Jul 22, 2024
With the imposition of the 2024/25 GP contract, providing a 1.9% funding uplift to practices, many GPs are angry that the government has not done enough to improve pay and working conditions in primary care.
The British Medical Association (BMA) has now provided guidance on how to approach the contract changes in practice, and a BMA ballot is underway until 29 July, asking GP partners whether they are prepared to take collective action in a stand against the contract.
In the meantime, the general election provides GPs an opportunity to see what the different political parties offer. We provide a topline round-up of their manifesto promises on primary care.
BMA guidance and ballot
The BMA’s raft of new guidance documents on changes to the GP contract includes measures on better digital telephony and simpler online requests, use of referral forms or proformas and advice and guidance, as well as advice on GP data sharing, among others. The BMA advises members to start implementing the measures to improve patient safety and staff working conditions.
If GPs vote in favour of collective action in the ongoing BMA ballot, the BMA will invite them to choose from 12 possible actions in the ‘GP practice survival toolkit’ from 1 August. These actions, which will not breach contracts, cover a range of optional measures including: delaying signing off for aspects of the PCN directed enhanced service, freezing or withdrawing data sharing agreements, applying BMA safe working guidance, and ending non-contractual activities that reduce pressure on other NHS services.
Negotiations on pay will determine next steps
Whether these collective actions continue, escalate to strike action, or are de-escalated depends on negotiations with the next government.
As specialist and associate specialist (SAS) doctors voted to accept a pay uplift of 9.5–19.4% (for those with open contracts) for 2023/24, Professor Phil Banfield, the BMA chair, argued that “it is possible to negotiate a successful end to the doctors’ disputes with the right investment, right offer and improvements to working conditions.”
The Doctors and Dentists Review Body (DDRB) is expected to make recommendations on 2024/25 pay in July, soon after the general election. However, the BMA’s DDRB Uplift swingometer shows that a 10.7% uplift is required just to restore core contract funding to 2018/19 levels, and the general practitioners committee England (GPCE) thinks this is unlikely to be achieved.
The BMA GPCE deputy chair, Dr David Wrigley, warned, “Whoever is in government after 4 July should know that we are ready to stand up for our patients and practices.”
What do the parties’ manifestos promise for GPs?
Common themes in the main parties’ manifestos are to prioritise health and care in local communities, reduce pressure on GPs by expanding community-based services such as Pharmacy First and use technology to modernise primary care and appointment bookings.
Do any of the parties promise an increase in GP funding?
- Although the Conservatives pledge to ‘increase NHS spending above inflation in each year of the next Parliament’, their manifesto does not spell out what this would mean for GP funding. In terms of capital investment, they promise to build 100 new practices, refurbish 150 more, and add 50 more community diagnostic centres.
- Likewise, the Labour manifesto does not provide details on funding for primary care. However, Shadow health and social care secretary, Wes Streeting, promised: “Labour will provide the investment and reform needed to get patients seen on time again and bring back the family doctor”.
- The Reform manifesto does not give details on primary care funding, but states that overall NHS pledges would cost £17bn/year.
- The Green Party promises that primary care would receive an increased allocation of NHS funding, up to an additional £1.5bn/year by 2030.
How do the parties intend to boost the GP workforce?
- The Conservatives would continue to support the NHS long-term workforce plan, but have not specified a target number of GPs.
- Labour has committed to train ‘thousands more’ GPs and deliver the NHS long-term workforce plan; they would also ‘reset’ the relationship with NHS staff to end strikes. Wes Streeting confirmed that Labour would review the ARRS scheme ‘preventing practices from recruiting the GPs that are desperately needed’.
- The Liberal Democrats promise 8,000 more GPs and a 10-year plan for staff retention. They also pledge to reduce ‘top-down bureaucracy’ so that practices can ‘hire the staff they need and invest in training’ as well as establishing a ‘properly independent’ pay review body.
- Reform would, within the first 100 days, introduce a zero basic rate tax for NHS and social care staff for three years, end training caps for UK medical students, and write off student fees pro rata per year after 10 years of service for doctors, nurses and medical staff.
- The Green Party promises an ‘immediate boost’ to NHS staff pay, including restoring junior doctors’ pay.
- In addition, Plaid Cymru would recruit an additional 500 GPs in Wales.
What do the manifestos promise for patient access and waiting times?
- The Conservatives and Labour promise to return to meeting NHS performance standards; both would use the independent sector to help bring down waiting times for diagnosis and treatment.
- Labour would guarantee face-to-face appointments for those who want one and would ‘bring back the family doctor’ by incentivising GPs to see the same patient.
- The Liberal Democrats would give everyone the right to see a GP (or most appropriate practice staff member) within seven days, or within 24 hours if urgent, and give everyone aged >70 or with long term conditions access to a named GP.
- Reform would introduce a voucher for private treatment if patients cannot see a GP within three days, a consultant within three weeks or have an operation within nine weeks; and cut A&E waiting times with a campaign of ‘Pharmacy First, GP Second, A&E Last’.
