The British Medical Association, the self-ascribed “leading trade union and professional association for doctors and medical students across the UK”, announced at the end of May that the GP Committee for England had voted ‘overwhelmingly’ in favour of ‘Plan B’. They have not actually released the voting numbers, so we are left to guess what sort of majority ‘overwhelming’ might represent. Up to this point, I had not really heard about Plan B, and assuming many readers here may be similar. It merits some detailed discussion below, but put simply it is a proposal to shift all GP healthcare in England to a means-tested, subscription-based service, such as those being offered currently by NHS dentists.
Plan B takes the view that the current GP contracts in England are failing both patients and practices, and that due, to these failings more and more GPs are opting to work outside the NHS. In response to this, the GP Committee are calling for new GP contracts which will allow GPs to provide private services to their NHS patients when those services are not contractually available to them. BMA GPs Committee chair Dr Katie Bramall said:
Under current contractual arrangements, GPs are prevented from meeting patient demand for some services. These obstacles limit our ability to deliver the care patients ask for or deserve, restricting clinical flexibility.
Plan B, would enable GPs to offer NHS patients private healthcare services. These services, paid for out of pocket or via insurance, are currently not available through the publicly funded NHS, which is currently funded through patients paying tax. We might think about this as countervailing power move #1 on the part of the BMA.
The BMA then goes onto state that they:
believe that general practice within the NHS is no longer financially viable and a move towards a hybrid NHS and private GP service is the only option for the future.
The reason presented for this radical restructuring of NHS care is placed firmly at the door of Government. This stems from concerns around the new contract between GPs and Government, which includes demands to provide unlimited access, with GP practices required to provide same-day appointments for patients with urgent clinical needs. They are to be unlimited in the sense that practices will be forbidden from capping the number of consultation responses they can provide . So here we might consider this countervailing power move #2, on the part of the BMA, whereby rising workloads created by this new contract are cited as a reason for rationing access to healthcare (through means testing).
It is the imposition of the new contract with its ‘unreasonable demands’ that forces this change. The motion goes further by calling for a national strategy to enable GPs to exit the General Medical Services contract and to work outside the NHS. This is countervailing power move #3. The net result of all these changes is a means-tested, subscription-based service, modeled on the one currently being offered by NHS dentists (move #4).
For me, a good indicator of relevant and robust sociological theorising is when we can see that theory in practice, when the underlying tenets of a theoretical approach are writ large in the events unfolding before us. I have previously researched many similar processes around Donald Light’s theoretical work on countervailing powers. The proposed changes to the GMC contract can loosely be characterised as a buyers’ revolt, whereby the single payer state (the government) seeks to impose and direct the practices of the monopoly provider (the medical profession), accomplished through various appeals to improving the quality of the service for the patients. What Plan B represents, I would argue, are the countermoves, on the part of the monopoly provider intended to force a backdown by the single payer. This is a game of move and countermove that has been played out across UK healthcare since 1948 (or even before). Quite how this spat will play out is still up for debate, but the threat to blur the boundary between public and private practice clearly demonstrations of the extent to which the BMA is committed to resisting the imposition of the new contract.
I don’t intend to propose how this will all play out. Rather, what is of interest in the current context, from my sociological perspective, is how the topic of the GMC contract has become the arena in which these countervailing moves have played out. Disputes over contracts have happened before, and typically, have resulted in industrial action. For example, the imposition of the new Junior Doctors Contract in 2016 resulted in a prolonged period of industrial action, with these issues ultimately resolved in 2024, with the settlement in favour of the monopoly providers (e.g. a substantial pay uplift and creation of resident doctors rather than junior doctors). In this instance, the monopoly provider won out over the single payer. Directing their countervailing moves at the contract itself represents a strategic development that suggests that the stakes are much higher this time around. It is almost as if the profession is playing its trump card early, in a way I am not sure we have seen before. Certainly, there was no talk of withdrawing from the GMC contract in the context of the 2012 Health and Social Care Act, in a set of policy changes so vast they were described by the then NHS Chief Executive as being visible from space. For me, this raises a question of why the threat of withdrawal from the GMC contract was not a central plank of strategy back in 2010.
In previous research, we outlined how the imposition of the 2012 Health and Social Care Act marked a countervailing victory for the single-payer state, by determining changes in the mode of delivery of healthcare services, in a way that constrained or limited the power of the monopoly provider. Maybe what we are seeing now, in terms of the Plan B strategy, is GPs and the BMA learning from previous disputes. Perhaps Plan B marks a new departure in the countervailing moves being played out across the monopoly providers and the single payers. It strikes me that it is a dangerous game of bluff and counterbluff, and if the single payers call their bluff, and the BMA fail to remove themselves from the GMC, then it would be a spectacular failure of industrial relations strategy. Whether or not the BMA is ‘crying wolf’ remains to be seen, and it is something we should all be paying attention to.
