ by general practitioner members of the British Medical Association (BMA).

The BMA is balloting its GP contractor/partner members in England through a non-statutory ballot currently due to conclude on 29 July. Whilst the ballot remains open – and the degree of participation by GP practices in any collective action is uncertain – the BMA have indicated that they will encourage participating practices to take part at scale from 1 August.

It remains our hope that action will be averted. However, whilst discussions take place it is important we plan for all contingencies to keep patients safe – as we have in other periods of industrial action. We are committed to having arrangements in place that manage the impacts in a reasonable worst-case scenario.

Expectations for regional and integrated care board planning

The BMA has announced nine potential action areas (see Protect your patients, protect your GP practice (bma.org.uk)) for members to consider reducing or ceasing activity, however each practice will decide which actions they will take and at what point.

Regional and ICB level Primary Care and EPRR teams should already be working jointly to plan ahead and identify any services or practices of concern in their area. This work should now intensify and involve Mental Health, AHP, Nursing, children and young people’s services, as well as elective and UEC team input at a both regional and local level.

There should be open lines of communication with local GP practices and Local Medical Committees (LMCs) to ensure ICBs are made aware of any proposed service changes in a timely manner. The BMA’s General Practice Committee (GPC) have stated that they will not ask practices to breach their contract during collective action. Where practices do change their service offer, commissioners may need to seek assurance from participating practices that national and local contractual requirements continue to be met.

Clinical input and leadership are vital. Regions and Integrated Care Boards (ICBs) should draw on the expertise of their primary care teams in anticipating and managing changes to service levels in primary care but must take a whole system view of potential impacts and risks to patients when planning ahead.

Planning should therefore take into account the secondary impacts and consequences which may occur – such as potential pressure/congestion on UEC, elective and discharge pathways (if primary care access is reduced) – and impacts on mental health and community pathways (such as mental health crisis teams, urgent community response, children and young people’s services, midwifery, intermediate care, falls prevention, and Enhanced Health in Care Homes services).

There may be short, medium, and longer-term changes to patient flows between and across primary care, 999, 111, and UTCs/MIUs; and planning should also seek to understand any potential impacts on diagnostic and elective activity. As in other disputes, maintaining services for patients with urgent needs, such as those with deteriorating conditions, meeting urgent diagnostic requirements, and ensuring timely triage to essential services will be key.

National planning assumptions (and caveats) will be communicated via regional teams in due course.

Communications to patients about GP collective action should provide clear instructions on how they can continue to access services. A communications toolkit for use by ICBs and Regional teams is in development and will be cascaded via Regional Head of Communications separately, in due course. This toolkit will provide national messaging, however messaging at ICB level will need to reflect local mitigations and arrangements. It is also vital that Practices have in place plans to pro-actively communicate any changes of services to patients, both to ensure safe continuity of care and to avoid additional demand upon practices for information on the changes.

Decision-making and oversight arrangements

Given uncertainty regarding the scale and whole system impacts of the collective action, ICBs are asked to stand-up proportionate incident management arrangements during August to allow any initial operational and patient safety risks to be identified and managed.

Enhanced incident management arrangements may also be put in place at national and regional level in early August, as required.

Consideration should be given to a decision-making infrastructure that can scale up and down in light of the local impacts seen in early August and then can be sustained by Primary care and supporting teams over coming weeks and months, given that collective action could continue and evolve over an extended period.

Arrangements might for example be based on existing System Control Centre meetings or Primary care oversight meetings, leveraging in additional expertise as needed.

Early intelligence and readiness return – ICB requirement and deadlines

Recognising that this is an evolving picture, a self-assessment of readiness is requested from ICBs. The template seeks to capture an initial ICB level view of anticipated impacts, not practice-by-practice. The information provided will help identify common areas of risk and inform national decision-making and support.

We are not requesting that ICBs contact each individual practice to ascertain their intent and appreciate in many cases it may not yet be fully clear which actions individual practices are likely to take, nor is it clear whether all practices will take part. Likewise assessments of wider system impacts are likely to be best estimates. ICBs are asked to complete the document to the best of their understanding, based on local area teams, existing relationships, and other local intelligence.

Collation of feedback will be through existing regional and national incident planning and management meetings and then a single written return:

• Initial assessments and concerns can be fed into national-regional Primary Care-led ‘deep dive’ meetings which are occurring through early and mid-July.
• A verbal ICB by ICB updates on plans, readiness, risks, and areas for national support will be subject to check and challenge at the IA Working group on Thursday 25 July 2024. 
• A written return will then be required from each ICB detailing their near final position on 30 July. Regional colleagues will be in touch with ICBs to confirm the exact date and timings for ICBs to submit their returns to their Regional Operations Centre (ROC). These written ICB self-assessment returns will be reviewed by regional and national teams and discussed at the national IA Working Group during the afternoon of Tuesday 30 July 2024.

Early intelligence and readiness return – regional role

Regional Operations Centres (ROCs) are asked to work with their regional Primary Care and EPRR colleagues to ensure a comprehensive and accurate overview of local preparations and to identify service and geographical areas of concern across all ICBs.

Where ICBs indicate there are practices or services of concern and the return lacks detailed information, the ROC or other NHS England regional colleagues should contact the ICB for further details.

Regional Primary Care leads (commissioning and medical directors) and EPRR leads for industrial action, will be invited to the meetings listed above.

Thank you for your ongoing cooperation and assistance. We appreciate your dedicated efforts to deliver the highest quality care to NHS patients during this period of collective action. Should you have any queries, please reach out to your regional team.

Yours sincerely,

Mike Prentice, National Director for NHS Resilience, NHS England
Dr Amanda Doyle OBE, MRCGP, National Director Primary Care and Community Services, NHS England