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Pulse’s contract verdict: As good as it could have been

Editor’s blog

The cynic in me thinks that the furore over GPs conducting care homes visits was a kite flying exercise by NHS England, designed to make GPs grateful for whatever they get.

If so, it has worked. The reaction to the new contract has been fairly positive. Our verdict is that it is as good as could have been. Let us emphasise that ‘as it could have been’ is doing a lot of work in that sentence.

Because political realities mean that it would’ve been impossible for NHS England and the BMA to come up with much better. Everyone (even, I suspect, NHS England) would love to see GPs being given money to just get on with their job, without strings attached. We’d all love the CQC inspection process to be overhauled, so it actually helps practices, rather than become a burden. We’d all love new services to immediately triage patients who have no need for a GP practice away from the GP practice.

But, let’s face it, this was never going to happen. Even with this rather modest boost to general practice, I’ve seen some experts on social media talk about ‘mouths being stuffed with gold’.

So the GPC and NHS England should be congratulated. The £20k incentive for GPs to become partners is a decent outcome (even if it doesn’t sound much when spread over the five years that GPs will need to stay partners, and taking into account tax and superannuation).

Political realities mean that it would’ve been impossible to come up with much better

The funding for new staff will reach £1.13m for an average PCN by 2022/23, and the introduction of mental health workers and potentially advanced nurse practitioners should help alleviate workload. Whether there are enough out there is another matter altogether.

The service specifications are certainly an improvement on the draft ones and, indeed, if anyone saw the mention of enhanced care home support in last year’s contract, then the outcome is probably half-way between their biggest hopes and worst fears.

Again, the global sum increase of 4% is not too bad – unless you are an MPIG practice, or one that relies on seniority payments.

One thing that is looming is the ‘patient experience’ measures. There isn’t much detail, but the contract does say these will be linked to incentives. But there’s a thin line between the carrot and the stick – I fear that practices who score low on these measures may find themselves facing punishment.

This is not the time for GPs to celebrate in the streets. But it might be the best they could’ve hoped for.

Jaimie Kaffash is editor of Pulse. Follow him on Twitter @jkaffash or email him at

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Readers' comments (23)

  • ‘So the GPC and NHS England should be congratulated’.....on their ‘kite flying exercise’...
    Others might suggest ‘just another nail in the coffin of primary care in UK’.

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  • ‘mouths being stuffed with gold’-a mouth that has no time to chew and there is a big hole at the bottom of that mouth for all the gold to fall through.
    The BMA has fallen short. Make no mistake. There is more work. Work and money that we do not want.

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  • 1 unit of money for two units of work what a bargain!!!

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  • It probably is as good as it can be, which is still demoralising. We hope these additional roles will help but can 20 people make an enormous difference to the 50+ contacts a day of your average GP?? Is it enough to save partnerships??

    Answers on a postcard.

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  • I question the validity of your ‘experts’ Jamie

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  • Still makes me want to avoid partnership with a barge pole

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  • above.

    Not seeing the massive queue waiting to apply for partnerships...

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  • Reading the small print it seems like PCNs are really going to be the explosive devices to sink primary care or specifically partnerships' with more funding going to these each year and will be divisive and cause frictions between surgeries

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  • This is a re-run of tactics used to get GPs to sign up to the 2004 contract. The extra money was all clawed back in subsequent years and so it will be again.

    The structure of this contract is the problem for general practice. It is but the beginning.

    We cannot engage with this hasty managed transformation. We need a moratorium on transformation until core general practice is stable, and any new plans must be directed solely to support core general practice.

    Knowing what is likely to follow in the next few years, it's still a 'No' from me.

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  • A little bit of extra money, promises of a few more staff. But still, a herding exercise? Getting GPs to work in larger organisations with large numbers of noctors providing less than perfect care, under our supervision. The large groupingenious are designed to take the power away from GPs, facilitating a model where OOH can be unceremoniously dumped back on us. Make no mistake, the future holds more work, more liability, less autonomy and precious little extra resource. We will be powerless ‘lords’ over teams of other clinicians - forced to flog the workers, yet hold the responsibility when things inevitably go wrong. Whichever way I look at the PCN model I see punishment coming our way. We should keep our eyes wide open to this. And do people like working in superpractices? Has anybody bothered to ask?

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