What are the next steps after the 1.9% uplift contract offer?

The Government has included a 1.9% uplift to GMS funding in this year’s GP contract offer. As the GPC England meets to discuss and vote on the offer today, Anna Colivicchi looks at what could happen next. UPDATED: 17:45, 1 February 2024

What we know

Pulse revealed exclusively that the Government’s initial offer for this year’s GP contract includes a 1.9% uplift to GMS baseline funding.

The current five-year contract is running out, and it had been thought that the 2024/25 would herald a seismic change in general practice in England. However, NHS England said that this will instead be a ‘stepping stone’, since the commissioner is ‘not in a position’ to negotiate to a new five-year GP contract due to a lack of a funding commitment.

GPC England chair Dr Katie Bramall-Stainer wrote to primary care minister Andrea Leadsom asking her to intervene to improve the current ‘grossly inadequate’ offer – and met with her on Thursday 31 January.

In her letter to Dame Andrea, Dr Bramall-Stainer said that should this not be improved ‘significant numbers of practices’ will have ‘no choice but to make staff redundant and freeze recruitment’, reducing patient services, ‘severely impacting patient access’ and ultimately reducing quality of care.

The following day (1 February 2024), Ms Leadsom wrote back to say that the 1.9% offer was based on a ‘planning assumption’, and the Government would reconsider the offer after the DDRB makes recommendations ‘in the coming months’.

What GPC England is demanding as part of the contract negotiations

The GPC has said that this year’s contract ‘must be about GPs feeling safe, their contracts feeling sustainable, and giving hope to the profession’. When asked by Pulse what GPC England was asking for in negotiations, Dr Bramall-Stainer said they ‘asked for flexibility’.

It asked NHS England and the Department of Health to go to the Treasury to ‘seek resource to match the offers they have made to other branches of practice’. This comes as other parts of the health service have received funding uplifts of 6% to cover inflationary costs.

A ‘red line’ during the negotiations was the inclusion of GPs in the the additional roles reimbursement scheme, which Dr Bramall-Stainer described as ‘an obvious solution’ to financial and recruitment issues faced by practices.  

In a statement on 1 February, Dr Bramall-Stainer said that they had suggested a number of ideas around supporting practices, including employing GPs and nurses – potentially referring to the idea of adding roles to the additional roles reimbursement scheme. In her response, Ms Leadsom said she was ‘open’ to the suggestion.

It is unlikely that PCNs will be scrapped as part of the new contract, with Dr Bramall-Stainer stressing that they are ‘the only show in town as far as the Department of Health and NHS England are concerned’. In an interview with Pulse last year, NHSE’s primary care director Dr Amanda Doyle said there is absolutely no risk to PCNs. 

The Government is currently consulting on the future of GP incentive schemes, and on whether QOF should be scrapped. However, we are unlikely to see any changes just yet, as the outcomes of this consultation are expected to form the basis of negotiations for the 2025/26 GP contract.

What happens next

The GPC voted against the contract and has asked for negotiators to open new talks. How successful this will be is another matter, taking into account the Government’s dealings with secondary care doctors.

In their November conference, LMC leaders voted in favour of balloting members ‘once the outcome of the negotiations is known’ as part of a motion that reiterated existing conference policy.

The GPC seems confident it will have a deal to take to the profession, even giving a provisional date for a referendum of GPs on whether they support the contract – which will be 1 March.

It is likely, however, that the contract – including the funding settlement of 1.9% – will be imposed from 1 April, and that any changes would be backdated.

Dr Bramall-Stainer told Pulse earlier this month that what happens on the back of the referendum ‘is not for her to determine’. It could lead to industrial action down the line, if that is felt ‘strongly enough’ by the profession.

‘We’ll have to see what the profession says, but depending upon what the profession responds to us, it may then lead us to consider an indicative ballot later in the spring,’ said Dr Bramall-Stainer.

Dr Bramall Stainer also said that that the process could go into later this year, around the time of the general election, and that ‘if GPs are forced down this road’ they will make general practice ‘the doorstep conversation’ during the election campaign.