UK GP leaders vote to explore ‘dentist’ model ‘outside the NHS’

GP leaders from around the UK have voted in favour of drawing up a strategy for ‘exiting GMS contracts’ and ‘future working outside the NHS’.

LMC leaders agreed that general practice within the NHS is ‘no longer financially viable’ and called for ‘a move towards a hybrid NHS and private GP service’, which is ‘the only option for the future’.

At their conference in Belfast today, they voted in favour of a motion to ballot the profession on ‘a plan B option for general practice’ that includes consideration of a ‘means-tested, subscription-based service’, such as those being offered currently by NHS dentists.

Proposing the motion, Dr Michael McKenna, from Eastern Northern Ireland LMC, said: ‘The current NHS contract model is no longer capable of sustaining the workload, the complexity or the risk that modern general practice carries.

‘We are being asked to deliver unlimited access on a budget that shrinks every year, and the result is predictable: exhausted clinicians, collapsing practices and patients who can no longer rely on the continuity that we value in our profession.

‘This motion asks us to stop pretending that the model can be rescued by goodwill alone. It can’t. The NHS-only funding structure for general practice is no longer financially sustainable, and continuing to rely on it is not just unrealistic, it is unsafe.

‘Let me be clear, this motion is not about abandoning the NHS. It is about saving general practice from a slow, politically convenient collapse.

‘Because while governments talk about access and modernisation, patients are already paying privately, not just through their own GP, they’re paying online corporates, private GP chains and commercial screening companies. The only clinicians prevented from offering those services are the ones who actually know their patients best.’

Speaking in favour of the motion, Berkshire LMC’s Dr Laurence Chacksfield said that leaving the NHS could be used as ‘leverage’ by English GPs during the ongoing collective action organised by the BMA.

He said: ‘This motion is not about implementing this tomorrow. It’s about leverage, and we need that. Every time the BMA undertakes collective action, we discover the same thing: our hand is not strong enough.

‘It doesn’t matter if [health secretary] Wes Streeting resigns today. It doesn’t matter whether or not the new health secretary is more moderate, radical or sympathetic, because ultimately it will be the Treasury who will say to them “the computer says no”.

‘Government borrowing is currently higher than it’s been for the last quarter of a century. And actually, if we do not have a stronger hand, we will find our position eroded and very quickly in the next couple of years.’

After the motion passed, in an update to the conference, GPC England chair Dr Katie Bramall said that her committee will meet next week ‘determine if we wish to progress with a ballot’.

In her speech opening the conference yesterday, Dr Bramall said: ‘I would simply urge colleagues to think very carefully about the implications [of a plan B]. Sometimes ideas can sound appealingly simple.

‘A plan B always sounds simpler when written on a conference motion than when implemented in the real world.

‘The reality is far more complicated. That is why it matters that we actively listen. Healthcare systems are extraordinarily good at making simplistic solutions look attractive right up until the point that we have to live, work and operate inside them.’

Before voting on the motion, the conference heard a talk by Dr Maitiú O’Faoláin, from the Irish Medical Organisation (IMO), who shared his experience of the mixed public/private model of general practice in the Republic of Ireland.

Dr O’Faoláin said: ‘The principles and the ethos of free access to GP and nursing care when you need it, without out of pocket expense, is a very laudable aim, and genuinely something you should all be very proud of.

‘Internationally, people do look to the United Kingdom and the NHS. However, general practice is a business, and we sell units of times. We call them consultations, but we’re selling consultations to somebody who’s buying them, be it the state or a private patient.

‘We provide professional care during that time, but do not be under the illusion that running your businesses, you’re doing anything other than selling units of time – and it’s finite.

‘Health care “at a profit”, but not “for the profit”, is how I see my role as running my business. So while the NHS is a laudable and high ideal, it is only deliverable if it is fully funded, like we have begun to experience in the Republic of Ireland over the last five or six years.’

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.

And last year the BMA’s Northern Ireland GP committee was instructed by LMCs to set up a working group to ‘develop a plan B for general practice’, and to ‘immediately’ begin development of a strategy for exiting the 2004 GMS contract and ‘future working outside of the NHS’.