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After GPs voted in March to reject the 2024/25 contract, the British Medical Association (BMA) formally entered into dispute with NHS England and issued guidance on how to approach the contract changes in practice.

Since then, the Doctors and Dentists Review Body (DDRB) recommendations for pay have been accepted by governments in England and Wales. Furthermore, progress in recruitment of new GPs is promised through investment in the Additional Roles Reimbursement Scheme (ARRS).

However, GPs are not convinced that these announcements will do enough to make general practice sustainable after years of inadequate funding, rising workload, and bureaucracy. Here we summarise the latest developments.

 

What did the DDRB recommend?

The GP contract 2024/25 includes an interim 2% pay rise for contractor or salaried GPs and other staff, including those recruited through ARRS. Although thousands of GPs voted to reject it, the contract was imposed from 1 April 2024.

However, in July, the government accepted the recommendations of the DDRB to increase pay elements by 6% for this financial year. As a result, a further 4% uplift will be backdated to 1 April 2024 and global sum payments per weighted patient for GP practices will rise by £7.77 (7.4%) to £112.50.

 

Who will receive the DDRB-recommended pay uplift?

The pay award is intended to cover GP contractors, salaried GPs and salaried practice staff. Practices must pass on the full DDRB pay lift to GPs employed on the BMA model salaried GP contract, and terms for other salaried GPs should be ‘no less favourable’, according to general medical services and personal medical services contracts.

Whether the uplift will be passed onto other members of the GP workforce is unclear. Experts have cautioned that in most practices the 7.4% rise in global sum payments will be insufficient to deliver the same increase for GP partners. It is also uncertain whether other pay streams will increase in line, such as dispensing fees and ARRS funding.

 

 

Progress in the GP employment crisis?

Concerns have grown that the ARRS scheme is directing funds to recruitment of other roles in general practice instead of GPs, leaving GPs out of work. To address this, the new government announced an emergency measure of £82m in additional, ring-fenced funding for ARRS, to enable recruitment of newly qualified GPs in 2024/25, available from October.

 

Questions remain about the terms of employment for ARRS-funded GPs, and about supporting recruitment of established GPs who are struggling to find work, but the government said it will be seeking longer-term solutions to GP employment and general practice sustainability in future contract discussions.

 

GPs in England take collective action

Despite these developments, the BMA’s ballot concluded with 98.3% of GP partners voting in favour of collective action to press for a better deal for general practice. The action started on 1 August. The BMA’s ‘GP practice survival toolkit’ lists 10 possible actions that will not breach contract. Demonstrating the strength of feeling on the issue, the BMA reports that four in five practices are now taking part.

Implementing safe-working advice is expected to be the most common action and the BMA has updated its ‘safe-working guidance’. Options include limiting daily patient contacts to 25, adopting 15-minute appointments, introducing waiting lists, and stopping all non-contractual work. These actions are expected to lead to a fall in appointments and a need to refer patients elsewhere, but the BMA argues the action is needed to protect safe, high-quality patient care and the wellbeing of the workforce.

Although the BMA advised deferring sign off for ‘better digital telephony’ as a form of collective action, practice teams should be aware that this guidance has been updated. After NHS England sent instructions in August, the BMA sought legal advice and now states that practices are contractually required to enable digital telephony data extraction by 1 October 2024. Any failure to do this could be a breach of contract.

 

GPs in Wales want a fairer share of NHS funding

On 10 September, the Welsh government also accepted the DDRB recommendations. In response, GP leaders in Wales have called for urgent contract negotiations on delivering the promised funding uplift. The government says that further details will be available once the annual contract talks, due to begin later in September, are complete. However, negotiations in 2023 failed to reach agreement and this year has seen a delay in restarting talks. The BMA has warned that it is evaluating options in case of a dispute.

With GP surgeries in Wales struggling to maintain financial viability, the BMA Wales launched the Save Our Surgeries campaign in 2023, urging the Welsh government to increase general practice’s share of NHS funding and introduce measures to grow and sustain the GP workforce. Hundreds of GPs in Wales have signed a letter backing the campaign and in a BMA poll, 73% said they were willing to take industrial action.

 

 

If you have any concerns about the ongoing collective action or other recent developments related to GP funding and recruitment, please call us for advice at Medical Defense Society.