Jul 1, 2025
On instructions from the Medical Defense Society, we recently concluded the successful defence of a GP and Medical Defense Society member in fitness to practise proceedings before the General Medical Council (“GMC”).
Background
Dr A is an experienced GP and partner in a GP practice in England. She is also an avid user of social media. Since the outbreak of the Gaza War in 2023, Dr A has frequently posted about this topic. Her postings range from sharing commentary from journalists such as Owen Jones of the Guardian, to expressing solidarity with US students sanctioned for pro-Palestinian protests, to condemning Israel’s actions and using hashtags including #GazaGenocide #GazaHolocaust and #CeasfireNow. On a number of occasions, Dr A has described Israel’s actions in Gaza as “slaughter” and “reminiscent of Nazi Germany”.
A complaint was submitted to the GMC alleging that Dr A’s social media posts were in breach of the duties of a doctor registered with the GMC, due to being antisemitic and offensive. The complaint further alleged that Dr A’s actions were potentially in breach of Sections 5 and 18 of the Public Order Act 1986. These provisions relate to causing harassment, alarm or distress and stirring up racial hatred. The complaint asked the GMC to “take urgent action” in respect of Dr A.
In response to this complaint, the GMC opened a fitness to practise investigation into Dr A and notified her of this, following which Dr A immediately contacted Medical Defense Society to seek assistance.
GMC Guidance
The GMC publishes a range of material which is relevant to Dr A’s situation. For example, the GMC’s core guidance, Good Medical Practice, says:
“You must follow the law, our guidance on professional standards, and other regulations relevant to your work”.
“You must not abuse, discriminate against, bully, or harass anyone based on their personal characteristics, or for any other reason. By ‘personal characteristics’ we mean someone’s appearance, lifestyle, culture, their social or economic status, or any of the characteristics protected by legislation – age, disability, gender reassignment, race, marriage and civil partnership, pregnancy and maternity, religion or belief, sex and sexual orientation”.
“You must not express your personal beliefs (including political, religious and moral beliefs) to patients in ways that exploit their vulnerability or could reasonably cause them distress”.
The GMC’s supplemental guidance Using Social Media as a Medical Professional also says:
“The standards expected of you as a medical professional do not change because you are communicating through social media, rather than face to face or through other methods of communication”.
“How you behave when using social media matters. Medical professionals, like everyone else, have rights to freedom of belief, privacy, and expression. But exercising these rights when using social media as a medical professional has to be balanced with the possible impact on other people’s rights and interests”.
It is important to note, however, that although every doctor has a responsibility to be familiar with Good Medical Practice and to meet the professional standards set by the GMC, Good Medical Practice is not a set of rules and it does not cover every possible scenario which may arise in a doctor’s life.
Meeting with Dr A
Following our instruction, we contacted Dr A within 24 hours and then met with her to provide reassurance and to discuss the GMC complaint and Dr A’s thoughts on it. We explained to Dr A that the GMC could not determine the allegations of criminal law breaches made against her (which would be a matter for the Police), but would consider her alleged actions by reference to GMC standards and the legal concept of fitness to practise.
Dr A reported feeling extremely upset by the GMC process, which is very common. In a recent survey of doctors investigated by the GMC, 91% reported that their case triggered stress and anxiety, with 31% experiencing suicidal ideation.
Despite her distress, Dr A also felt strongly that she had not done anything wrong and she believed that the GMC process was being used to inappropriately discourage legitimate criticism.
Having reviewed all of Dr A’s social media posts cited in the GMC complaint, we advised that we felt her actions were defensible and this was not a case where Dr A would be best served by demonstrating remorse, insight and remediation. We agreed with Dr A that we would draft a response to the GMC complaint for her consideration and that this response would deny any wrongdoing or impairment of her fitness to practise.
Human Rights Act Entitlements
In our view, the GMC’s guidance should include greater reference to doctors’ Human Rights Act entitlements, in particular Article 8 (Right to respect for private and family life) and Article 10 (Right to freedom of expression).
The starting position is that, under the Human Rights Act:
- Everyone has the right to freedom of expression. This includes freedom to hold opinions and to receive and impart information and ideas. A person’s rights under Article 10 specifically include the right to express opinions that offend, shock or disturb others.
