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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.