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Not worth the paper it’s written on

Not worth the paper it’s written on

Jaimie Kaffash says ministers and NHS England can’t be trusted to deliver on any promises not nailed down in the GP contract

Ahead of the contract imposition, the BMA’s GP Committee held what seemed at the time to be constructive talks with primary care minister Neil O’Brien. Part of the optimism involved the upcoming ‘general practice recovery plan’, which would – among other things – focus on the ‘primary-secondary care interface’.

The assumption is the plan includes fresh efforts to stop workload dump from secondary care, including specialists asking GPs to refer elsewhere in the same hospital, or order blood tests. The problem is, we’ve already had such a plan. 

The GP Forward View in 2016 used almost identical wording to the BMA’s update. It, too, promised to address the ‘primary-secondary care interface’, even changing trusts’ standard contract. But it failed miserably, as evidenced by the need for another drive to tackle it, seven years on. 

Sadly, GPs are all-too used to government plans that don’t deliver, as our Best Laid Plans investigation reveals. Ministers and the NHS repeatedly make bold promises, often as a supposed carrot to the stick of punitive new demands. 

To be entirely fair, in some cases these incentives have been implemented and some of the punitive elements quietly discarded. 

Yet the plans often turn out to be underwhelming. Take the Forward View’s £2.4bn more per year for general practice and its promise of extra staff. NHSE would no doubt claim to have followed through on these, but much of the ‘investment’ is in the form of staff via the additional roles reimbursement scheme, criticised by GPs for its prescriptive nature. Worse still, many PCNs haven’t been able to find suitable ARRS staff, meaning the funding goes unspent and is lost.

Sometimes they even cause harm. While the Forward View’s promise of a hotline for GPs to speak to consultants seemed a great idea, it has now morphed into the advice and guidance scheme, which is being used in place of referrals in some areas, to the concern of GPs.

The main problem here – and the same will no doubt be true of the recovery plan – is that nothing is binding. There is nothing stopping the NHS and ministers wriggling out of any measure that proves troublesome, or just making implementation the responsibility of local commissioners, with no extra funding. 

One of the reasons we did this investigation was to hold the Government to account for these plans, which aren’t really worth the paper they’re written on. I hold out little hope for the recovery plan – if it is not in the GP contract, it is not a true pledge. 

Luckily, major GP contract negotiations are around the corner. I realise how naively optimistic this sounds, considering there has just been a contract imposition. But these will be major negotiations, not simply adjustments.

For the 2024 contract, if I’m a GPC negotiator, I’m saying anything useful in the recovery plan must go into the GP contract on our terms. Workload dump? The contract must oblige NHSE to implement an easy process for GPs to bounce back work from trusts. And money for additional roles must go into core funding so practices can hire staff as they see fit. 

Ministers and the NHS will have their own agendas; negotiators will need to be wary of attempts to link access to recovery in the contract. But, in contrast to all the vague ministerial plans for primary care, GPs will have elected negotiators feeding into any changes, and should have the means to reject anything unacceptable. They will have legal recourse to refuse work outside the contract (and the GPC should insist on stronger mechanisms to allow GPs to do this). 

Then the recovery plan and all its predecessors can be put to good use at a time when the cost-of-living crisis has left toilet roll prices at an all-time high.

A version of this column originally appeared in the March 2023 issue of Pulse

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