Jaimie Kaffash considers the potential for industrial action after the BMA rejected an ‘insulting’ GP contract offer from NHS England
The news that the BMA’s GP Committee England rejected an ‘insulting’ contract offer for 2023/24 came more or less out of the blue. It centres on funding – like all other public sector professions, general practice is struggling with the increase in the cost of living. But the bad blood from these negotiations might have significant ramifications for the future of general practice.
The current contract in England was implemented in 2019, and the five-year agreement will soon come to an end. For some, April 2024 – which is when a new contract is set to be implemented – was seen as a potential light at the end of the tunnel, when we can reset general practice.
There seemed to be some appetite for radical change on both sides (though not necessarily aligned). Some LMCs are pushing for practices to be paid by activity, rather than by capitation – ie, being paid on the number of consultations rather than by the number of patients on their list. There has also been a lot of talk about contractual workload limits, which could include safeguards in place when the workload limits are breached.
Other suggestions have included scrapping QOF, which seems to have some support from NHS England and Chancellor Jeremy Hunt, who has been outspoken on this. A number of GP leaders want to see the end of the Network DES, with more money put into core funding.
But any radical change like this will need a consensus – and there is definitely no consensus as it stands if the current negotiations are anything to go by. The statement from the acting chair of the GPC, Dr Kieran Sharrock, was forceful. The contract offer was ‘insulting’ and a ‘slap in the face’, it said.
However, there was little detail about what actually was in the offer. We do know that there was ‘nothing to meet the spiralling costs of running practices as inflation runs rife’, but this is hardly a shock. A huge number of public sector workers are taking strike action because the Government is refusing to offer inflation-matching price rises, so it would have been a huge surprise if they offered one to GPs, considering how they have treated GPs in the past.
Jeremy Hunt was a fearless cheerleader for more NHS funding before he took on his current role – unfortunately, he has been quiet on the subject since. It is highly unlikely the Government are going to have a change of heart in terms of increasing funding considering the wider context of public sector strikes. But, for GP leaders, increased funding to enable GPs to survive while inflation is sky high is the priority. It is hard to see how an agreement can be struck.
One thing that could mitigate real-terms funding cuts could be a reduction in workload – though even this would not be enough for agreement were funding not increased. But, even on workload, it is highly unlikely that NHS England or the Government would make too many concessions – as evidenced by this ‘insulting’ contract offer that ‘endangers patient safety’. And the Government have an obsession with access, and their efforts so far seem to suggest GPs are to blame for the problems with access.
The problem for the GPC is that the public has been willing to absorb this GP-blaming message – logic that they don’t apply to nurses and ambulance staff. All in all, there is little indication that the Department of Health and Social Care and the Treasury are bothered about striking an agreement – even if NHS England were.
GPC members are being tight lipped about what was in the offer, mainly because they want more weapons if and when the time for industrial action came. The possibility of industrial action was mentioned in the statement from the GPC yesterday. What this could consist of is a matter for the BMA’s legal team – the GPC executive has traditionally tried to temper any appetite for industrial action by pointing out that GP partners are not employees.
As it stands, the most likely outcomes will be either a continuation of the current contract or the imposition of a new contract, which could be even worse. Both courses of action will probably be enough to increase calls for industrial action.
The political context cannot be ignored, either. The Conservatives are way behind in the polls and it may be that they are unwilling to take on the tough task of clearing up their own mess in general practice (or the NHS, or the public sector as a whole). The next contract was supposed to be the big one that radically changes general practice, but the seminal 2004 contract was agreed with a stable government and we certainly haven’t got a stable government now. Unfortunately, it also doesn’t seem as though the Labour Party is developing good solutions for general practice.
The losers in this are grassroots GPs, who are struggling to cope at the moment. They find themselves in the same boat as nurses, ambulance staff, teachers, firefighters, train workers and the like who are also struggling to cope. One thing we can probably be sure of now is that 2024 won’t see sunny uplands for general practice – if they make it through this year.
This article was updated at 10:00 on 4 February 2023
Excellent article as usual.
Back in the 2004 Primary Care crisis we had a growing economy, a sympathetic public, a less malignant media, and a government that seemed to be genuinely concerned and listening.
In 2023 we have an economy teetering on recession, a hostile public, a vicious media, and a government drowning in multiple crises frankly not interested in the problems of what the D Mail tells them are “underworked and overpaid” GPs
As a result of the 2004 Contract we received a relatively revolutionary Contract that removed obligatory OOH, a decent (though annoyingly target driven) pay rise, and improved pension rights.
Of course, after a brief purple patch, these hard won gains were gradually eroded.
Pay fell behind, targets became tougher in an infuriating box-ticking frenzy, new taxes destroyed pension benefits, and even OOH threatens to return through the PCN back door.
As a result Partnerships are crumbling across the UK, with services plummeting into crisis on a weekly basis…..and no end in sight.
But in 2023 there is is no cavalry coming over the hill like 20 years ago.
Even the most optimistic GP is expecting nothing other than tougher targets, falling income and worsening chaos.
We’re on our own this time.
Buckle up, kids, it’s gonna get bumpy.
We GPs must show complete transparency and integrity and pass on to patients the real-terms cuts to primary care that NHSE intends.
Bills and salaries rising out of proportion to funding must translate into less money for care and fewer appointments.
The 2004 contract was only just voted in and left many practices on MPIG and turning to PMS /APMS to make ends meet. We have never resolved the issue of Carr-hill formula and deprivation. Successive governments have undermined even this by removing MPIG and PMS funding reductions. General practice is always undervalued and underfunded.