A strategy in need of surgery?

In the last few weeks, general practitioners (GPs) in the UK have announced what they describe as “collective action”.  For the first time in 60 years, GPs have adopted an approach involving restricting their work to achieve their objective of better pay and funding.  This action is at the discretion of individual GP practices and was backed by a huge majority in a ballot.  The last government offered them a 1.9% funding increase for this year which the BMA (the doctors’ union) considers inadequate and has now demanded 11%.  The new Health Secretary, Wes Streeting has made sympathetic noises and spoken of his desire to build a new partnership with GPs.  Streeting has backed a recommended above-inflation 6% pay increase for GPs and their teams – a 4.1% uplift to GP contract funding on top of the 1.9% rise. 

This dispute is set against the background of the resolution, shortly after the new government came into office, of the junior doctors’ long-running dispute with a 22% unconditional 2-year deal which is yet to be accepted.  Also, a two-year dispute with train drivers has recently been the subject of another unconditional 15% three-year offer which is being recommended for acceptance.  It could be the case that the GPs reflect on the government’s approach and the recent public sector pay award of just over 5% accompanied by the Chancellor’s statement that it is “cheaper than strikes” and decide that pressure works so why not apply it.

When you negotiate, your power will emanate from having the ability to inflict damage by doing something your counterparty doesn’t want you to do – strike or impose restrictions or unfavourable conditions or even end a relationship – or from your ability to empower both parties to achieve something they want.  Right now, I see Streeting as being on the back foot with the GPs – they are exerting pressure on the NHS and him and his concession to the junior doctors does not serve him well as a tactical precedent.  The approach of the GPs is understandable because it has been successful for others.  However, with a new government and the virtual certainty that they will be in office for at least the next five years, the Health Secretary has a strategic opportunity.  He could paint a long-term vision of an NHS which the GPs would support and he could release funding and pay increases as the vision is achieved within an agreed timescale.  That approach may need some financial priming now to get buy-in but if the ultimate objective and the route to it and changes needed are agreed as part of the deal then he has an opportunity to define and build the partnership he has spoken of.  Yet more unilateral concessions will, I predict, reinforce the current precedent and lead to yet more pressure and action in the public sector.

This may be an opportunity to change the dynamic of relationships in the NHS and move from the image of perpetually aggrieved staff, industrial action and budgetary restrictions to a government and staff agreeing a future, knowing what it will cost the parties in terms of finance and working practices and committing to work towards it.  Consensus generally can achieve more than conflict – building a shared vision will be the critical part but let us hope that, with the will to achieve, it can be done.