What might the next GP contract look like?

Details of the GP contract for 2024/25 emerged last week as the Government made its initial offer, which was rejected by the GPC. As the BMA hopes to re-enter negotiations, Eliza Parr looks at what we know and what we might expect.

Last week saw a flurry of action on GP contract negotiations, after Pulse exclusively revealed the Government’s initial offer of a 1.9% uplift.

On Thursday, the GP Committee for England met and voted down the offer, instructing its negotiating committee to go back to the table.

It is hoped a new, more palatable offer can be achieved over the course of the next month, with the contents put out to a referendum of the profession on 1 March.

But what outcome can we expect?

It seems disappointment may be in store for any GPs with high hopes of a revolutionary 2024/25 contract.

Core funding

The Government has made an initial offer of a 1.9% uplift to GMS baseline funding, which equates to £178m. This came as other parts of the health service have received pay uplifts of 6% to cover inflationary costs.

Since 2019, GP partners have been locked into a five-year deal which aimed for a 2% year-on-year partner pay rise (although there was an extra funding uplift of 2.39% last year to cover a 6% pay rise for staff). The five-year deal comes to an end in March, but it’s not likely the new contract will boost core funding dramatically. NHS England has warned that the 2024/25 contract will be a ‘stepping stone’ since the commissioner is ‘not in a position’ to negotiate a new five-year contract due to a lack of funding commitment.

Despite lowered expectations, the offer of 1.9% has nevertheless shocked GPs. GP Committee England chair Dr Katie Bramall-Stainer described it as ‘grossly inadequate’, while committee members tell Pulse they find it ‘derisory’, ‘unacceptable’, ‘insulting’, and ‘overwhelmingly awful’.

Dr Paul Evans, GPC member for Gateshead and other areas in the North East, says he was ‘gobsmacked’ with the offer, and that it ‘wasn’t really going to fly’ with the committee.

‘I didn’t think it would be great, but I didn’t think that – having offered consultants and juniors north of 10% each – they would offer us 1.9% when CPI is 4% at present and has been significantly higher in the past year. That’s another pay cut.’

This 1.9% uplift may well change between now and April as the GPC goes back to negotiations with NHS England and the Department of Health and Social Care (DHSC).

Primary care minister Dane Andrea Leadsom confirmed last week that the Government will reconsider its offer once the Review Body on Doctors’ and Dentists’ Remuneration (DDRB) makes its recommendation in ‘the coming months’. 

In December, health secretary Victoria Atkins asked the review body to make recommendations on GP contractor pay for the first time in five years. And Pulse revealed last month that the BMA will allow GPCE to submit evidence on partner pay to the DDRB, despite the union’s previous policy to withdraw from the process.

But the DDRB’s report may come as late as summer, meaning any improvements to the uplift would be backdated for practices, and may leave them struggling to manage costs in the meantime. 

QOF

On Friday, the Government confirmed that the new GP contract will reduce the number of QOF targets in order to cut bureaucracy.

Pulse understands that this formed part of the offer presented to – and voted down by – GPC members on Thursday, and that the proposal was to cut the number of targets by around 40%. The number has already reduced from 74 to 55 within this year’s GP contract.

This shouldn’t come as a big surprise to GPs. NHSE has already said it intends to make the incentive programme ‘more streamlined and focused’, while the Government is currently consulting the public on the future of QOF, including a question on whether it should be scrapped altogether.

In isolation, the proposal may have gone down well, but GPC members tell Pulse it is a small detail in comparison to the more important question of core GMS funding.

PCN Direct Enhanced Service (DES)

Last year, under the former executive team, the GPC said it would demand QOF, IIF and PCN DES monies be moved into one simplified core funding stream, saying the DES had been a ‘failed project’.

NHS England committed to reviewing PCNs ahead of this upcoming contract – but it looks like they’re sticking around for the time being. National primary care director Dr Amanda Doyle confirmed to Pulse in August that there is ‘no risk’ of PCNs being scrapped. 

The GP Committee has also tried to negotiate on the future of the Additional Roles Reimbursement Scheme (ARRS). Dr Bramall-Stainer has called for the inclusion of GPs in the ARRS, describing it as ‘an obvious solution’ and a ‘red line’ in negotiations.