If plan A doesn’t work, move to plan B…
by Ewen Speed Jun 17, 2026The British Medical Association, the self-ascribed “leading trade union and professional association for doctors and medical students across the UK”, announced at the end of May that the GP Committee for England had voted ‘overwhelmingly’ in favour of ‘Plan B’. They have not actually released the voting numbers, so we are left to guess what sort of majority ‘overwhelming’ might represent. Up to this point, I had not really heard about Plan B, and assuming many readers here may be similar. It merits some detailed discussion below, but put simply it is a proposal to shift all GP healthcare in England to a means-tested, subscription-based service, such as those being offered currently by NHS dentists.
Plan B takes the view that the current GP contracts in England are failing both patients and practices, and that due, to these failings more and more GPs are opting to work outside the NHS. In response to this, the GP Committee are calling for new GP contracts which will allow GPs to provide private services to their NHS patients when those services are not contractually available to them. BMA GPs Committee chair Dr Katie Bramall said:
Plan B, would enable GPs to offer NHS patients private healthcare services. These services, paid for out of pocket or via insurance, are currently not available through the publicly funded NHS, which is currently funded through patients paying tax. We might think about this as countervailing power move #1 on the part of the BMA.
The BMA then goes onto state that they:
The reason presented for this radical restructuring of NHS care is placed firmly at the door of Government. This stems from concerns around the new contract between GPs and Government, which includes demands to provide unlimited access, with GP practices required to provide same-day appointments for patients with urgent clinical needs. They are to be unlimited in the sense that practices will be forbidden from capping the number of consultation responses they can provide . So here we might consider this countervailing power move #2, on the part of the BMA, whereby rising workloads created by this new contract are cited as a reason for rationing access to healthcare (through means testing).
It is the imposition of the new contract with its ‘unreasonable demands’ that forces this change. The motion goes further by calling for a national strategy to enable GPs to exit the General Medical Services contract and to work outside the NHS. This is countervailing power move #3. The net result of all these changes is a means-tested, subscription-based service, modeled on the one currently being offered by NHS dentists (move #4).
For me, a good indicator of relevant and robust sociological theorising is when we can see that theory in practice, when the underlying tenets of a theoretical approach are writ large in the events unfolding before us. I have previously researched many similar processes around Donald Light’s theoretical work on countervailing powers. The proposed changes to the GMC contract can loosely be characterised as a buyers’ revolt, whereby the single payer state (the government) seeks to impose and direct the practices of the monopoly provider (the medical profession), accomplished through various appeals to improving the quality of the service for the patients. What Plan B represents, I would argue, are the countermoves, on the part of the monopoly provider intended to force a backdown by the single payer. This is a game of move and countermove that has been played out across UK healthcare since 1948 (or even before). Quite how this spat will play out is still up for debate, but the threat to blur the boundary between public and private practice clearly demonstrations of the extent to which the BMA is committed to resisting the imposition of the new contract.
I don’t intend to propose how this will all play out. Rather, what is of interest in the current context, from my sociological perspective, is how the topic of the GMC contract has become the arena in which these countervailing moves have played out. Disputes over contracts have happened before, and typically, have resulted in industrial action. For example, the imposition of the new Junior Doctors Contract in 2016 resulted in a prolonged period of industrial action, with these issues ultimately resolved in 2024, with the settlement in favour of the monopoly providers (e.g. a substantial pay uplift and creation of resident doctors rather than junior doctors). In this instance, the monopoly provider won out over the single payer. Directing their countervailing moves at the contract itself represents a strategic development that suggests that the stakes are much higher this time around. It is almost as if the profession is playing its trump card early, in a way I am not sure we have seen before. Certainly, there was no talk of withdrawing from the GMC contract in the context of the 2012 Health and Social Care Act, in a set of policy changes so vast they were described by the then NHS Chief Executive as being visible from space. For me, this raises a question of why the threat of withdrawal from the GMC contract was not a central plank of strategy back in 2010.
In previous research, we outlined how the imposition of the 2012 Health and Social Care Act marked a countervailing victory for the single-payer state, by determining changes in the mode of delivery of healthcare services, in a way that constrained or limited the power of the monopoly provider. Maybe what we are seeing now, in terms of the Plan B strategy, is GPs and the BMA learning from previous disputes. Perhaps Plan B marks a new departure in the countervailing moves being played out across the monopoly providers and the single payers. It strikes me that it is a dangerous game of bluff and counterbluff, and if the single payers call their bluff, and the BMA fail to remove themselves from the GMC, then it would be a spectacular failure of industrial relations strategy. Whether or not the BMA is ‘crying wolf’ remains to be seen, and it is something we should all be paying attention to.