- Everyone has the right to respect for their private and family life, home and correspondence.
- Postings on social media outside a work context (as was the case here; Dr A’s social media accounts are personal accounts) specifically attract the protections of Article 8 and Article 10.
Regrettably, these rights are barely mentioned within the current versions of GMC guidance.
Response to GMC
The submission to the GMC which we prepared on behalf of Dr A asserted that:
- Nothing stated by Dr A was in fact antisemitic or capable of amounting to hate speech.
- Dr A was profoundly shocked and saddened by the extent of the human suffering in Gaza, and believed it was important to raise awareness of this suffering.
- Dr A holds legitimate concerns about the Israeli government’s actions in Gaza. The Employment Tribunal has held that anti-Zionist beliefs (distinct from antisemitic beliefs) qualify as protected beliefs pursuant to the Equality Act 2010.
- The GMC had no lawful basis on which to interfere with Dr A’s Human Rights Act entitlements. The test for doing so, as affirmed in the recent High Court case of Adil v General Medical Council [2023] was not made out in Dr A’s case.
- If Dr A’s case was referred forward to a full fitness to practise hearing, there was no realistic prospect of a finding that her fitness to practise is impaired.
Outcome
The GMC’s fitness to practise investigation into Dr A was closed with no action, allowing Dr A to put this matter behind her and continue enjoying her use of social media.
Learning Points
It is important for doctors to be familiar with the GMC’s published guidance mentioned above – Good Medical Practice and Using Social Media as a Medical Professional – and to adhere to it.
However, doctors should not be misled into believing that the GMC’s guidance is the only relevant or authoritative source of information regarding their expression of beliefs.
Doctors’ Human Rights Act entitlements are powerful and there are limited grounds on which the GMC can interfere with these entitlements. Doctors, like all citizens, have the right to campaign or speak up about issues of importance to them.
Being the subject of a GMC investigation is often very upsetting. In addition to contacting your medical defence organisation without delay, it’s important to access wellbeing support. Some excellent, free sources of this include Practitioner Health, Frontline19 and The Doctor Support Service.
Links:
Author: Andrea James, Partner – Professional Discipline & Healthcare Regulatory Specialist, Keystone Law
This case study is presented for informational and educational purposes only. The views expressed by the individual involved do not represent the views or positions of the Medical Defense Society. Medical Defense Society remains neutral on all matters of political or personal belief and is committed solely to providing fair, expert medico-legal support to its members.
Jun 2, 2025
In an increasingly complex healthcare landscape, it’s striking how many elements of general practice have evolved except the assumptions underpinning GP indemnity.
At Medical Defense Society, we speak to GPs at all stages of their careers: newly qualified, established partners, clinical directors, portfolio GPs, and locums. What connects them all is a shared challenge ensuring their indemnity keeps pace with the real shape of their working life. And too often, it doesn’t.
A Profession No Longer Defined by One Role
The traditional model of general practice was relatively straightforward: a full-time, surgery-based GP managing a list of registered patients. But that is no longer the reality for many doctors in the UK.
Today’s GPs are clinical educators, public health advisers, NHS England appraisers, charity founders, digital health consultants, and PCN leaders. Many work part-time in clinics and spend the rest of their week contributing to system-level change, research, policy, or innovation. Others balance NHS sessions with private work or voluntary roles overseas. The profession has diversified and rightly so.
Yet the indemnity landscape hasn’t always kept pace.
The Risk of Rigid Cover in a Flexible World
When indemnity is purchased or provided based on a fixed model of care assuming that all work is direct clinical contact in NHS primary care settings it creates blind spots. Some GPs unknowingly leave parts of their portfolio unprotected. Others pay for coverage they don’t need. Worst of all, some assume they are covered for every role they undertake, only to discover during a medico-legal challenge that their protection didn’t stretch that far.
This is not a theoretical risk. We’ve seen cases where non-clinical roles, leadership positions, and even informal teaching arrangements have introduced legal liability or regulatory scrutiny. If a GP’s indemnity doesn’t extend to these areas, they’re left exposed at precisely the moment they expect protection.