Member for Cheshire and Mid Mersey Dr Ivan Camphor tells Pulse ‘I think that was a sensible and reasonable offer, but apparently it wasn’t taken up by the Government. It would’ve been an easy fix for the current impasse that we have.’

Dr Bramall-Stainer had suggested in a Pulse interview last month that there would be some pushback on this GPC demand, warning that the Government may argue GPs are not technically ‘additional’ roles.

There has been movement for other professions, however. On Friday, DHSC announced that the new GP contract would allow for nurses to be recruited under ARRS, but made no mention of GPs.

Despite this, the primary care minister has hinted at exploring potential solutions to ‘practice staffing issues’.

According to her letter to Dr Bramall-Stainer last week, the GPC wants to ‘explore options for ringfencing parts of the global sum for payment of different groups’, where currently GP partners decide how to allocate their funding based on their proportion of partners and salaried staff. The minister said she ‘welcome[s] discussing’ this further.

Pulse understands this is not related to GPC calls for GPs to be included in ARRS, but would be more similar to the old Red Book staffing allocations.

Dr Camphor says the Government is ‘very clear’ they do not want to include GPs within ARRS. But a clearer Government stance may emerge over the next month. Indeed, the DHSC will have to respond to petition on this issue which received over 10,000 signatures.

Other DESs

Aside from the Network DES, in this year’s contract NHS England also offered practices the opportunity to sign up to schemes for the learning disabilities health check, violent patients, and minor surgery. 

There has been no indication from the Government or the GPC that these DESs will be scrapped or changed in the year ahead. 

Other areas of focus for 2024/25

Beyond core funding and target schemes, it looks like the DHSC is open to working with the BMA on wider issues impacting on GPs. Dame Andrea’s letter raised a number of key issues which ‘will benefit from immediate, intensive and collaborative work’. 

Retention of GPs has come up time and again as a critical challenge facing the profession. When NHSE published its long-awaited workforce plan last year, GP leaders criticised the lack of strategies to retain existing GPs. And more recently, the RCGP said it was ‘disappointing’ that NHSE chose to end two GP retention schemes, including the fellowship scheme which funds newly-qualified GPs to spend a session a week doing CPD.  

Instead of a national scheme, funding will now be allocated to ICBs to decide how to deliver it locally. However, this decision may not be final. Dame Leadsom invited the GPC to provide ‘evidence on the benefits of the fellowship scheme’. Depending on the strength of this evidence, the minister may decide to restart the national programme.

The interface between primary and secondary care was also raised as a key issue. NHS England’s primary care recovery plan asked ICBs to make progress to resolve interface issues by working with both GPs and LMCs. In their board reports during the autumn, some local commissioners warned that progress is slow, particularly due to lack of capacity or commitment from secondary care. 

However, this will continue to be a priority – DHSC confirmed that there will be a ‘clear requirement’ for ICBs to make progress in the 2024/25 NHS planning guidance. And Dame Leadsom said she is ‘keen to work with’ the GPC to ‘embed this further in order to cut excessive work and bureaucracy’ as the second year of the GP recovery plan approaches.

There’s no doubt this is an important issue for GPs. Last month, one LMC revealed that over £4m of NHS funding is wasted on ‘interface’ issues such as workload dump, with GPs having to deal with 6,600 problems each month in just one region. But since NHS England has left it up to ICBs to drive solutions, progress nationally may be variable and hard to track.

Finally, Dame Andrea acknowledged ‘the genuine and pressing issues regarding the primary care estate’, and said she has held a series of meetings to understand these issues. 

‘I am keen to work with you to help determine the best approach going forward to ensure that GPs and their teams have both the right quality of estate, as well as enough space to train new GPs and accommodate their wider teams,’ she told Dr Bramall-Stainer.

This is not the first time a health minister has highlighted the issue – former primary care minister Neil O’Brien said the lack of focus on new GP provision when new housing is built is ‘mad’. Speaking at a Conservative Party conference fringe event, Mr O’Brien said the Government is looking at revising the planning framework to give priority to primary care facilities. 

In November, the RCGP called on the chancellor to address ‘unsafe’ GP premises with a cash injection of £2bn. While such investment is unlikely, it seems the Government is exploring potential solutions to boost development of GP estates.