GPs in England have introduced a policy of imposing work rules in a dispute with the government. They say the government is short of funds. This threatens to lead to chaos in the system.

Surgeries are taking a range of measures, with some limiting the number of patients seen by each GP to 25 per day. Reduce the number of available appointments By one-third.

But since many patients are already having difficulty getting to a doctor, there are growing concerns that this could put patients at risk.

Dr. Tom Gorman says participating in work-to-rule is a last resort, but he’s forced to do it for the safety of his patients.

The 41-year-old has been a GP for eight years and says The system is at “breaking point”,

“We’re not able to serve our patients. They’re having trouble getting appointments. We don’t want to take any action, but we’re forced to do so to protect our patients and staff.”

There is ample data to support such claims.

The most recent British Social Attitudes Survey – the gold standard measure of public attitudes to the NHS – shows satisfaction with GPs has fallen to an all-time low.

moreover, NHS England polling data The report reveals that one in three people feel they have to wait too long for an appointment, while one in five people rated their experience of contacting their GP as poor.

Young adults and people in the poorest areas are the least happy.

As a partner in a practice in Newcastle, Dr Gorman is in charge of deciding what action to take next.

This is because GPs are effectively independent businesses – so this is not a strike or campaign of industrial action in the traditional sense.

The British Medical Association (BMA) recommends that G.P. Selecting from multiple options,

These include limiting the number of patients seen per day, not reserving tests and screenings for hospitals, ignoring rationing guidelines that could result in a flood of referrals for hospital care, and rejecting requests to share data.

Dr. Gorman said he and the other partners haven’t yet decided what steps they will take, but they definitely plan to participate.

“We are focused on stopping the huge amount of work that we are not contracted for or paid for – or that is unsafe to do.”

GPs believe this focus means that acting to the rules will not put them in breach of their contract under which they provide NHS services and should, therefore, avoid cuts to their funding.

Dr. Gorman gives the example of blood and other tests conducted by hospitals to illustrate his point.

“It’s more convenient for patients, but we often don’t get paid for it,” he says.

“We’re basically doing our own work and the hospital’s.”

Dr Samira Masood, a GP in Kent, agrees. She has worked as a locum in recent years, giving her the freedom to choose her own working hours, because the pressure of the job became too much.

“We are expected to see a lot of patients, work late into the evening and take appointments. This is not safe and leads to burnout.

“I was seeing 35 to 40 patients a day and you can’t give them the time they need. Limiting the number of patients can make things a lot better for GPs and patients.”

Of course, restricting numbers has a negative impact – it makes it harder to get an appointment for all patients who want to see a GP.

NHS England has warned the rules could lead to more people seeking help from A&ES, as well as have wider impacts on the system, such as delays in discharge from hospital.

And patient watchdog Healthwatch England believes this could ultimately harm patients.

“GP access is the most common issue we hear about,” says chief executive Louise Ansari.

“We’re concerned that following the rules could make problems worse or even discourage people from seeking help.”

“Any delay in care can have a huge impact on people’s physical and mental health.”

Even some GPs share this concern.

A snapshot survey of more than 250 GPs by the medical journal Pulse released this week showed one in four believed routine work could cause harm in the short term.

However, half of people said they were willing to continue working indefinitely.

Now a lot depends on how many GPs participate in it.

The numbers involved are still unclear since work-to-rule was announced by the BMA at the beginning of August.

It is unlikely that all GPs will join in – after all, only two thirds are union members – and the BMA itself has said it hopes this will be “slow”, with GPs gradually increasing the pressure.

The core issue of contention is money. Earlier this year the previous government announced that funding for general practice would be increased by around 2%.

The BMA recognised this was not enough, and put members to a poll ahead of the election.

The independent status of GP surgeries means that the staff working for them are not directly employed by the NHS, so while nurses and doctors did strike because of last year’s pay awards, they were not the reason for the strike.

The new Government has already said it will pump more money into this, and Health Secretary Wes Streeting has urged GPs to end their work schedules.

Dr Bex Fisher, director of research and policy at the Nuffield Trust think tank, believes more than a one-off stimulus will be needed to end the problem, as financing has been “lagging behind demand and inflation” for years.

The result? A crisis of recruitment and retention. Despite big promises to increase the number of GPs during the last two parliaments, the Tories have failed to get anywhere near the targets they set.

This means that the number of patients per GP is rising, and crucially, the people most likely to leave a GP are those under the age of 30 – the very group on which the future of general medicine depends.

Dr Fisher says the controversy is likely to continue until the field is put on a more “stable footing”.

“GPs don’t like feeling like they aren’t able to provide patients with the high-quality care they deserve,” she adds.

Research and data analysis by Hannah Karpeles