- The Green Party guarantee rapid access to a GP and same day access for urgent cases.
Reactions to the manifestos have been sceptical that the NHS funding pledges would be anywhere near sufficient to deliver on waiting times and make the ambitious improvements to services that are promised. How the next government starts to address the funding gaps and how they prioritise primary care will be crucial issues for GPs this summer.
If you would like advice about the impact of the proposed collective actions on your practice, please get in touch with our expert team at Medical Defense Society.
Jul 11, 2024
The 2024/25 GP contract that was imposed by NHS England on 1st April provides practices with a funding uplift of about 1.9%, an increase labelled as ‘an insult’ by GP leaders. They warn that much more is needed to prevent practice closures and sustain patient services.
The British Medical Association (BMA) general practitioners committee England (GPCE) is now formally in dispute with NHS England over the contract, following its overwhelming rejection by GPs in a BMA referendum. Feelings on the issue are so strong that many GPs are prepared to take industrial action.
However, negotiations with the government and NHS England continue and a further uplift is possible after the Doctors and Dentists Review Body (DDRB) makes its recommendations.
Changes in the GP contract for 2024/25
With the 2024/25 GP contract, NHS England hopes to implement ‘simpler and more flexible arrangements’ that will free up practice time and improve patient experiences. This includes:
- Cutting bureaucracy and increasing financial flexibility through changes to the Quality and Outcomes Framework (QOF), Investment and Impact Fund (IIF), and Capacity and Access Improvement Payment (CAIP) systems.
- Increasing staffing flexibility for Primary Care Networks.
- Simplifying the Directed Enhanced Service (DES) requirements.
- Reviewing digital data to better understand overall demand on general practice.
More controversially, practice funding is rising by £259m, an uplift of about 1.9% plus extra to account for population growth and inflation. With this increase, overall contract investment has risen to £11,864m. Practices will now be receiving global sum payments per weighted patient of £107.57, an extra £2.84.
This funding increase assumes a 2% pay rise for GP partners, salaried GPs, other practice staff, and staff in Additional Roles Reimbursement Scheme (ARRS) roles.
Rejected by GPs
The contract was unanimously rejected by the BMA GPCE in February. Subsequently, over 19,000 GPs voted in a BMA referendum from 7–27 March 2024, with an overwhelming 99.2% responding ‘no’ to the question: ‘Do you accept the 2024/25 GMS contract for general practice from government and NHS England?’
On 17th April, the GPCE chair, Dr Katie Bramall-Stainer, informed NHS England that general practice is in dispute over the contract.
BMA leaders have described the 1.9% uplift to GP funding as ‘derisory’ and warned that it will lead to more practice closures and reduced services. In negotiations with NHS England over the contract, they argued that an 8.7% increase would be needed just to return practice finances to their position in 2019, before the five-year contract that has now ended.
Indeed, many practices are experiencing unsustainable financial stress, despite being busier than ever. Consequently, they cannot afford to recruit and retain qualified GPs, which adds to workload stress for remaining staff and impacts on patient satisfaction.
Threat of industrial action
The strength of feeling against the contract is such that in a GPonline poll, 72% of respondents said they were prepared to take industrial action. Although many were uncomfortable with the idea of industrial action and concerned about public attitudes to this, the key reasons for GPs supporting action included burnout and stress, pay, workload, and concerns about patient safety.
The BMA GPCE is considering options for collective action by GPs that would target the government and NHS England, but not patients. Furthermore, the BMA wants ‘contractors to feel safe that they’re not going to get breach notices from their [integrated care boards] ICBs, that they’re not going to stick their neck out and find they’ve got [Care Quality Commission] CQC after them.’
In polling, most GPs (84%) favoured taking action by restricting their work to BMA guidance on safe working limits, while 60% supported partial or complete list closures. Other proposed actions garnered less support.
Dr Bramall-Stainer said, “This is a political choice that ministers must make – and we need to give them every opportunity to recuse us having to go down that line, because that’s a last resort.”
What happens next?
The BMA GPCE plans to hold focus groups with GPs during June and July to determine the form of any industrial action, and will disseminate information to GPs during the next few months. In addition, the committee intends to issue advice and guidance about the contract changes, including an update to the BMA’s safe working guidance.
Meanwhile, it is hoped that continuing talks with NHS England and the government will lead to mutually acceptable solutions to avert industrial action.
Following the end of the five-year contract, GP funding is now subject to the standard DDRB pay review process. The BMA GPCE has submitted its own evidence for consideration by DDRB. This may help to address concerns that evidence submitted by NHS England includes out-of-date information from 2013/14 to 2021/22, showing rising GP income because of extra funding for delivering millions of COVID-19 jabs. It does not mention that GP income has since fallen and that inflation is now causing intense financial pressure.
Hopes remain of an additional uplift for GP funding when the government responds to DDRB recommendations, expected later in the year.