And because the traditional indemnity narrative rarely discusses this nuance, the problem goes unnoticed until it’s too late.
Reframing the Question: “What Do I Actually Need Cover For?”
A more useful approach starts with a mindset shift. Instead of asking, “Do I have indemnity?”, the question should be:
“Does my indemnity reflect the full scope of what I do?”
It sounds simple, but in practice, many doctors have never audited their roles against their cover. If you’re part of a multidisciplinary team, teach undergraduates, consult on service design, or act as a CCG adviser, these are not edge cases. They are real, daily parts of your professional contribution and they deserve proper protection.
This lack of clarity is compounded when indemnity is built into employment contracts, provided via state-backed schemes, or bundled through employers. In such cases, GPs can be unclear on whether third-party schemes include vicarious liability, regulatory defence, or support for complaints outside the clinical setting.
In short: just because someone else arranged it, doesn’t mean it covers everything.
What GPs Can Do: Practical Steps to Regain Control
- Review your indemnity annually
Careers evolve. Your protection should too. Schedule an annual check to ensure your indemnity reflects your current roles not just the ones you held when you first signed up.
- Be explicit about non-standard work
Activities like teaching, committee participation, policy advising, and digital triage may not be automatically covered. Don’t leave it to assumption ask your provider directly whether these are included.
- Avoid “catch-all” assumptions
If your provider claims to cover “everything,” ask them to specify. Insist on written confirmation that your roles especially less traditional ones are within scope.
- Check across settings
If you work in both NHS and private practice, across multiple locations, or through different agencies, confirm that your indemnity bridges each setting without exclusions or duplication.
These steps are not just about risk mitigation. They’re about ensuring peace of mind, enabling doctors to contribute confidently and creatively to the profession without second-guessing their protection.
The System Must Catch Up
The move towards flexible, portfolio careers should be seen as a strength of modern general practice. It brings fresh perspectives, cross-sector innovation, and greater sustainability. But until indemnity providers adapt to that flexibility, doctors remain stuck navigating an outdated model that assumes uniformity where diversity now thrives.
We must move away from the notion that indemnity is a fixed product for a fixed type of doctor. Instead, it should be a responsive service, a service one adapts to changing roles, listens to what doctors actually do, and evolves alongside them.
This is not just about legal protection. It’s about supporting the kind of career GPs increasingly want and need to build.
Protection That Fits
At the Medical Defence Society, we believe your indemnity should fit the career you’ve created not the one the system assumes you have.
We’re not locked into legacy systems, flat-pack policies, or outdated risk models. We’re built for today’s GP: flexible, multi-faceted, and evolving. That’s why we offer tailored indemnity support that adapts with your role and not against it.
Whether you’re teaching, leading, consulting, or simply working outside the traditional box we’re here to ensure your protection is as dynamic as your practice. No jargon. No assumptions. Just honest, doctor first support.
So, if your career has moved on but your indemnity hasn’t, get in touch. Let’s build cover that reflects your reality, not restricts it.
Not a Medical Defense Society member, not a problem. Contact us and we can help you work out the right questions to ask your current indemnity provider.
Feb 1, 2025
GPs will have been concerned to read that an independent review of the Care Quality Commission (CQC), led by Dr Penny Dash, identified ‘significant internal failings’ that hinder the regulator’s ability to effectively judge how health and social care services are performing.
As GPs strive to maintain a high standard of service for their patients, they need to know that their efforts are fairly and consistently judged by the CQC. They would also want to understand how the CQC’s ratings are generated so that improvements to care can be made where necessary.
Yet, the report’s findings suggest that GP practices may be impacted by inconsistencies in CQC ratings, opaque ratings calculations, and infrequent inspections performed by teams without sufficient clinical expertise.
Overall report findings
Dr Penny Dash, chair of the North West London Integrated Care Board, began her review of CQC in May 2024. In the course of this, she spoke with around 300 people in total, from within the CQC, the services it regulates, and from a range of patient and user groups.
However, despite these concerns, she emphasised that the people she spoke to recognised the need for a ‘strong, credible and effective regulator’, and that CQC personnel were generally professional and dedicated to their work.
What were the key issues?
