Nov 6, 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 in November.
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.
Sep 11, 2024
As Sir Keir Starmer and the new Labour government roll up their sleeves and set out their priorities for the coming months, healthcare is a key issue on the agenda. Having diagnosed that the “NHS is broken”, the government now has the challenging task of trying to fix the problems.
In this article, we examine Labour’s first moves to tackle the crisis in the NHS, including key ministerial appointments, initial actions in office, and pledges for the future. We also look at the reactions from GP leaders and the implications of the ongoing BMA ballot on collective action.
Key appointments in health
Wes Streeting was appointed the new health and social care secretary after narrowly holding onto his seat as MP for Ilford North in Redbridge. Having previously held the role of shadow health and social care secretary, he is positive about the challenge, seeing an “enormous opportunity” to get the NHS “back on its feet making it fit for the future”.
In other government appointments, Stephen Kinnock, MP for Aberafan Maestag and son of former Labour leader Neil Kinnock, is the new minister of state for care, with responsibilities including primary care; Karin Smyth, MP for Bristol South, became the minister of state for health responsible for secondary care.
Andrew Gwynne, MP for Gorton and Denton, has a new role as parliamentary under-secretary of state for public health and prevention while Baroness Merron is now parliamentary under-secretary of state for patient safety, women’s health and mental health.
First steps in power – “The cavalry is coming”
Since taking office, Wes Streeting has reaffirmed the government’s commitment to resolving the crisis in the NHS and general practice. In his article for GPonline, he declared that for GPs considering their future in the NHS, “the cavalry is coming”.
However, he emphasised that restoring general practice will require “both investment and reform.” One of his first actions has been to order an independent review of NHS performance in England to inform his upcoming 10-year plan for the NHS. This will be led by Lord Ara Darzi, an NHS surgeon and independent peer. The report is expected by September.
Mr Streeting’s “number-one priority” for the NHS is cutting waiting times, a point reiterated in the King’s Speech. He has also committed to reversing underfunding in general practice and shifting the focus out of hospitals and into the community. Highlighting this shift, Mr Streeting’s first official visit was to a GP practice – Abbey Medical Centre in North London. He said, “I’m determined to make the NHS more of a neighbourhood health service, with more care available closer to people’s homes.”
Pledges on investment and reform
Labour has been clear that problems in the NHS cannot be fixed ‘overnight’. Money is tight, and any plans need to be affordable. So far, the party has not committed to detailed funding plans for primary care, but Wes Streeting promised: “Labour will provide the investment and reform needed to get patients seen on time again and bring back the family doctor”.
GPs will be watching to see how Labour delivers on its pledges to:
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Train ‘thousands more’ GPs, deliver the NHS long-term workforce plan and ‘reset’ the relationship with NHS staff to end strikes.
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Review the ARRS scheme preventing practices from recruiting GPs.
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Guarantee face-to-face appointments and incentivise continuity of care.
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Prioritise health and care in local communities and trial Neighbourhood Health Centres, bringing together services such as family doctors, district nurses, care workers, physiotherapists, palliative care, and mental health specialists.
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Return to meeting NHS performance standards.
Reactions from GP leaders
GP leaders have welcomed Mr Streeting’s statements and are pushing for further commitments to general practice funding.
The British Medical Association (BMA) England GP committee chair, Dr Katie Bramall-Stainer, called for the general practice share of NHS funding to increase by 1% each year until it reaches 15%. The BMA chair, Professor Philip Banfield offered to work together with Mr Streeting and called for a new and “mutually agreed” GP contract.
RCGP chair, Professor Kamila Hawthorne, was “really encouraged” and said she was looking forward to working with Mr Streeting to ‘ensure that we have the right balance of workforce we need to look after our patients, in particular we need more GPs working in our practices’.
The BMA ballot on the GP contract
Given that Mr Streeting has already engaged with junior doctors, there is renewed optimism that the new government is willing to negotiate with NHS staff over pay. However, a BMA ballot is underway until 29 July, asking GP partners whether they are prepared to take collective action in a stand against the 2024/25 GP contract that was imposed in April and delivered only a 1.9% funding uplift.
Whether GPs vote in favour of collective action remains to be seen, and the extent of any action will depend on negotiations with the new government and their response to the Doctors and Dentists Review Body (DDRB) recommendations on 2024/25 pay.
If GPs vote in favour of collective action, the BMA will invite them to choose from 12 possible actions in the ‘GP practice survival toolkit’ from 1 August. Although this covers a range of options, introducing safe working advice is expected to be the action adopted by most practices.
Meanwhile, the BMA has provided guidance on how to approach the contract changes in practice, and advised members to start implementing the measures to improve patient safety and staff working conditions.
If you would like advice about GP funding issues or the impact of the proposed collective actions, please get in touch with our expert team at Medical Defense Society.
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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