General practice is being cut out of its own future

Pulse editor Sofia Lind hopes that it is not too late for the BMA to claw back their seat at the negotiating table – as the future of general practice is at stake

The Government’s decision not to negotiate the GP contract with the BMA’s GP committee in England marks an extraordinary moment for general practice. The Government says it took the decision because the GPC chair can’t be trusted. While she insists she has not lied, ministers insist she has.

In my last editorial I said that if mistakes were made, we need to know. Nothing since has brought us particularly closer to certainty, and yet those allegations are now being used to justify one of the most consequential decisions for the profession in decades.

So is it all Dr Katie Bramall’s fault? Probably not. Even before the row, the language around the contract process had shifted – the Government started talking about consultation rather than negotiation, and it is clearly their plan to freeze the BMA out, as we can see in their treatment of other doctors.

That being said, something now needs to be done – urgently – to claw back the profession’s voice and give the Government no excuse to sideline the GPC. Because the NHS is currently undergoing a complete remodel a.ka. the 10-year plan, and the GP contractor model was mentioned in it only once – alongside a suggestion that it needed alternatives.

Labour has wanted to do away with the GP contractor model since the NHS was founded, but while previous governments have used the tactics of a thousand cuts, with this Government it’s more like a hundred slashes.

When GPCE met yesterday, members received a verbal report into how the core hours online access mandate made it into the contract without proper scrutiny. While it confirmed that mistakes were made, much of the blame was placed on processes and back-office staff.

Members also passed a motion stating that the GPC no longer has confidence that a new GMS contract will be negotiated any time soon. It reflects a growing recognition within the committee that they may have been sidelined altogether, and it reinforces the concern that the contractor model is being allowed to wither.

In a video message to the profession, the GPC chair seemed to suggest that the pause in negotiations could be limited to one year. She also pointed out that governments have stepped away from talks before. But this situation is of an entirely different order. This is not something that can be downplayed. It is a huge moment for the profession. When I put her suggestion to the Government, I was told that this change could be made permanent if it works well. Make of that what you wish.

The 10-year plan makes no mention of GMS, GP contractors or GP partners. And while the BMA continues to speak explicitly about GMS, ministers talk instead about remodelling the GP contract in general. A small shift in terminology that signals a much larger shift in direction.

The deputy chair of GPCE has been more outspoken than the chair herself. In a quote issued not by the BMA but by Keep Our NHS Public, ahead of a meeting tomorrow to launch a campaign to save primary care, he warned that it is entirely possible that general practice could follow the dentistry model, with good access only for those able to pay.

It is a striking comparison and one that deserves attention. It is also one that should give this Labour Government pause. A two-tier service in general practice would be hard to square with its stated values.

That is why the GPC needs to show they are the reasonable ones in this episode to get back to the table now.  The GPC leadership has managed this episode poorly and ministers have been quick to seize on the opportunity, but it is not irredeemable.

The GPC executive need to hold their hands up and say that mistakes were made. In reality, the Government were determined for this to go through – it was a red line for the health secretary. If it was addressed at the time as it should have been, all it would have done is give the GPC the moral upper hand. But right now, that would be invaluable. They would be able to focus solely on safety, rather than be drawn into ‘he said, she said’. By holding their hands up, and getting away from this spat, they can again focus solely on safety. I hope that it is not too late for that. 

Meanwhile, the Government must be honest about its intentions for the contractor model, although that might be a forlorn hope.

Moving away from the ‘lying’ accusations doesn’t guarantee that the door will reopen – it may not. But the alternative is to watch the most significant overhaul of general practice in a generation unfold without the voice of those who understand it best. That would be a loss for the profession and, ultimately, for patients.

Note: A previous version of this blog previously stated that the 10-year plan did not mention the GP partnership model. This was incorrect and has been updated.