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BMA GPC ‘blindsided’ by NHS England over imposed GP contract changes


transparency BMA


The BMA is ‘bitterly disappointed’ with the changes to the GP contract for 2022/23, and said they ‘have not been agreed or endorsed by the BMA’.

Under the changes, primary care networks (PCNs) will be required to provide a full range of services from 9am to 5pm on Saturdays from 1 October as part of the Network DES.

The BMA said it started negotiations with NHS England in January over ‘further support’ needed for general practice due to the pandemic. 

Conversations reached a ‘stalemate’ in mid-February ‘when it became clear that NHS England would not be offering an update that would impact meaningfully on patient care’.

BMA GPC executive member Dr Richard Van Mellaerts said the BMA had been ‘blindsided’ after NHS England gave the GPC Executive team ‘less than two hours notice of their letter, which was then trailed on WhatsApp’.

GPC chair Dr Farah Jameel called for a new contract, and said that the letter ‘defies everything’ the BMA was hoping to achieve in terms of resetting the relationship with the Government.

The BMA had lobbied for solutions including:

  • Extra money to cover increased employers national insurance contributions and growing inflation costs;
  • Versatility for PCNs to employ staff based on local need rather than being ‘bound by rigid, prescriptive job roles;
  • A properly financed pandemic recovery plan which mirrors the ‘emphasis and urgency placed on the elective recovery plan in secondary care’.

But despite further discussions with NHS England and a meeting with health secretary Sajid Javid, the BMA said the letter ‘fails to make any progress’ in addressing its concerns.

BMA England GPC chair Dr Farah Jameel said: ‘We are bitterly disappointed that NHS England has chosen to ignore the appeals from the profession and the needs of patients in today’s letter.’

She said in spite of the committee’s efforts to find constructive resolutions, ‘NHS England has instead decided to follow a path laid out three years ago, long before the arrival of Covid-19’ and has presented a contract that ‘fails to address the current pressures faced by general practice’.

She said: ‘Failing to offer practices something as simple as reimbursement to cover additional costs for national insurance contributions means they are losing funding that should be going towards looking after patients. Therefore, a tax aimed at funding the NHS, has become a tax on the NHS itself. The result will be fewer members of staff to care for the growing needs of patients.

‘Today’s letter attempts to sell the changes as stability. While stability is important, the reality is that general practice needs an emergency rescue package. Without this emergency life support, patient care will suffer. The waiting lists currently seen across the NHS are now going to become more of a reality in general practice.’

She said that GPC had entered into negotiations ‘in good faith, recognising the need to uphold previous agreements but striving for improvements in patient care’. 

She added: ‘GPs and practices will see today’s changes as devaluing their goodwill and demolishing their spirit. The letter does nothing to capture the scale of changes needed nor safeguards patients, and further highlights the need for a new contract that delivers high quality safe care in the new world we live in.’

BMA GPC executive member and Doncaster GP Dr Dean Eggitt confirmed that the BMA GPC executive team ‘did not agree’ to the changes.

The current contract was implemented in 2019/20, and was meant for five years. However, there was to be negotiated incremental changes every year.

But Dr Eggitt said on Twitter: ‘Due to the failure of NHSEI to recognise GP workload and its impact upon patient safety, there will be no negotiated GP contract agreement for 2022-23.

‘NHSEI has chosen to implement the contract without any additional support for safe patient care.’

Dr Van Mellaerts agreed NHS England’s decision to apply changes without agreement from the GPC was ‘deeply disappointing’. 

He added there was ‘no recognition of massive pressures in GP, huge patient backlog, increased costs of NI contributions’, meaning ‘patient care will be impacted’.

NHS medical director for primary care and GP Dr Nikki Kanani said: ‘The NHS is focused on recovering services and tackling the Covid-19 backlogs that have inevitably built up over the pandemic and so as part of the contract for General Practice in 2022/23, extra funding will be given to primary care teams to increase checks for cancer and heart conditions for our patients.’

READERS' COMMENTS [6]

David Jenner 1 March, 2022 7:20 pm

Dear BMA , you should never have agreed this back in 2019without getting a mandate from the profession.
The deal was So bad it had to be radically redesigned in 2020 ( which it was ).
Please call an emergency GPC meeting or LMC conference and seek a renewed mandate for mass resignation ( or delayed agreement to) the PCN DES .
If practices walked away from the PCN DES I am confident NHSE will come back to the table.
If they don’t, CCGs can then commission the PCN DES service from any willing provider , of which I doubt there are many willing or able providers .
Less Income for sure but a load less work! ( and you can always earn some of the income back at the right price )

Patrufini Duffy 1 March, 2022 7:20 pm

Made to look like fools. Tube workers in London striked today and paralysed the entire city. Tube workers. No guilt. No fear. Not the first time, not the last. And they got everything they wanted. Because only they can do the job.

Bob Hodges 2 March, 2022 2:41 pm

The ability to impose contractual changes was explicitly for national emergencies in the 2004 GMS contract was it not? I was told that, which is one of the reasons I moved in general Practice in the first place.

The vague desire for a few favourable headlines for the (Russian funded) party in power does not constitute a national emergency. The Government openly admits that primary care is significantly understaffed and there is a recruitment shortfall of their own making, yet they propose to spread an inadeqaute resource over a 15% longer working week, introducing costs and inefficiencies through duplication of reception and other staff costs and heating and lighting etc.

It is being forced on GP contractors who have unlimited liability and as such do not have a neutral option to simply decline the ‘offerred’ contracted. Therefore this is coersion tantamount to indentured servitude, immoral and abusive.

This needs to be tested in law because it is a fundamental change to GP contracts and terms and condition, with no clear defining reason for it. GP contractors cannot unilaterally change the T&Cs of employed doctors and ARRs staff in response.

If the General Practice DEFENSE Fund can’t test this in law, i.e. DEFEND General Practice, then what is the GDPF for?

(Expanding on Twitter debate currently ongoing)

Rogue 1 2 March, 2022 6:23 pm

I am getting sick of this!
We as a profession need to pull the nuclear option, and decline the NHS
Go private like all the dentists, then we can charge every single patient for every single thing we do. Then no QOF targets either, but we would still have to face CQC.

David Ruben 2 March, 2022 8:05 pm

.. if GPs had uniformity of purpose (something our profession seems lack when comes to contract negotions) and every practice refused to bow to CQC oversight/hoop-jumping creep, that what is CQC going to do ? Close all practces in turn ? Just need be sure don’t close a few test-case surgeries one at a time hoping to frighten the rest into submission (iei if 1 practioc closed for “poor” outcomes then surrounding practics in PCN also volunatary immediately close doors for self-declared liekwise unacceptable poor performance…

Patrufini Duffy 2 March, 2022 10:13 pm

Let us be clear.
Consultants are creaming private care, from NHS backlog in their own departments, and while being permitted to reject you left right and centre. Their private practices are booming, permitted to practice even within the same hospital building, on the private wing, using the NHS junior doctor. Whilst you are cleaning the expanding gutter. That’s levelling up.