Exclusive: NHSE leak reveals GP ‘work to rule’ could cost £570m in four months

The NHS England document seen by HSJ (see below) calculates that, based on a 30 per cent reduction in GP activity from August to November, the cost of work diverted to other services would be £569m.

This includes more than a million extra A&E attendances, and nearly two million more pharmacy visits, as well as many extra calls to 111 and urgent care centre visits. 

NHSE’s modelling also includes a less severe scenario, where GPs reduce activity by 10 per cent for four months – but even under this scenario projected costs could hit around £205m and nearly 250,000 extra referrals could be generated.

The British Medical Association GP Committee announced last week that GP partners had voted overwhelmingly to scale down work that goes “above and beyond” their contract, in an unprecedented move.

This could include a range of “work to rule”-style actions, including: capping daily appointments; stopping “rationing referrals, investigations and admissions”; and stopping using “e-referral advice & guidance”.

HSJ understands system leaders are finding it hard to predict how much action GPs will ultimately take, but believes the impact will likely ramp up in a “slow burn” over coming months.

The figures lay bare the potentially profound impact service reductions could inflict if GP partners take a robust approach. The financial cost to the service follows an estimated £1.7bn bill for strike costs, mostly for action by junior doctors and consultants, in 2023-24. 

NHSE was given extra money to cover some of those costs, although the service was also forced to cut back activity and development plans.

Under the 30 per cent scenario, the £569m costs over the four months comes from several sources, as set out in the slide. These include an extra 1.2m A&E attendances (£319m); 492,000 elective referrals (£104m); 736,000 urgent care centres attendances (£67m); 1.8m more pharmacy visits (£27m) and 1.8m more calls to NHS 111 (£21m).

Other projected scenarios NHSE has modelled included a 10 per cent reduction in GP activity for the same four months.

This could lead to projected costs of £205m, including 389,000 extra A&E attendances (£106m); 246,000 extra elective referrals (£52m); 245,000 UTC attendances (£22m) and around £9m of pharmacy costs.

The NHSE slide also calculates the impact of scenarios of a 10 per cent or 30 per cent reduction for a single month, August. These projections suggest a 10 per cent in-month reduction would cost around £37m, while a 30 per cent reduction would cost £103m with 43,000 or 86,000 additional elective referrals respectively.

The BMA GP Committee has not said how long the action is planned for, and there is no legal end-point, but it has been holding talks with the health and social care secretary Wes Streeting, to talk about pay and other concerns.

An NHSE spokesperson told HSJ: “As collective action has only just started, it’s not clear yet what the system-wide impact is and we are monitoring the situation closely, including working with [integrated care boards] to undertake modelling, which will be updated once we have confirmed information.

“We are continuing to work with GPs, the BMA and the government to resolve and end the action, including accepting the 6 per cent DDRB uplift and adding GPs to the ARRS scheme.”

In its statement announcing the GP collective action, BMA GPC chair Katie Bramall-Stainer said the “funding crisis in general practice” meant practices “are struggling to keep the lights on, can’t afford to hire much-needed GPs and other staff, and some have even closed for good”.

She said: “This will not be a ‘big bang’. It will be a slow burn. It’s likely that impact may not be felt for some time. We hope this will give the new government time to consider our proposed solutions including fixing our contract once and for all.”