If you are concerned about the impact of the 2024/25 GP contract on your own practice, please ask for advice from our medico-legal advisory team at Medical Defense Society.
Jul 11, 2024
The imposition of the 2024/25 GP contract on 1 April, giving practices a funding uplift of about 1.9%, was resoundingly rejected by GPs in a British Medical Association (BMA) referendum.
Now, the BMA general practitioners committee England (GPCE) has announced a non-statutory ballot, from 17 June to 29 July, asking GP partners whether they are prepared to take collective action against the contract.
This article examines some of the key issues behind GPs’ negative reactions towards the contract and discusses arrangements for the BMA ballot and potential collective action. Now that the general election is confirmed for 4 July, will that affect the plans?
Sense of injustice over sub-inflation pay rise
A major issue for GPs is that the 1.9% uplift to funding in the 2024/25 contract, described as ‘derisory’ by BMA leaders, is seen as a further real-terms funding cut that will lead to practice closures and a reduction in patient services.
Dr Steve Taylor, GP spokesperson for Doctors Association UK (DAUK), has warned that: “GPs will be looking at the government finally offering pay increases to SAS doctors and consultants with a sense of injustice.” He said, “Despite it being the only part of the NHS doing more than 2019, the government has ignored pleas from GPs to provide the funding needed to continue to provide the care patients need and deserve.”
The government has so far refused to negotiate, saying that extra funding could come after the Doctors and Dentists Review Body (DDRB) issues its recommendations.
However, with the general election now scheduled to take place around the time the DDRB is expected to issue its advice, GPs are concerned that a decision will come too late to stop more practices closing.
Dr Taylor said, “With GPs facing significant issues on funding that need urgent attention, DAUK hope that MPs will not delay decisions on funding and make it a priority on the resumption of parliament.”
Does the contract ‘cut bureaucracy’?
Another key issue is the bureaucracy that many GPs feel is overwhelming their ability to focus on patient care.
While NHS England has emphasised that the 2024/25 GP contract is intended to cut bureaucracy – “the biggest reduction of unnecessary and burdensome bureaucracy in 20 years” – GP leaders have rejected this claim.
GPs have argued that there is more bureaucracy than ever, including:
- Completing complex forms and clinical tests to refer patients to hospital
- Writing referrals for patients from other providers
- Filling out sick certificates and prescriptions on behalf of other providers
- Supervising Additional Roles Reimbursement Scheme (ARRS) staff and registrars
- Working with primary care networks and integrated care boards.
The GP unemployment crisis
A further big issue is GP unemployment. Despite rising demand for GP appointments, and falling numbers of full-time equivalent GPs, thousands of sessional and locum GPs have reported struggling to find work, while GP registrars fear that there will be no work for them when they qualify.
The BMA called for an urgent government review, warning that many practices cannot afford to recruit GPs due to funding cuts and inflexibilities in ARRS funding.
Professor Kamila Hawthorne, Chair of the Royal College of GPs (RCGP), also expressed her frustration: “The College has been calling on the Government to allow practices to use ARRS funding to recruit more GPs and to increase the overall funding for general practice so we can recruit all the staff we need to meet patients growing levels of demand.”
BMA ballot for collective action by GPs
Given the overwhelming rejection of the 2024/25 contract by GPs, the BMA GPCE voted on 16 May to conduct an online ballot, from 17 June to 29 July, in which GP partners will be asked whether they are willing to take ‘safe and legal action’ to protect their practices and their patients.
Dr Katie Bramall-Stainer, chair of the BMA GPCE, called this “phase one” of the response to the BMA referendum. Despite the general election being held on 4 July, she confirmed that the ballot will go ahead and “does not change our plans for GP action”.
GP leaders hope that the ballot will help to put general practice funding on the agenda for discussion during the political campaigns and put pressure on politicians to find solutions that will avert the need for action.
However, if the ballot outcome is in favour, collective action could start from 1 August, just three weeks after the new government is installed.
Actions that GP partners may be asked to take will not breach GP contracts. They may include limiting daily appointments to 25 patients per GP in line with BMA safe working advice, and stopping or reducing non-contract work.
The BMA promises a series of roadshows, webinars, and resources to explain the plans to healthcare professionals, as well as a public campaign.
Public support for prioritising GP funding
In polling, 72% of GP respondents previously said they were prepared to take industrial action. Even so, many expressed their discomfort with the idea and their concern about the public response.
However, it seems that prioritising investment in primary care is a key issue for the public too. Findings of the Rebuild General Practice campaign in 2023 found that 52% of respondents wanted the government to prioritise general practice in allocating NHS funding. Recent research by the Health Foundation and Ipos UK also demonstrated widespread support for prioritising community-based services, including general practice.
With the general election just weeks away, prospective MPs will no doubt be tested on their understanding of the issues facing GPs and their patients in provision of primary care services. Their plans to address these issues may well be an important factor in how the public vote.
If you have questions about how the proposed collective action could affect your practice and medico-legal responsibilities, our advisory team is here to help at Medical Defense Society.
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