The Government’s upcoming 10-year plan must include a commitment to negotiate a new GP contract that ‘revitalises’ general practice, the BMA has demanded.
The plan should also end ‘the scandal of doctor joblessness’ taking ‘particular steps’ to address unemployment among sessional and locum GPs, the union said in its response to a consultation launched earlier this year.
Expected in spring 2025, the 10-year plan will be ‘underlined’ by a shift from ‘hospital to community’, with plans to deliver ‘neighbourhood health centres’ where GPs work under the same roof as district nurses, physiotherapists, health visitors and others.
But the BMA argued that these neighbourhood health services promised by Labour will ‘hinge’ on GPs, and that general practice need to be resourced ‘accordingly’ with a new GP contract and adequate funding.
It reiterated demands to increase core funding by at least £40 per patient (£2.5bn in total) and specifically a rise in funding for staffing expenses to cover the cost of increased National Insurance contributions.
The Government should also allow GPs ‘greater flexibility in using their resources’, including broadening the ARRS scheme, enabling practices to recruit ‘based on need’.
And the plan should also include ‘a new deal’ for GP premises, allowing all premises costs, including management fees, to be reimbursed.
The BMA said: ‘General practice plays a pivotal role within the NHS and is critical to the plan’s success, serving as an exemplar of cost-effectiveness and efficiency for the rest of health system.
‘However, conscious long-term underfunding has left GPs caring for more and more patients, overstretching practices and placing excessive costs unnecessarily elsewhere in the system.’
‘The plan should commit to negotiating a new contract that revitalises general practice and reverses the erosion of the value of the current GP contract.’
The union also argued that the plan should address GP-patient ratios, to ensure that GP workload is ‘manageable and safe’, echoing a demand made by the GPC, which argued that practices should have a list size of up to 1,000 patients per GP to ‘ensure safety.
The BMA demands for general practice
The plan should:
- Commit to negotiating a new contract that revitalises general practice and reverses the erosion of the value of the current GP contract.
- Invest in general practice to ensure GPs can meet demand, increasing funding by at least £40 per patient (£2.5bn in total) – just 1.5% of current NHS spending.
- Stabilise practice finances, including by increasing GP practices’ funding for staffing expenses to cover the cost of rising National Insurance contributions.
- Address GP-patient ratios, to ensure that GP workload is manageable and safe, supports genuine continuity of care, and allows patients to be seen more quickly.
- End doctor unemployment, including providing sufficient funding to immediately address salaried and locum GP unemployment, in line with the BMA model contract and pay scales. This helps address inequities in supply of services to the rising demand of patients.
- Establish a new deal for GP premises, committing to funding practices of the future and allowing all premises costs, including management fees, to be reimbursed.
- Expand the GP workforce, to ensure practices are able to take on the additional work associated with shifts in care, including the creation of a two-year fully funded GP fellowship post-CCT (Certificate of Completion of Training) practicelevel scheme.
- Allow GPs greater flexibility in using their resources, including broadening the ARRS scheme, enabling practices to recruit based on need, including practice nurses in ARRS and introducing practice-based GP nursing fellowships.
- Ensure GP practices and neighbourhood care centres have sufficient capacity and the right infrastructure, including investment to expand premises, improve technology, and provide diagnostic equipment.
- Recognise the importance of out-of-hours GP services to community-led care, ensuring they are properly funded and led by GPs.
Source: BMA
It comes after the GPC 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.
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’, and the outcome of the negotiations ‘will be subject to approval’ from the profession ‘via one or more referenda’ of BMA members.
GPs have also been urged to share ideas for how to ‘fix’ general practice in order to shape the 10-year plan.
The 10-year plan, plans for which were announced over the summer, will be informed heavily by Lord Darzi’s recent investigation which said increased general practice funding should be a ‘fundamental strategic shift’ for the NHS.
Writing in Pulse when the consultation on the plan was first announced, NHS England primary care director Dr Amanda Doyle said that there is a ‘real sense of hope’ as this new Government is committed to shifting more NHS resources into primary care.
But the Prime Minister has previously said that there will be ‘no more money without reform’, as he pledged the ‘biggest reimagining of our NHS since its birth’ following the publication of the Darzi review.
Heard this BS so many times. Now out of UK we have a new contract to discuss this month. As clinicians we will walk away completely if not suitable. The authorities know it too.
Invest in the most efficient and productive part of the NHS? Should be a complete no-brainer for the government.
Best way to do this effectively over the long term would be for general practice to have a fixed portion of the overall NHS budget, as this will stop NHSE from diverting funds (that could support and improve GP services) off to prop up a failing hospital model that cannot balance its budget or maintain/improve productivity levels.
A fixed 15% would do nicely, and the resultant increase in quality and capacity in general practice would solve a lot of the NHS’ secondary care problems for it.
Then, once we are back on our feet, they can consider shifting resource and funding to enable us to operate an outpatient service that is based in the community, like in most european models – leaving hospitals to do what only hospitals can. Outpatients can then even share our IT, doing away with letters, communication problems, prescription problems etc.
A sort of reverse-vertical integration, and the very opposite of what NHS has been trying to do for the last 15 years.
What the BMA could usefully do is construct a plan for how GPs could leave the NHS at scale, whilst continuing to earn a living and treat patients.
The NHS is a failed construct, but the BMA insists on handcuffing GPs to it’s corpse.