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 Liberal Democrats promise a £1bn package to improve general practice, pledge a Strategic Small Surgeries Fund for GP services in remote and rural areas, and would implement a 10-year investment plan for hospital and primary care estates.
- 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.
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