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.
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