‘The final nails in the coffin’: All the reaction to the GP contract imposition

We will be featuring all the reaction to NHS England’s imposed contract from the BMA to NHS England to grassroots GPs. This will be constantly updated. If you would like to send in your reaction, email editor@pulsetoday.co.uk

Dr Kieran Sharrock, acting chair of GPC England at the BMA

‘It’s extremely frustrating to see a second GP contract imposition forced on the profession, especially one that does absolutely nothing to improve what is fast-becoming an irreparable situation for practices and their patients up and down the country.

‘GPC England approached these contract negotiations in the spirit of collaboration, hopeful that common ground could be found, with the profession, finally, given the support it needs. Instead, the profession was roundly insulted by an inadequate first offer – which the Committee had no choice but to reject – and later subjected to a tick-box exercise meeting with the Secretary of State, who flatly refused to supply additional help to practices.

‘This contract is the result of a failure to listen to what GPs actually need, and totally ignores the calls for any extra support to help practices meet the rising costs of keeping their doors open. Despite warnings from GPC England, it also introduces more bureaucracy and arbitrary targets that only set practices up to fail and take GPs away from direct patient care.

‘Ministers have focused on eking out more without providing the resources to do this. Without investment to do more, practices have to free up resources from elsewhere. This hasn’t been properly considered, ramping up GP workload, and without the support needed, will lead to more GPs leaving the profession. Ultimately, it’s our patients who suffer most, and this means more of them will be left waiting longer for the care they desperately need.

‘This is not the contract our profession or patients need or deserve. Staff will be incredibly worried about how their practices can now possibly survive. The Government must surely understand the link between ignoring the profession and the fact that we’ve now lost the equivalent of more than 2,000 full-time, fully qualified GPs in England.

‘General practice can no longer be expected to take whatever is thrown at it, and the Committee’s recent rejection of the contract offer still stands. We will now look to enter serious discussions with our membership and the wider profession on what action we take next.’

Dr Ursula Montgomery, NHS director of primary care

‘GP teams have worked hard to deliver record numbers of appointments with half a million more delivered each week last year compared to pre-pandemic, and this new contract aims to build on this further with more access for patients. 

‘As well as providing same day care to more than two fifths of patients, GP teams will also step-up preventive action against heart attacks and strokes over the next year, with health professionals encouraged to prescribe statins alongside other preventative measures such as exercise to a much wider number of patients with heart disease, arterial disease and those who suffered a stroke or who have high levels of cholesterol.

 ‘Millions more patients will also have access to their own health records on their smartphones so they can check their test results without needing to contact their practice.

‘Frontline teams will be backed by greater funding to expand their teams, with more mental health practitioners, advanced practitioners, and apprentice physician associates joining the workforce, combined with changes to ensure staff spend less time doing paperwork and more time with patients instead.

‘This contract supports GP teams to provide what matters to patients, and later this Spring the NHS will publish the GP Recovery Plan on how access to care will be expanded even further.’

Department of Health and Social Care spokesperson

‘We’re committed to supporting GPs and are incredibly grateful for the work they do.

‘The updated terms of the contract first agreed with the BMA in 2019 will ensure patients receive better care and get to see their GP quicker – allowing practices to employ more highly skilled and experienced nurses and mental health practitioners.

‘There are 400 more doctors in general practice compared to a year ago, we are delivering almost 120,000 extra appointments every day and will shortly be setting out our plans to help primary care recover further and faster with more support for staff and for patients.’

Professor Kamila Hawthorne, chair of the Royal College of GPs

‘GPs and our teams want to be able to ensure all their patients receive safe, appropriate and timely care. But workload is escalating while GP numbers are falling – 340m consultations were delivered in general practice last year, up 9% on 2019 yet with 843 fewer fully-qualified GPs. We have a finite number of GPs, a finite number of other clinicians who can help patients, and a finite number of appointments we can offer on any given day. The details of contractual negotiations are for the BMA GPC, but we are concerned that the access requirements and timelines are asking GPs and our teams to do significantly more without sufficient resource, especially given the increased patient expectation it will lead to. The contract does set out some funding flexibilities, such as within the Additional Reimbursement Recruitment Scheme, but these do not go far enough.

‘Our warnings about the intense pressures GPs and our teams are working under and the impact this is having on patients need to be acted upon. We know thousands of GPs are considering leaving the profession in the coming years, many citing workload and workforce pressures as the reasons why, and that would make it even harder for patients to get the care and services they need when they need it. We are concerned that imposing this contract could worsen this situation, particularly if significant additional resources do not follow.

‘GPs and our teams make the vast majority of NHS patient contacts and in doing so, alleviating pressures elsewhere in the health service, including emergency departments, but our service is struggling. We need support – not further demand without it. This is why we need to see a bold new plan to increase the GP workforce beyond the 6,000 more GPs the Government promised in its election manifesto, alongside more investment in our services, including our IT systems and premises, and further efforts to cut bureaucracy to allow us more time with patients.’