Remarkably, Dr Dash found that CQC failures were having a direct impact on the activity of health and social care providers, impeding their capacity and capability to deliver services and implement improvements.

Ten key issues were revealed:
- Poor operational performance: A declining level of inspections, leading to a backlog in new registrations, delays in re-inspections, and an increasing age of CQC ratings.
- Significant challenges with the provider portal and regulatory platform: Problems with new IT systems, installed in 2021, hindered roll out of the ‘single assessment framework’ (SAF) and induced frustration for providers and CQC staff alike.
- Delays in producing reports and poor-quality reports: These issues hampered users’ ability to access information, while impacting on the credibility and utility of assessments.
- Loss of credibility within the health and care sectors due to the loss of sector expertise and wider restructuring, resulting in lost opportunities for improvement: After internal restructuring in 2023, operational staff moved from specific sectors into integrated teams, leading to loss of expertise as well as loss of relationships between CQC and providers.
- Concerns around the SAF and its application: issues include poor communication about the assessments and ratings categories, insufficient attention to the effectiveness of care and outcomes, and no reference to the efficient and economic delivery of care. There is also little acknowledgement of the challenges in balancing risk and ensuring high-quality care across an organisation.
- Lack of clarity and concerns regarding how ratings are calculated: overall ratings calculations may include aggregate outcomes from inspections over several years, and providers do not understand how the ratings are generated.
- CQC’s assessment of local authority Care Act duties could be improved.
- Concerns about Integrated Care System (ICS) assessments, which are in the early stages of development.
- CQC could do more to support improvements in quality: for example, by sharing best practice and innovative approaches to care delivery.
- There are opportunities to improve the sponsorship relationship between CQC and the Department of Health and Social Care (DHSC).
How is this impacting on GP practices?
Like all providers of regulated healthcare and adult social care services in England, GP practices must register with CQC and undergo inspections, with ratings assigned following the assessments.
The CQC’s inadequate performance was reported to be negatively impacting GP providers in several ways, including: a ‘lack of consistency’ in assessments across large GP practice groups; reliance on unrepresentative GP patient data; lack of transparency in how ratings are decided; as well as delays and IT problems.
In addition, Dr Dash concluded that a lack of relevant expertise among CQC’s senior leaders and GP practice inspection teams was causing providers to lose trust in the outcomes of reviews.

The recommendations
Dr Dash stressed the importance of a high-performing regulator for the health and care sectors, and a need to restore confidence in the CQC. Among her recommendations were:
- Rapidly improve operational performance, IT systems and report quality
- Rebuild expertise and relationships with providers
- Make the SAF fit for purpose
- Clarify how ratings are calculated
Following the interim report, Dr Dash commented, ‘Our ultimate goal is to build a robust, effective regulator that can support a sustainable and high-performing NHS and social care system which the general public deserves.’
First steps towards improvements
Following Dr Dash’s interim report, the CQC accepted the recommendations in full, committing to take rapid action to rebuild trust and performance with the ‘right structure, processes and technology’ in place.
Wes Streeting was reportedly ‘stunned’ by the extent of CQC’s failings in the report. He promised action, including: the appointment of Professor Sir Mike Richards, former Chief Inspector of Hospitals, to review the assessment framework; increased transparency around CQC ratings; greater oversight; and a further review of patient safety organisations, to be published in early 2025.
The CQC’s internal review by Professor Sir Mike Richards examined the assessment framework and its implementation. He concluded that the organisation needs a ‘fundamental reset’ to meet its objectives, with the recommendations including:
- Revert to the previous organisational structure
- Simplify the assessment framework and abandon the concept of a ‘single assessment framework’ for all the diverse services that CQC regulates
- Provide immediate feedback at the end of inspections, particularly for serious adverse findings
- Urgently review staffing
- Consider whether changes to the ‘one-word ratings’ could be beneficial.
In October, the CQC announced that Sir Julian Hartley will become its new Chief Executive. He said, ‘I will do my utmost to bring all I have learned to serve people who use services and to work with CQC staff and with providers to deliver high quality regulation which drives improvement across the health and care system.’
Please contact the expert team at Medical Defense Society if you have any concerns about CQC reviews and ratings.
