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Updated 2 March: What next for the GP contract?



BMA leaders say the contract in England is ‘not fit for purpose’. Jaimie Kaffash analyses the implications for practices. Please note, this was updated on 2 March in light of the contract announcement the previous day

GPs in England could have been forgiven for a sense of optimism after an email last month from BMA GP Committee chair Dr Farah Jameel.

Following an extraordinary GPC meeting on 10 February, the new chair wrote: ‘The committee is calling on the Government to enter negotiations… for a refreshed, fit-for-purpose contract.’

Dr Jameel had earlier issued a press statement that went further: ‘While the contract practices are currently bound to was agreed in good faith three years ago, it simply does not reflect the experiences and needs of GPs and their patients today.’ 

She said the ‘new leadership of our committee’ offers a chance to ‘renew, reset and renegotiate a contract that delivers for both the profession and patients’.

However, the chair’s words seem to go beyond the agreed strategy of the committee. A motion passed at the meeting simply calls for negotiations ‘beyond the five-year agreement ending in 2023/24’. In other words, it asks the GPC to negotiate a new contract once the current one expires. 

For some committee members, this motion changed nothing. One described it as ‘vanilla’, while another said it ‘merely reaffirms what we expect of the GPC executive team’.

And the imposed contract, announced on 1 March, has set back relations between the GPC and NHS England. Although the changes to the core contract were not major, there were nasty surprises in terms of the PCN DES.

However, in terms of the long term, the motion and Dr Jameel’s words do offer some pointers for what could happen with the contract. However, we are talking long term and, as one GPC member put it, ‘We’ll all be dead from burnout by then’.

Here, we consider the potential implications of the extraordinary meeting and everything that has followed. 

What will happen with the contract in 2022/23?

The current contract was agreed in 2019 and it was for five years, aiming to provide stability for practices. There have been minor changes to the core contract, mainly around immunisations. But the main change was to the PCN DES, with networks being told they had to offer routine appointments on Saturdays from 9am to 5pm. The reaction to this was not exactly positive.

On top of this, under the five-year agreement, the funding uplift for practices is set to be 2.1%, and the Review Body on Doctors’ and Dentists’ Remuneration will not even make a recommendation on this. For salaried GPs, the Government has now suggested a 2% pay uplift in its submission to the review body, citing a need for ‘financial restraint’ as the NHS ‘returns to its pre-pandemic financial regime’.

However, the cost of living – and of running a practice – has risen dramatically since the uplift was set, so GPs will be facing a real-terms pay reduction. 

Will there be any other support?

The GPC motion and Dr Jameel called for more immediate support. The motion ‘endorses the GPC England executive to negotiate additional support for general practices to deliver the recovery/backlog demands in 2022/23 and 2023/24’. 

One of the GPC’s main gripes with the 2022/23 contract was that there was no extra support, and it doesn’t look as though support will be coming from any other avenue, either.

NHS England’s elective care backlog plan,  published on 8 February,  makes little mention of general practice other than to reiterate plans to increase use of advice and guidance. This might be a bullet dodged – there were fears GPs could be forced to take a more active role in clearing the backlog. 

That said, Dr Jameel rightly pointed out that there will be a ‘knock-on effect’ of the elective backlog on practices, as well as the ‘invisible GP backlog of patients who have not come forward over the past two years and become increasingly unwell’. GPs will ‘desperately need more immediate support’ with this, she added. 

Ministers and NHS England will point to the £250m winter access fund – which has many strings attached (and it is still unclear how much has been allocated). 

What is happening with PCNs? 

NHS England sets much store in the primary care network project. Perhaps because of this, GPs view withdrawal from PCNs as a potential lever to negotiate contractual changes. 

In the wake of the controversial winter access plan, the BMA polled members on support for withdrawal from the PCN DES. As an enhanced service, it is not an obligation, and practices can opt out at the start of the financial year. 

Well over half of respondents (58%) said they would support mass withdrawal from the PCN DES at the next ‘opt-out period’, while 39% said they would be willing to disengage outside the opt-out period. 

However, a report of the GPC extraordinary meeting written by Surrey and Sussex LMCs chief executive Dr Julius Parker claimed the BMA had missed the ‘window of opportunity [to] legally encourage GPs’ to take part in a mass withdrawal from the DES in the opt-out period for 2022/23. 

Dr Parker said: ‘No further action has been taken or currently appears to be planned for by GPC England.’

This followed demands from the England LMCs Conference that the BMA negotiate no new work or funding for GPs via the PCN DES past 2023.

The growing opposition to PCNs is not simply a negotiating stance against NHS England, however. The workload involved in the specifications, and problems accessing staff through the additional roles reimbursement scheme, are also factors. There is a chance practices will simply withdraw from the DES for 2022/23, without the BMA’s lead. 

This is all the more so with the announcement about the extended hours requirement. The GPC is currently considering its ‘next steps’.

Is the GPC united and is there an agreed strategy?