Dr Lizzie Toberty, GP lead of Doctors’ Association UK

‘This contract imposition seems to imply NHSE does not view GPs as equal partners in providing high quality patient care, but as a profession who need to be beaten into submission. If we as a profession do not collectively act to resist these changes, I fear we will see an acceleration of two-tier medical care, similar to that of dentistry.

‘We need to work together to develop a well-resourced model of primary care deserving of the people of this country.’

Dr Peter Weeks, GP Partner, the Lunesdale Surgery, Carnforth

Define your core service and absolutely stick to it. No negotiation just impose it. Welcome to one of the final nails in the coffin.

Dr Amir Hannan, chair of the Association of Greater Manchester LMCs

‘This is an absolute kick in the teeth, having worked so hard trying to support the system as best we can… we’ve been rewarded for working even harder to keep the system on by being told work even harder. Especially at a time when the BMA has clearly said that full-time GPs should not be doing more than about 25 contacts a day, it’s not safe to do that.

‘We’re still gathering opinions. We’re having lots of conversations with the chairs to understand what this means. Lots of views, discussions about strikes – we don’t know whether partners can strike or not. We don’t quite know what next, but strike is an option.

‘This is crazy, the plan seems to be no plan – that’s no way of showing leadership at all. Very disappointed, very upset, very worried about where the future lies and very concerned about our staff as well as our patients. This is just going to widen health inequalities and make a bad situation much, much worse.

‘What this is doing is forcing our hands into say, “just offer an appointment, it doesn’t matter who it’s with, or if there’s any continuity or not”. That’s going to kill us.’

Dr Lis Galloway, GP Partner, Witley and Milford Medical Partnership

Many practices will now be looking at their future options. It’s either a complete lack of oversight of how primary care is the bedrock of the NHS, or a wilful aim to dismantle general practice the way we know it. Either way, primary care fails and the NHS fails.

Dr Selvaseelan Selvarajah, GP Partner in Tower Hamlets, East London

As expected, NHS England has unilaterally imposed a contract on GPs to start next month, which includes more stipulations around access, but no extra funding. An unhelpful and deeply disappointing escalation. Can’t improve patient care without resources.

Dr Irfan Malik, senior partner at Elmswood Surgery, Sherwood

‘It seems to be a unilaterally imposed contract without any discussion with the BMA. I think it’s just hammering a profession that’s already on its knees with a lot of emphasis on access for patients, which is brilliant and I don’t disagree with that, but there are reasons why access is difficult, simply because we haven’t got enough clinicians on the ground to meet the demand. This contract just feels like banging your head against a brick wall – there are reasons why access is difficult and putting it out there that we should improve access, how does one improve access when the clinicians aren’t there? A lot of negativity from the profession. I know many GPs who have an exit plan and have had enough.

‘I’ve been qualified 31 years and I’ve never known general practice in such a poor state as it is now. The youngsters are just not wanting to come in and become GP partners, the partnership model is being eroded and year on year we see this getting worse.

‘It’s brilliant having these ideas and putting it into a contract like this, but there isn’t the workforce on the ground to make this into a reality.

‘I’m in my mid-50s and probably retirement is not far away from me, and I don’t think I have that energy to fight this politically anymore.

‘I’ve not seen one positive comment on social media about this contract.’

Dr Sharon Raymond, out of hours/111 GP and director of the Crisis Rescue Foundation

I think it’s really important for people to know where to get the help that they need and in a way that’s understandable. But I don’t think necessarily that it should be down to GP surgeries who are already full to capacity with the demands of primary care. It’s not always appropriate for the GP surgery to take that role and do all of that, there are other ways of sharing that information. We need to share that load in order to make general practice more manageable. T

here’s a lot of pressure in general practice and the bottom line is, that can be shared. There are ways of approaching the task that can relieve some GP capacity – services taking health and wellbeing information and general advice outside of the GP surgery walls and into the hearts of communities to improve access to resources, particularly for those people who may be experiencing barriers to accessing healthcare and to help address health inequalities.

Dr Chandra Kanneganti, GP principal at Goldenhill Medical Centre and Five Towns GP Surgery, Staffordshire

‘These are significant goals on access and patient satisfaction but no more new funding in spite of a 10% increase in inflation and GP practice struggling with increased gas bills and increased charges. It’s the same 2.1% as in the five-year deal.

‘More support to come in to improve access is not mentioned in there but they want us to improve access. How does it work? Nobody knows.

‘There are some good stories about ARRS, about increasing flexibility to include ACPs, that’s definitely welcomed, and also confirmation that ARRS funding is not going to stop, it will continue to be available.

‘But what is not addressed yet are practices working tirelessly in deprived areas on childhood vaccinations. We lost money already, they have to come up with some kind of amendment for immunisations, like they lowered to 81% from 89%, but that’s not enough. We need to have some way to say why we are scoring less, because of the patient population.

‘But the main thing is the “call back tomorrow” is a symptom of increasing demand vs capacity. We need to look at solutions for improving the workforce… increasing access to the public without increasing the funding is not good. You could have some gains by training your receptionist in care navigation, good triage and continuity, but there will be a pressure to achieve this access target, it may break a lot of GP colleagues who are already on the last straw.’