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 firstname.lastname@example.org