You will be well aware of the changes that NHS England have made to the GP contract. They published the new terms on 6th March 2023, and there haven’t been such major contract changes since 2004. Almost twenty years on, we look at the key points from the new contract, and what they mean for GPs and GP practices.
The backdrop to the contract is:
- A worrying decline in the GP workforce
- An ongoing dispute between the BMA GP committee and NHS England
- A demoralised workforce: 97% of GPs consider primary care to be in a state of crisis, 99% feel overworked, and 94% are experiencing mental health challenges as a result (MCG primary care survey 2022)
Earlier in the year, the BMA and NHS England held talks to negotiate the terms, but didn’t manage to reach an agreement. The BMA described the proposed changes as ‘insulting’ and argued they did nothing to relieve the pressure on primary care. NHS England moved ahead regardless and imposed the new contract.
Some key points from the new terms
- Practices will 'no longer be able to request that patients contact the practice at a later time'. Patients must be assessed, or directed to the appropriate service, at first contact.
- GPs will have to publicly declare earnings over £156,000 for 2021/22; £159,000 for 2022/23; and £163,000 for 2023/24. This rule was due to be introduced earlier, but it was initially delayed due to the pandemic
- £246m of IIF funding will focus on improving the patient experience of contacting their practice
- Patients should be assessed 'for example same day or within two weeks where appropriate, depending on urgency'
- 70% of that money will be monthly payments to Primary Care Networks as the 'capacity and access support payment'
- A PCN will receive the remaining 30% at the end of March 2024 if they meet the criteria in an agreed 'access improvement plan'
How have medical professionals reacted?
Acting chair of the BMA GP Committee Dr Kieran Sharrock argued that 'To offer nothing to meet the spiralling costs of running practices as inflation runs rife, and teams continue to do more with less, is insulting to staff and unsafe for patients.’
Dr Matt Mayer, MCG Healthcare GP Wellbeing lead, commented, ‘This forcibly imposed contract does absolutely nothing to address the GP crisis in the country at the moment, and instead makes things even worse. The obsession with 'access,' demonstrated by the shifting of all targets to only measure access, in the context of GPs continuing to leave the NHS due to some of the highest workload levels in the world, displays not only the risk to patient safety that this contract brings, but also the total ignorance of its authors to the situation on the ground.’
What impact will the new contract have?
The NHS plan ‘Investment and Evolution: A five-year Framework for GP contract reform’ sets out a funding increase of 2.1%. With inflation at 9.2%, with stricter performance targets, and with ongoing staff shortages, GPs and surgeries are pessimistic about the outlook for their practices and their livelihoods.
The letter itself acknowledges the work that GPs have been doing. “In January 2023 General Practice delivered 30m appointments, an increase of 11% on January 2020, a testament to the incredible work of GP teams.” However, it seems that verbal appreciation hasn’t translated into action.
Before the announcement, Dr Mayer explained the decline in the GP workforce in stark terms. ‘GPs are unfairly treated. Because of that, they are leaving in droves. There’s a limit to what they can take.’ He called the contract negotiations ‘make or break’ and ‘our last chance to fix the problem.’
So, what will the consequences be for GPs and for primary care? Dr Mayer argues, ‘There is a very real risk of ending up with a two-tier system. GPs could almost certainly make a lot more money from that, but because of the empathy that took them into the job, a lot of my colleagues would be quite sad about it. But if it’s a choice between losing their house and putting food on the table for their kids, they’re going to make the obvious choice.’
What is the answer to better care outcomes and GP retention?
According to Dr Mayer, retaining GPs is about making the profession an attractive career.
‘GPs here work more per unit of salary than in most other developed countries. You only have to look at the countries GPs are going to, to see it can be a very satisfying, very fulfilling job which provides a very sustainable, high-quality service for patients. Less workload seems to be the main thing that attracts people.
‘I just don’t think there’s the political will to do that. I think there’s a will to provide a skeleton service on the cheap. A GP gets about £100 per year per patient. That’s less than it would cost to insure a pet hamster, and it covers unlimited care.’
MCG Healthcare champions the work and the wellbeing of all healthcare professionals. In his role as GP Wellbeing lead, and in his LMC work, Dr Matt Mayer provides support for GPs who are facing stress, burnout, and mental health challenges. If you are a GP and have worked with MCG, speak to your consultant, who can arrange a wellbeing call.
If you’re a practice manager looking for the perfect GP or locum, or a GP looking for the perfect role, call 0330 024 1345 or email hello@mcghealthcare.co.uk
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