Jan 1, 2025
Both the Royal College of GPs (RCGP) and the British Medical Association (BMA) recently voted to phase out Physician Associate (PA) roles on grounds of patient safety. However, around 2,000 PAs already work in general practice.
In recognition of this reality and the need for clarity around PA roles, the RCGP issued new guidance in October, covering induction and preceptorship, supervision and the scope of practice of PAs. It sets a ‘deliberately narrow’ scope of practice to protect patient safety and to reflect the limited evidence base.
Echoing previous BMA recommendations published in March, the RCGP guidance makes clear that PAs should not see undifferentiated patients. With the General Medical Council (GMC) preparing to regulate PAs from December, it is essential that GPs, practices and PAs are familiar with the guidelines and maintain a clear distinction between GP and PA roles.
PA preceptorship, induction and supervision
The RCGP guidance defines PAs as ‘dependent healthcare professionals’ working in the multidisciplinary team with ‘supervision from a named GP Clinical Supervisor’. The GP Clinical Supervisor oversees the work of the PA and retains overall clinical responsibility for the patients the PA sees.
The guidance says that PAs should also have an Educational Supervisor to oversee educational and professional development during a preceptorship period, normally 12 months long. A learning needs assessment, performed by both supervisors together with the PA, will form the basis of a job plan, setting out the PA’s role.
Furthermore, PAs must have a minimum induction period of two weeks, full-time equivalent, when they begin a new role. During this time, the practice should ensure that the PA and other staff understand the PA role, lines of accountability, and how the PA should be introduced to patients – transparency is key.
Job plans must include protected time for daily supervision and regular review meetings, with frequency dependent on the experience and competence of the PA.
What can PAs do?
Despite the restrictions, the RCGP guidance sets out responsibilities that are in scope for a PA. For example, PAs can be the first point of contact for patients over 16 years with suspected minor conditions that have clear clinical pathways and escalation processes. The RCGP proposes starting with the seven common minor illnesses in the Pharmacy First programme.
While PAs can ‘take a history, complete a physical examination, and construct an appropriate diagnostic and management plan’, they must share the plan and all patient notes for approval by their GP Clinical Supervisor.

- PAs may also perform tasks including annual NHS health checks and assisting in making referrals as agreed with a GP. They may also support or lead practice clinical audits, learning events, research and service development and other practice initiatives.
- However, there are strict limits on the PA’s role with regards to clinical procedures, tests, prescriptions, and patient forms. Only PAs with further training may take on a wider scope of practice, if agreed with their GP Clinical Supervisor, such as providing contraceptive advice, vaccinations, performing certain clinical tests and reviews, and additional administrative tasks.
PAs must follow clinical protocols
PAs must always use the GP practice clinical guidelines and protocols, and document all patient encounters, including advice given by the GP Clinical Supervisor. Practices should ensure they have a protocol for safe prescribing for patients seen by the PA.
Importantly, PAs must always introduce themselves to the patient and make it clear in communications with patients and other staff that they are not a doctor. Practices must also inform team members about the PA role and ensure that patients are told when they are seen by a PA.

PAs have a limited scope of practice and must not see undifferentiated patients
The GP Clinical Supervisor will determine the PA’s scope of practice at the start of their employment, based on their clinical competencies, and the PA must always work within this, and within the scope of practice of their GP Clinical Supervisor.
In particular, the RCGP guidance states that ‘PAs must not see patients who have not been triaged by a GP and only undertake work delegated to them by, and agreed with, their GP Clinical Supervisor’.
Notably, this contrasts with wording in the updated network contract directed enhanced service published in September, which indicates that PAs can see undifferentiated patients if their ‘named GP supervisor is satisfied that adequate supervision, supporting governance and systems are in place’.
The RCGP guidance provides a list of patients that should not be triaged to PAs, including those with potentially serious, complex or rare conditions, suspected mental illness, pregnant or post-natal women, and children under 16.
GMC to regulate PA roles from December
From 13 December 2024, the GMC will begin to regulate PAs, setting expected standards of practice, education and training.
