The must-read stories and debate in health policy and leadership.

GPs will limit the number of appointments per day and refuse to carry out additional work if a ballot announced yesterday by the British Medical Association is successful.

The BMA’s GP committee voted to launch the ballot on “collective action” following a dispute with NHS England over the 2024–25 contract, which saw a funding uplift of 1.9 per cent.

A majority vote would mean GPs might limit the number of patient appointments per GP per day to 25 — the maximum safe level the BMA has pushed for since 2016. 

GPs would also stop or reduce workloads that have been shifted to primary care from hospitals. This could include completing fit notes, prescriptions, investigations or asking trusts to communicate with patients about re-booking hospital appointments. 

A full GP strike — in which GPs would refuse to carry out contracted work — has been ruled out for now. As independent contractors, GP partners would be in breach of their contract and fully liable, regardless of the result of a union vote. 

The move would be the first time GPs have taken action of this kind since 2012, when they struck over pensions, alongside other medics.

The ballot will open on 17 June and close on 29 July.

Cull complete

NHSE has completed its restructuring, slashing its workforce by 30 per cent, marking one of the largest public sector overhauls in the UK.

According to a report presented to NHSE’s board yesterday, the trio involved — NHSE, Health Education England and NHS Digital — collectively employed 24,300 staff at the outset in 2022–23. This number has since dropped by 30 per cent.

Over the next two years, NHSE plans to shift more roles to integrated care boards due to devolution initiatives, such as specialised commissioning and vaccination and screening services. This move will result in a total reduction of 36 per cent, leaving NHSE with 15,300 remaining positions. Additionally, NHSE is keeping around 800 (5 per cent) posts vacant to curb costs.

Released figures indicate a slight uptick in the proportion of NHSE staff from minority ethnic backgrounds and those with disabilities. However, gender and sexuality representation, as well as non-white staff in senior roles, remain largely unchanged.

Many NHSE employees expressed concerns about the restructuring process, feeling mistreated and misled.

Also on hsj.co.uk

In The Integrator, Dave West looks at the “race to the bottom” of incentives for local NHS productivity, and in Comment, Rich Pugmire makes the case for the NHS to adopt an open-platform approach to achieve AI innovation and sustainability.