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Senior figures within the British Medical Association have urged GP surgeries to ‘overwhelm’ hospital emergency departments in an alleged attempt to ‘sabotage’ Pharmacy First, which the union leaders claim is designed to “undermine” general practice.

In a letter seen by The Times, Dr Becky Haines and Dr Paul Evans, region leaders of the BMA’s general practice committee, shared their advice to surgeries on how to protest government measures implemented on October 1 that require surgeries to enable online appointment booking. The doctors wrote in their capacity as members of the North East and North Cumbria Local Medical Committee (NENC LMC).

They urged colleagues to send a warning message to NHS England (NHSE) and their local Integrated Care Boards (ICBs) by sending patients to emergency departments, which commissioners are anxious not to see “overwhelmed”. 

The letter states that instead of following the NHS guidance to refer certain minor illness queries to the Pharmacy First service, GPs should reply to patients attempting to make online bookings with text messages such as: “Attend your nearest emergency department/A&E immediately.”

The letter states: “You will note there is no ­option to divert to pharmacy — this is because Pharmacy First is a scheme that by design has significant potential to undermine us and, frankly, [NHE] want us to get patients used to being seen by less-skilled people, to ­further enable the steady downgrading of patient expectations.

“If you’re diverting urgently, please use ED as this is the only part of the system that ICB/NHSE do not want to see overwhelmed.”

This passage was deleted from a subsequent version of the letter, reports The Times, which also quotes the letter writers as saying it was sent in error and that their signatures were added to it without their knowledge.

“Patient safety is our number-one priority,” said the BMA in response to questions on the letter's potential impact on the health service and patient safety. 

The union added: "This was not a BMA communication. We had no role in its drafting or dissemination, and its content does not represent the position of the BMA or GPC England. 

"Whilst we expect all general practices to comply with the regulatory and contractual changes introduced by the Government on 1 October 2025, we remind GPs to review their online consult tool processes, ensuring where possible that measures are in place to prevent urgent requests from being submitted erroneously. The number one priority for the BMA and its members continues to be patient safety.

P3pharmacy has requested a comment from Dr Haines and Dr Evan, both of whom are Gateshead GPs.

Commenting on the letter, one pharmacist said it was a “disgrace” and “wholly unethical,” with another describing the “militant behaviour” as increasingly “tiring”.  

Leyla Hannbeck, chief executive of the Independent Pharmacies Association, said the IPA was “shocked” at the letter. 

Ms Hannbeck added: “The NHS can only meet patient demand by working together and local pharmacies are an essential part of the mix. As the 'front door' of the NHS, pharmacies play a key role and Pharmacy First enables them to provide patients with appropriate immediate treatment for a range of minor conditions.

“In a recent Health Watch report nearly 80 per cent of patients who had used the Pharmacy First service said they would use it again. Patients like the accessibility, convenience and professionalism of community pharmacies. Does it not matter to those who drafted that letter what patients want?

“If we are to deliver the Neighbourhood Health Service patients deserve, GPs need to work together with their local pharmacists rather than engaging in any sort of 'turf war' that would have made a 1970s trade unionist blush. 

“As always, as a sector we are very happy to work with our GP colleagues and the BMA for the benefit of patients care.”

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