DHSC opposes GPs moving to private model as BMA plans for ballot as soon as next month
The Government has said it does not believe general practice should be moving towards a private model and wants to work with GPs to ‘build a sustainable future’, after the BMA announced it will ballot the profession on a ‘plan B’ outside the NHS as soon as next month.
The Department of Health and Social Care told Pulse that a model of private, means-tested or subscription-based GP services is not ‘in the interests of patients or the NHS’ and a two-tier health system ‘would only serve to deepen the health inequalities that already exist’.
Yesterday the union’s GP committee confirmed it supports balloting the profession on ‘a plan B option for general practice provision’ that includes consideration of a model similar to those used currently by NHS dentists. This will be the first time the union is balloting GPs on an alternative model.
In terms of when the ballot could run, the BMA confirmed to Pulse that it would be within the next BMA session, which is from the end of the union’s annual representative meeting (ARM) on 22-24 June, until the end of the subsequent year’s ARM – so the ballot could be held any time between 25 June this year, and late June 2027.
The BMA also told Pulse that how the ballot will be run as well as the question to be put to GPs and the timing are all to be decided.
The union said that the GPC has made clear that it wishes to proceed to a ballot, but they have also been clear that they must get all the details right and will take the time necessary to make sure members are fully informed before voting.
It comes after GP leaders from around the UK voted in favour of drawing up a strategy for ‘exiting GMS contracts’ and ‘future working outside the NHS’, at UK LMC conference earlier this month.
GP leaders at the LMC conference suggested that leaving the NHS could be used as ‘leverage’ by GPs during the ongoing collective action organised by the BMA against this year’s imposed GP contract.
BMA GPC chair Dr Katie Bramall said that the need for this ballot ‘can be prevented’, but the Government must ‘urgently engage’ with the concerns GPs have around the GMS contract.
A Department of Health and Social care spokesperson told Pulse: ‘We do not believe that moving towards a model of private, means-tested or subscription-based GP services is in the interests of patients or the NHS and a two-tier health system would only serve to deepen the health inequalities that already exist.
‘The founding principle of the health service – that care is free at the point of use – must be protected.
‘We want to work with GPs to build a sustainable future for primary care as the front door of the NHS – we have already hired thousands more doctors, provided record funding for general practice, and expanded the use of online tools to increase access to GPs across the country.’
In 2024, UK LMCs had already authorised the BMA’s GP committees ‘to use the threat of mass resignation to improve the NHS offer to practices’, adding that GPs ‘walking away’ from the NHS will be more powerful than collective action.
Related Articles
READERS' COMMENTS [12]
Please note, only GPs are permitted to add comments to articles
In another story, Turkeys vote against Christmas, Bears vote that they must have access to wooded areas, and the Pope votes that he must be considered to be a Roman Catholic. Or to put it another was as Mandy Rice-Davies put it they would say that wouldn’t they
Dear DHSC- its obvious that DHSC wouldn’t want GP walking out of NHS because currently they are getting bloody good deal from GP . Primary care is the only service which is running withing budget and efficient and delivers value for money ,and DHSC doesn’t want to pay more money . Can you show evidence that there is real term increase in number of GP .Please do not confuse lay people by showing increase in number of PA and other ARRS role . There is no record increase in funding in general practice . whatever funding increased is mainly rearranged from other primary care sources. You have simply rearranged deck chairs on sinking ship. By expanding online access you have opened the flood gates and have eased patients problem of access to GP ,but have you solved the problem for GP as to how can they fulfill this unending demand , or is that not your problem?
Patients would not want GP to walk out of NHS as they wouldn’t want to pay for service they are currently getting it free. Would anyone pay for groceries if government started giving groceries free !!!!.
If government really interested in keeping GP in NHS We would like them to get to negotiating table with GPC/ BMA and have constructive dialog with meaningful solution to GP current problems. But I doubt that will happen.
What needs to happen is patients need to get responsible for their health and use NHS services responsibly and not abuse it. and solution to that is some kind of small token payment which will make them use services judiciously and not abuse it.
Government needs to stop this obsession about 24/7 unlimited access to GP . No country in the world where health care is funded by government has unlimited access to GP.
Ironic to find oneself agreeing with government, but this splitting of the profession will ultimately only play into DHSC’s hands. Availing GPC of leverage that neither patients nor most GPs would support is a paper tiger.
