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Insulting our intelligence

Insulting our intelligence

Jaimie Kaffash on NHS England’s ‘insulting’ contract offer

The BMA’s announcement that it was rejecting an ‘insulting’ contract offer from NHS England caught me completely by surprise. Mainly because I wasn’t aware negotiations were taking place, what with this being a five-year deal.

But when we obtained details, it was quite clear why there was such a strong reaction. The offer was insulting, as the BMA said. More emphasis on access, despite Pulse’s analysis that revealed access was far more dependent on systemic issues than practices’ own performance; no change to the childhood immunisation scheme, despite the effect on deprived practices; and prospective access to records for all patients from no later than 31 July 2023, despite the safety concerns that – as far as I can tell – haven’t gone away.

However, although they are all insulting suggestions, the thing that really annoyed me was the principle behind this all. The 2019 deal was supposed to be a five-year deal, with only minimal changes every year. Of course, if NHS England does feel it needs to change, they have every right to ask the BMA to negotiate (as they do most years, to be fair).

But when it comes to uplifting funding, they start to invoke arguments about this being a five-year contract. We are seeing record inflation, practices unable to afford heating bills, yet NHS England feel that the one area that warrants a change to the contract is implementing access metrics. 

There was even an apparent remedy for this in the contract itself – the ‘balancing mechanism’. This was supposed to allow for inflation or deflation yet I suspect nobody within the BMA or NHS England knows exactly how it would work.

Regardless, in another, better world, all parties will be working towards improving general practice, supporting GPs and improving patient care. Yet it feels that NHS England – and, to be fair to the organisation, one that is limited by the Department of Health and Social Care and the Treasury – are not bothered about getting to the core of the problem.

This does make me worry about the negotiations for 2024, where we have a big chance to reset the whole contract. So my question to NHS England and ministers is this: will you develop a contract that will make life better for GPs and patients, or will you chase headlines? Sadly, I’m insulting my own intelligence by asking such a stupid question.

Jaimie Kaffash is editor of Pulse. Follow him on Twitter @jkaffash or email him at



Please note, only GPs are permitted to add comments to articles

Douglas Callow 8 February, 2023 6:21 pm

Still not enough clamour from voters who courtesy of a fairly rampant press media assault on GP last year don’t seem to know the real reasons for the crisis in primary care

Access has been weaponised

This administration has nothing to lose as not expecting to be in power anyway

Dr No 9 February, 2023 10:40 pm

Stonewall PCNs, QOF, All that telemedicine shite, all forms of no direct clinical consequence to the shredder. All consults F2F. Oh, and disengagement from appraisal, and the CQC. I especially enjoyed typing that last one. In typing this I realise all these measures will directly improve patient care and access.