The Government’s argument that GPs must to stick to the five-year contract has been ‘short-sighted’ in the face of ‘obvious budgetary pressures’, a report has concluded.
An annual ‘performance tracker’, undertaken by the Institute for Government (IfG) and the Chartered Institute for Public Finance and Accountancy (CIPFA), has found that public services, including general practice, are ‘crumbling’.
The report said that although the pandemic was ‘disruptive’, the current crisis is down to the decisions of successive governments, which included ‘short-term policy making’ and under-investment in capital.
The IfG and CIPFA warn that if the Government does not take ‘serious action’ to boost productivity across nine public services, it risks ‘getting stuck in a doom loop’ where the ‘perpetual state of crisis’ causes staff burnout and prevents long-term decisions.
Based on analysis of GP funding and activity, the tracker found that current performance is worse than on the eve of the pandemic, which was already ‘much worse’ than performance in 2009/10.
And current funding is ‘insufficient’ to get general practice back to pre-pandemic performance levels.
The report’s data analysis showed that real-terms core funding for GPs, based on the current five-year contract, will be 3.1% lower in this financial year than in 2019/20, despite registered patient numbers going up by 5.7% over the same period.
The BMA has repeatedly criticised the Government’s contract impositions, calling the 2023/24 contract ‘disastrous’ – although a motion to take industrial action on this imposition did not pass at the GP Committee in April.
While the IfG said there is ‘some merit’ to the Government’s argument that GPs should have to stick to the contract they agreed four years ago, it also said that ‘2023 is clearly different from 2019’.
The authors highlighted that the pandemic introduced new requirements for GPs without ‘sufficient additional funding’, and there has been a ‘bout of above-forecast inflation’ which has not been recognised by the Government in adjustments to the yearly GP contract.
On this issue, the report concluded: ‘The government’s line that GPs should honour the contract they agreed to in 2019 is short-sighted.
‘Maintaining such a hard line in the face of obvious budgetary pressures risks worsening the problem of retention in general practice and losing more of the workforce.
‘That will make it much harder for the government to provide a politically acceptable standard of primary care.’
In its chapter on the state of general practice, the report also covered increasing demand, issues around pay, inadequate estates, access, and ‘the crisis in GP workforce’ – which it said should be the Government’s top priority.
While the total number of fully-qualified, permanent GPs continues to fall, the report highlighted a particularly worrying trend among GPs under 40 – just under a quarter of GPs under 30 (23.2%) and 9.4% of GPs aged between 30 and 39 left their practice in the 12 months to September 2023.
And among the GP partner cohort, the data showed that over the past seven years there has been a decline of just under 50% in the number of GP partners under the age of 40, from 4,041 in March 2016 to 2,123 last month.
Earlier this month, shadow health secretary Wes Streeting said he had not reached a ‘firm conclusion’ on the future of the partnership model, but highlighted that being a partner is ‘unattractive’ to new generations of GPs.
To make partnership more attractive, the report supported reforming the contract to move from unlimited liability – where partners take on all the financial risk – to limited liability partnerships or companies.
On GP access, the analysis found that the Government’s recovery plan ‘only helps at the margins’ – improving patient experience of contacting the practice is ‘unlikely to meaningfully improve access’.
The authors said: ‘Improving GP access will require investment in general practice. Part of that investment would need to be in the workforce.The recruitment of direct patient care (DPC) staff has been successful…but some elements of the service can only be provided by GPs.
‘The NHS has plans to recruit more GPs as part of the Long Term Workforce Plan, but this chapter has shown that a large expansion in GP trainee numbers does not necessarily translate into rising numbers of GPs.’
In August, NHS England’s director of primary care Dr Amanda Doyle told Pulse in an exclusive interview that the 2024/25 GP contract will be a ‘stepping stone’ as they are ‘not in a position’ to negotiate a new five-year deal.
And in the same interview, Dr Doyle said this current five-year deal had made things ‘tighter’ for practices.
Institutional failure
HMG still hope that generative AI will bail them out of a predicament of their own making