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When Saturday comes

When Saturday comes

Yesterday’s news about the new contract in England took everyone – including, it seems, the BMA – by surprise.

As expected, there were very few changes to the core contract, other than slight changes to immunisation schedules and the requirements to offer online appointments.

Yet despite this, it became one of the most controversial contracts of recent years, for two reasons. First, this was unnegotiated – the BMA GP Committee negotiators didn’t agree to this. We don’t know exactly what happened, but my suspicion is that the GPC negotiators wanted a far greater change to the contract to reflect the effect the pandemic has had, but NHS England continue to consider this a five-year contract and were unwilling for wider negotiations.

Whatever the truth, this is already leading to greater animosity between the two parties.

The second reason this is so controversial is the change to the Network DES. It was always planned that the requirements for extended access would be detailed this year. But they are brutal – all PCNs are likely to have to offer routine services on Saturday from 9am to 5pm, as well as weekdays until 8pm. The reaction has (unsurprisingly) been almost unanimously negative from the GP community. The reasons for this are obvious – there aren’t enough GPs and spreading them more thinly will just make core hours even more stressful.

But I think NHS England are shooting themselves in the foot with such a policy. Because this isn’t core contract – being part of a network remains an optional enhanced service. And, although so much more money is funnelled through networks now, I feel that they may have overestimated how wedded GPs are to the network project. The BMA’s ballot on industrial action has demonstrated how many practices are willing to give up on networks.

Because, let’s face it, this is NHS England’s baby and GPs have never fully bought into it. I do think the concept of networks has merit, but when the biggest incentive – the promise of extra staff through the additional roles reimbursement scheme – has been so beset with problems, many practices are asking whether it is worth it.

These new onerous access requirements will be the point when many practices feel the risk-benefit analysis of being in a network swings too far towards risk. And the biggest losers in such a scenario will be NHS England.

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



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Patrufini Duffy 2 March, 2022 10:22 pm

What “their” letter didn’t say:

Thank you. Your contribution is not really recognised, nor valued or appreciated. I mean, you haven’t got any tangible reason to think so, but we thought we’d use the stock NHSE buzz words as they expire soon alongside the PPE and your ability to opt out of the PCN (we won’t mention the date here) – we keep them in our buzz word box, to cover-up the upcoming shafting – words like honesty, transparency and working with/against colleagues. Things went wrong, let’s brush the past under the carpet. Learning from mistakes, kind of. Shame about all that vaccine threat recently isn’t it and wanting to sack your colleagues and carers. If any of your relatives are nurses, sorry about the U-turn on that one, was kind of sick really, thought it would be a fun joke but we realised we don’t have the staff to do basic work. Just you – and we need you to do more. As you noticed, we went silent for a while after the public shafting you got in October 2021 – we didn’t want to stir you up again as we read that you might ballot – but you didn’t. As expected, thin air. We do hope you survived that debacle – as you saw, we successfully didn’t bother changing anything for you, even after your Manchester GP colleagues got abused and violated. That letter we wrote, did the trick, somewhat, do you remember: “I would like to thank the staff and their families who were caught up in the events on the day”. Thank you – for being harassed and putting your face on the line. But, let’s move on – Covid is over – and your post-traumatic stress has only just begun – but, as you’ll note on point 356.22 bullet point 7, Sajid sincerely says thank you, for signing up to this. You know, covering our back and keeping the public naïve about privatisation. We were happy that our American friends in Operose passed their “inspection” with the courts recently. That was a close chestnut. But, we hope to fragment the inert landscape more effectively, and more quietly moving forward and unsafely – you will have noticed it, and thanks for covering it up again, as your referrals are rejected, providers close their access, health visitors vanish and mental health becomes a hypothetical hope. We partially apologise for you having to do the work of hospitals. Consultants need to be free to do private work, up on the private wing of the NHS Trust. Thank you for the unpaid follow-up nevertheless. The blood bottles are back though – thank you for covering that up too. It kind of sums up your naivety, perhaps something for your next PDP. We were going to rename the PCN – Primary Care Naivety. We do hope you haven’t read the small print, well…you never read the initial contract anyway. We have continued our meetings with the private sector and all is well on their side – they are in agreement that if you clean up the general public, social care and the general high street, then they can establish themselves better and siphon off the routine care and cream. The podium was closed today – so we couldn’t announce this all to the public immediately. But, thank you again, for forgetting the last 2 years. Or 5 years. We look forward to disintegrating the care system soon with your help. Please remain in the PCN group – we find it better to herd and monitor you like that.