Although PAs will not be legally required to register until December 2026, they will be encouraged to apply as soon as possible. PAs on existing voluntary registers will be invited to sign up by the end of January 2025 and employers will be asked to promote this. Once registered, PAs will be required to follow ‘Good medical practice’ and participate in annual appraisals to support future revalidation.
GP practice responsibilities
GP practices should check that PAs are listed on the Physician Associate Managed Voluntary Register or, once GMC regulation begins, the GMC’s Register of PAs. Further advice on governance considerations is summarised in the RCGP guidance, including advice from the GMC and from NHS Resolution for doctors who supervise PAs.
Importantly, although RCGP cannot enforce its new rules, employers are responsible for handling of PA contracts, and the guidance may be ‘taken into account by NHS Resolution and medical defence organisations in a case of alleged negligence or clinical or professional mistakes’.
Employers must ensure that adequate professional indemnity insurance is in place for the PA. If you would like further advice about this, or have other questions about PA roles, please contact us at Medical Defense Society.
Nov 1, 2024
Medical Defense Society was pleased to sponsor and attend the Royal College of General Practitioners (RCGP) Annual Conference and Exhibition 2024 on 3–4 October at the ACC Liverpool. We heard from Wes Streeting, who addressed delegates in a keynote speech – the first secretary of state to do so in seven years.
He acknowledged the difficulties experienced by GPs in managing ‘increasingly complex care’ without the resources, infrastructure and authority required, saying: ‘Patients are frustrated they can’t see you. You’re frustrated you can’t meet their demands.’
His remarks reflect the findings of the Independent Investigation of the NHS in England, published on 12 September. Led by surgeon and former health minister, Professor Lord Darzi, the review was commissioned by the government to assess the current state of the NHS.
The Darzi review: NHS in ‘serious trouble’
In agreement with Mr Streeting, who declared the NHS was ‘broken’ on his first day as Secretary of State for Health and Social Care, Darzi found the NHS to be in a ‘critical condition’.

He said that while NHS staff are ‘doing their best to cope with the enormous challenges’, patient satisfaction has been eroded by increasingly long waiting times across the NHS, for GP services, surgery, cancer care, A&E, and mental health services.
He concluded that key drivers of the deteriorating service were: austerity in funding; the pandemic; lack of patient voice and staff engagement; and management structures and systems. In addition, the 25% cut in public health grants to local authorities since 2015 contributed to the worsening state of the nation’s physical and mental health, causing surging demand for NHS services.
Darzi judged that NHS money is not being spent where it should be: less should be spent in hospitals while community services should receive a greater share. In hospitals, staff numbers rose by 17% between 2019 and 2023. Meanwhile, in primary care, although GPs now see more patients than ever, the number of fully qualified GPs is falling and patients are struggling to get appointments.
Wes Streeting’s plans for general practice
The findings from the Darzi review will now inform the ten-year health plan that is expected in spring 2025. At the RCGP annual conference, Mr Streeting explained that the plan will shift the focus of healthcare in three ways – “from hospital to community, analog to digital and sickness to prevention”, with general practice playing a core role.

Reinforcing Labour’s commitment to improving continuity of care, he said: ‘it will be at the heart of this government’s plan to reimagine the NHS as much as a neighbourhood health service as a national health service.’
He also promised to ’bulldoze bureaucracy’ in general practice. This will include avoiding unnecessary GP appointments for referrals. He cited the example of a pilot to directly refer women with a worrying lump to a breast clinic via 111 Online, starting from November.
What is needed to ‘fix’ the NHS?
The Darzi review strengthened the case for radical reforms in the NHS. Labour now has the responsibility for trying to fix the problems, and GPs must await details of how the government plans to do this. While Mr Streeting committed at the conference to ‘growing the proportion of the NHS budget that goes into primary care’, he cautioned: ‘I can’t turn around 14 years of underinvestment in a single budget or even a single spending review, but we can start to move in the right direction.’
Siva Anandaciva, Chief Analyst at The King’s Fund, said: ‘There have been some reports that the NHS will be at the centre of the upcoming Budget, but against a backdrop of constrained public finances, the proof will be in the pudding of how far the government is willing to go to support health and care services ahead of next year’s multi-year spending review.’
