Yesterday, the BMA’s GP committee set out its demands for the Government to meet in order to end collective action – which included ‘a cast-iron commitment’ from ministers and NHS England to agree and implement a new GP contract by 2028 at the latest. Anna Colivicchi takes a closer look at what that contract could look like
BMA England’s GP Committee has called for the Government to commit to a new GP contract ‘that re-ignites patient hope in the future of the NHS’, to be implemented by April 2028 ‘at the latest’.
GPCE chair Dr Katie Bramall-Stainer said this new iteration of the GMS contract needs to be ‘fair’ and must ‘supports practices to deliver the care our patients deserve’, and she said this needed to be ‘in a local GP surgery that is well-staffed and safe’.
In an updated vision document, published this week, the GPCE has set out draft ‘heads of terms’ for this new-look contract – including more funding, more protection for practices and a commitment to return to a family doctor service.
The GPC wants negotiations to be finalised by the end of 2027, for the new contract to be implemented ‘by April 2028 at the latest’. The outcome of the negotiations ‘will be subject to approval’ from the profession ‘via one or more referenda’ of BMA members, it added.
It is also demanding that this new GMS contract has ‘no fixed end date’ and that any future changes to the final contractual agreement ‘can only occur via mutual agreement between the parties’. Each year there should be an opportunity for any of the parties to ‘initiate a negotiation over prospective changes to the GMS contract’.This follows consecutive contract impositions and ‘profound concerns’ among GP leaders when the Government said that discussions around the 2024/25 contract were a ‘consultation’ with various groups, and not a ‘negotiation’ with the BMA.So what could that 2027/28 GP contract look like?
Commitment to one GP per 1,000 patients
The GPC wants the new GMS contract to ‘support the recruitment, retention and return of GPs’ to reduce the GP to patient list size to ‘a safe ratio’, from the current rate of 2,293 patients per full-time equivalent GP. It wants the Government and NHS England to commit to ‘an in-perpetuity policy ambition’ of reaching the ‘optimal goal’ of one GP per 1,000 patients.
‘This will therefore mean modelling and projecting how many GPs the population will need to reach this goal, and subsequently resourcing the GMS contract accordingly to ensure GP registrars can be recruited into the NHS as soon as they qualify,’ the document said.
‘Sustained’ annual investment and year-on-year uplift
Setting out its demands to end collective action, the GPC said core funding should rise by at least £40 per patient for 2025/26, but in the long term it is calling for ‘sustained annual investment’ in general practice, taking into account inflation, and uplifted year-on-year.
GPC England negotiators have said they would turn down any attempts by the Government to negotiate long-term pay deals, pointing out that the five-year pay deal – which provided a 2% year-on-year funding rise from 2019-2024 – has contributed to pay erosion for partners and salaried GPs.
Improve premises reimbursements
The new contract should also aim at ending ‘time consuming and costly disputes’ between NHS Property Services, other landlord organisations and GP practices over ‘unfair or unregulated’ service charge hikes, by including a mechanism of direct cost reimbursement for charges, maintenance and improvement.
The GPC also pointed out that financial liabilities that practices currently hold ‘place a significant burden on them’, which can act as a disincentive to GPs becoming partners. It wants negotiations for the next contract to explore how these requirements and risks can be limited and mitigated against, especially in relation to the ‘complexities associated with information governance requirements and staffing and estates liabilities’.
‘These increased protections will help return general practice to a family doctor led service, where many GPs set down roots in one community for their entire careers,’ it added. ‘GPs will be allowed to focus more on continuity of patient care rather than organisational risk management, subsequently coming to know and understand their patients well, thus reducing a significant disincentive to younger GPs from becoming contract holder.’
Reduced bureaucracy and incentivised continuity of care
Last week, the health secretary announced that the Government is launching ‘a red tape challenge’ to ‘cut down’ on bureaucracy – this will involve asking GPs and ICBs ‘what works well and what needs to change’ before the feedback is considered by a review group made up of doctors in primary and secondary care.
But the GPC argued that the new contract should go even further and explore ways to ensure administrative processes are ‘streamlined’, remove ‘redundant requirements’, and foster ‘a more supportive environment’ that enables GPs to focus on delivering care to patients.
The new GMS contract should also incentivise continuity of care for patients, ‘over the achievement of activity metrics,’ rewarding practices that prioritise continuity of care for their registered patients, while recognising the local context within which the care is delivered.
More autonomy for GP practices and the role of LMCs
The GPC also wants the Government to explore opportunities for practices to have ‘greater autonomy and decision-making authority’ within the healthcare system.
The role of LMCs should also be ‘recognised and maintained’ in the contract. ‘LMC representation on ICBs will be enhanced, and a requirement will be placed on ICBs and commissioning bodies to engage with all relevant LMCs meaningfully and proactively regarding any matters relating to general practice, eg, especially any local transformation initiatives.’
Return to a family doctor service
Finally, the new contract should ‘enable general practice to return to being a family doctor service’, according to the BMA, and would be characterised by this set of principles:
- Have adequate time for every patient, and be able to routinely see the same patients on a list limited in size, per full-time equivalent GP, to an agreed safe ratio
- Be able to keep up to date with the latest clinical practice
- Have complete clinical freedom while in accordance with the GMC’s Good Medical Practice
- Have adequate, well-equipped premises
- Have at their disposal all the diagnostic aids, social services and ancillary services required to serve the needs of their patients within a community setting
- Be encouraged to acquire additional skills and experience in special fields, which enable them to better serve the needs of their local community
- Be adequately paid by a method acceptable to them, which encourages them to do their best for their patients
- Have a work-life balance, which assures doctors with caring responsibilities a career in general practice is feasible.
Next steps
GP collective action is currently ongoing, and is intended to provide leverage to the GPC for this contract, and any more minor amendments to the current contract in the meantime. The five-year contract deal ran out this year, and with the 2024/25 imposed contract being a ‘stepping stone’, the GPC will be discussing next steps with NHS England and the Government for 2025/26.
Dr Bramall-Stainer said that as part of these negotiations ‘objective metrics’ are ‘desperately needed’ and that for 2025/26 specifically, there must be ‘additional investment’ in the GP core contract ringfenced to ‘stabilise vulnerable practices, prevent further surgery closures and avoid rationing of services’.
The BMA’s main ask for the 2025/26 contract at the current time seems to be that GP practice core funding for should increase by at least £40 per weighted registered patient – with a deal that will deliver an additional 11p per patient per day.
Health secretary Wes Streeting again signalled his commitment to working with the profession, while urging GPs to stop collective action last week. To date, the GPC has complained that Mr Streeting’s side of the negotiating table has remained empty, but the upcoming weeks – and Autumn Budget statement – will need to show the Government’s hand more clearly.