The motion would suggest the GPC, which tends to comprise LMC officials, is united. However, there is  tension at the moment, especially around transparency and how members communicate strategy with practices within their LMCs. 

Pulse exclusively revealed last month that the BMA was so worried about ‘leaks’ from the committee that it employed a law firm to investigate them. Its main concerns were around two articles that appeared in The Telegraph and the BMJ following the departure of previous chair Dr Richard Vautrey. The lawyers had been contacting committee members to ask whether they had been talking to the media. 

The revelation followed the departure from the committee of Dr Clare Sieber, the GPC representative for East/West Sussex, who revealed she had been involved in ‘four independent external lawyer investigations’. 

But these issues have mainly cropped up as a result of frustration around strategy. One of the four investigations Dr Sieber mentioned related to a potential breach of the BMA’s code of conduct for sharing a critical report on a GPC meeting, which said there had been no progress on industrial action. 

The motion agreed at the extraordinary meeting was the outcome of a fraught discussion with little consensus, Pulse understands. The result was a ‘vanilla’ motion effectively calling for very little.

What does this mean for the GPC/NHS England relationship?

The relationship between the GPC and NHS England had been frosty over the past year. For a good part of 2021, there were no official talks between the parties after the GPC voted to suspend discussions in protest at NHS England’s line on GPs seeing patients face to face during the pandemic. 

Relations between the previous GPC Executive – ie, the negotiators, led by then chair Dr Richard Vautrey – and their NHS England counterparts were actually more constructive. The 2019 contract was welcomed by both sides. And Pulse understands that the GPC negotiators were pushing strongly to restart discussions during the hiatus, and this was partly the reason the committee’s support for Dr Vautrey wavered. 

However, the latest imposed contract looks seems to set back relations, and now they are at rock bottom, with the GPC hinting strongly that it will consider a vote of no confidence.

Even beforehand, Dr Jameel’s words suggest she is distancing herself from the previous team (of which, it must be said, she was a part) with her talk of a ‘new leadership’ that will ‘renegotiate a contract that delivers for both the profession and patients’.

The new antagonism between the two parties could have positives and negatives. On the positive side, GPs might argue that good relations have not improved their working lives, so a tougher BMA stance might help. However, it is the Department of Health and Social Care and the Treasury that sign off the contract and, in the absence of a deal, they have not been averse to imposing a contract, as they showed this week. If they impose a contract in 2024, this would have serious ramifications.

What does this mean for the longer-term contract?

Dr Jameel’s statement and the GPC motion suggest the next contract from 2024 will be radically different – possibly the most radical since 2004. Many GPs might welcome that, but it could easily be worse than the existing deal. 

From Dr Jameel’s statements so far, it seems clear she will be emphasising patient safety. This could be a canny move. As previous Pulse surveys have found, around half of GPs say their workload is at unsafe levels for patients. In practice, GPC negotiators might push for a cap on appointment numbers, or for standard 15-minute slots. 

There is also an emphasis on retention. But this has long been a watchword for ministers, NHS England and the BMA, yet no contract has so far stemmed the departure of GPs. 

Dr Jameel refers to ‘tired outdated premises, a population with increasing medical complexity’ and – most intriguingly – ‘barriers across the primary, community, social care and secondary care interface’, which could be a line from NHS England or health secretary Sajid Javid.

In a bulletin released on Tuesday 28 February, GPC deputy chair Dr Kieran Sharrock said that they will be consulting with grassroots GPs: ‘It is our intention to meet with LMCs and GPs over the coming months to seek your views on a model of general practice which is fit for the future, that will enable us to care [for] our patients safely.’

And GPs might not be alone in seeking radical change. Mr Javid has made no secret of his desire to promote face-to-face appointments, and this could find its way into the contract. Hints around trusts managing GP practices may also play a part.

So 2024 could be a seismic year – if any GPs are still around to see it. 

A version of this analysis will appear in the Pulse March 2022 print issue

READERS' COMMENTS [4]

Malcolm Ridgway 1 March, 2022 10:36 am

The GP contract requires a root and branch review as the current contract does not allow a manageable workload and GPs are voting with their feet. This may mean changes to what were once considered sacrosanct elements of the contract and how GPs operate. However nothing should be off the table and the negotiators need to think outside of the box.

Jeremy Platt 1 March, 2022 11:22 am

There must be a better way to limit demand than limit appointment numbers. I can’t imagine patients understanding it. Also why a contractual 15 minute appointment time? If you want 15 minutes then make it so

Just Your Average Joe 3 March, 2022 8:41 am

I will not be doing any Saturday work, no matter what.

The imposed contract is garbage and the leadership at the BMA needs to quit if this is not opposed strongly and if they are unable to negotiate a deal which is in favour of improvement of terms and conditions and recruitment to prevent a collapse of Primary care.

There is no capacity to do more and this imposed contract is further evidence of a coercive control type abusive relationship with the DOH having no real value for primary care.