Of note, the British Medical Association (BMA) has proposed terms for negotiations on future contract reform. The ‘heads of terms’ document is published as part of the BMA’s ‘Patients first’ vision for general practice, intended to be a ‘framework for future negotiations’ in line with Labour’s manifesto commitments and the Darzi review.
The aim is for a major new contract to be implemented by April 2028, aiming to fully resource general practice, enable continuity of care, and rebuild the workforce.
‘Stand down collective action’
Mr Streeting emphasized the need for government and GPs to work together and called on GPs to ‘stand down collective action’ as it would ‘punish patients’ and hinder recovery.

He wrapped up his speech by urging, ‘I need every part of the NHS to pull together as one team, with one purpose. To be the generation that took the NHS from the worst crisis in its history, got it back on its feet, and made it fit for the future. That’s the mission of this government, and I’m confident that together we will rise to it.’
However, in response, GP leaders in the BMA reiterated that general practice must take action to limit the unsustainable pressure. They called for an increase in core general practice funding from 2025/26 as a first step towards ending collective action.
Other news from the RCGP conference

Additional roles reimbursement scheme (ARRS) funding for GP jobs to continue beyond March:
An emergency fund of £82m is now available through the ARRS to enable recruitment of newly qualified GPs in 2024/25, from 1 October 2024 to the end of March 2025.
Following RCGP calls for a ‘public commitment’ that these jobs would not end in March, the college chair, Professor Kamila Hawthorne, questioned Wes Streeting on this point at the conference. He responded with a promise that the funding would continue beyond March, saying ‘that’s the kind of stability and the certainty that people need now, both in terms of employing people, but also taking up jobs.’
Despite this promise, GPs remain concerned that ARRS funding for GP roles is insufficient. There is also dismay that the overall ARRS budget uplift this year is limited to 2%, meaning that primary care networks may struggle to afford the 5.5% pay rise awarded to ARRS staff from 1 October.
Single register of GPs and specialist doctors:
For years, the RCGP has been calling for the GP and specialist registers to be merged into a single register, to give GPs ‘parity of esteem’ within the NHS and formally recognise their expertise.
Mr Streeting confirmed at the conference that he is ‘committed to the creation of a single register of GPs and specialist doctors, and this government will legislate to give the GMC the power to do it.’ He added, ‘It’s symbolic, but it’s also meaningful. It reflects the partnership I want to build with this profession.’
New RCGP guidance on Physician Associates (PAs) roles: Induction, preceptorship, supervision and scope
Since the RCGP conference, the college has published new guidance on PA roles in general practice, setting a ‘deliberately narrow’ scope of practice to maintain patient safety and reflecting the limited evidence base.

- Induction, preceptorship, and supervision: The guidance includes that all PAs should have a minimum induction period of two weeks, full-time equivalent when they begin a new role. Furthermore, each PA must have a named GP clinical supervisor and, during a ‘preceptorship period’ – normally 12 months – also a GP educational supervisor.
- Scope: The guidance states that ‘PAs must not see patients who have not been triaged by a GP and only undertake work delegated to them by, and agreed with, their GP clinical supervisor.’ It also provides a list of patients who should not be seen by PAs, including those with potentially serious or complex conditions.
While PAs can take a history, complete a physical examination, and construct an appropriate diagnostic and management plan, they must share the plan with their GP supervisor. There are also strict limits on the PAs’ role with regards to clinical procedures, tests, prescriptions, and patient forms.
- Employers are responsible: Importantly, although RCGP cannot enforce the rules, employers are responsible for the appropriate handling of PA contracts, and the guidance may be ‘taken into account by NHS Resolution and medical defence organisations in a case of alleged negligence or clinical or professional mistakes’. Employers must ensure that adequate professional indemnity insurance is in place for the PA.
Reports of Care Quality Commission (CQC) failings
Finally, Medical Defense Society members who rely on CQC registration will no doubt be interested in the reported failings of the organisation. The full report by Dr Penelope Dash has now been published, and will be the focus of our next article.
If you would like advice about any of the topics discussed here – including collective action, ARRS funding, PA roles, and CQC inspections – please get in touch at Medical Defense Society.
Oct 1, 2024
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.
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