“Government opposes GPs breaking the deal that is amazing for the Government”
A radically different contract is essential but ask most dentists what they think of their contract and it would be foolish to style our on theirs. Hopefully it is just a ‘simple’ way of describing Plan ‘B’
I think very few people really want to have to move away from the NHS to a Plan B. It is just that we are fed up with our dedication and professionalism being exploited by the DHSC. The reason that DHSC can offer us a fraction of what they offer other providers for the same work is that they consider us to be trapped, and are contemptuous of our value.
It is worth bearing several things in mind when considering what the vote does and doesn’t mean.
First, I don’t think anyone is advocating for a complete and immediate switch to private work, only that the BMA pushes for the current very severe restrictions to be lifted. For example, why can Boots offer private ear microsuction to everybody and anybody, when GPs cannot? These extra income streams might offer a valuable source of income to practices, who can then offer better terms and conditions to staff and improve overall access and care for patients.
Second, were there a potential escape route for practices, it would offer the BMA significant leverage that they currently lack: the strongest negotiationg position you can have is the ability to walk away from the table.
Third, I think the public messaging – if done correctly – might both have shock value and be helpful in getting our point across: general practice has been systematically defunded and over-exploited by the DHSC to the point of collapse – support us in our quest for fair and reasonable funding, or risk us collapsing and taking the rest of the NHS with us.
A final note: a chum recently returned from the dentist having signed up to one of their care programmes: 4 appointments with a dentist plus one emergency appointment, and one hygeinist visit per year for £49.50 per month, or almost £600 total. That’s where we need to benchmark our expectations for how the NHS contract should be funding us for 24/7 medical care.
BMA looking out of an Overton window of going private. That ship sailed long ago, now it’s mere empty threat, or a trap.
Out of the ashes of ww2, bankrupt and broken, how did we ever pay for and build the NHS hobbled as we were by a gold-backed dollar? Political will, not nonsensical self-imposed fiscal straitjackets.
These ungovernments won’t tell you, but we have the money to fund general practice properly and the common sense not to make false demands of it.
The BMA should only be campaigning on patient-facing matters such as safe consulting numbers, face to face consultation and continuity, personal data privacy, and the necessary funding GPs need to deliver the excellence that patients deserve.
There’s nothing to split the profession about. GPs are not part of the NHS. The government is reducing real terms GP income year on year while trying to insist on unlimited and unsafe workloads which is impacting on retention. The partnership model – as has been stated above – provides the best value for money of all NHS services, and YET the government resents even maintaining levels of funding from previous years. Instead they speak of a left shift of work out of hospitals with no mention of any funding following this work.
GPC needs to work up a model which demonstrates the real costs of delivering general practice in 2026 and includes capitation, accurate weighting for complexity IOS fees for EVERY intervention and annual cost-linked rises. These costs can be converted into an annual fee and per visit/activity cost and presented to the government as ‘if you want to deliver general practice free at the point of care, this is what it will cost’ If they refuse, the model could allow for conversion to a subscription model which the government will be more than welcome to pay on behalf of patients. GPs are not threatening to remove free at the point of care healthcare – we are simply stating that if that is what government wants – the real costs are as stated in the model. The model is essentially a contractor model to the NHS if the government accepts the terms – GMS is a contractor to the NHS model….
There has been too much hand-wringing from some fellow doctors in the BMA who believe that GP partners should subsidise the rest of the NHS by continuing to undertake non-contractual work. Work that hospitals are already paid to do, but ICBs have not contract managed them. Work that ICBs should have commissioned but why bother when GPs will do it for nothing and then just moan among themselves.
This is not a GP-created problem. It has been manufactured by successive governments who demanded more for less year on year with very little pushback from GPs. The government clarified last year beyond ALL doubt that GPs are NOT part of the NHS when they implemented ER NI rises which resulted in cuts to practices services. They did this in the knowledge that practices cannot raise prices like every other business and refused to reimburse the increase.
You could en masse start providing private services like ear microsuction etc – things the NHS doesn’t provide.. technically you have breached the contract. But if everyone does it they would have to hold the whole profession in breach of contract. And of course don’t tell the DHSC. Just do it. And they would have to explain themselves to your population as to why they are preventing you for offering such services.
Superb analysis Gerald Clancy. There is too much NHS worship in our profession.
The GPC are very slowly growing a pair. But not by threatening a ballot. They just need to do it.
Also they would need to survey non members who are already disillusioned with the Union.
I am actually quite surprised, since I thought DHSC would be pleased at the prospect of patients moving from being an NHS burden to paying for private GP care!
In addition, the big private medical companies and insurers stand to make a killing, and are probably preparing their lobbyists according as we type.
DHSC will be very happy that GP will take the blame for walking away from NHS, but they wouldn’t want to admit it that its the result they actually want it. It will be a political suicide for any party.