Other parts of the NHS are envious of the five-year GP contract and want their ‘share of the cake’, according to the former chair of the BMA’s GP Committee for England.
Speaking at Pulse Live last month, Dr Richard Vautrey said the key issue for general practice is whether there is any further investment from the Government in next year’s new contract.
But he added that extra funding wasn’t guaranteed, partly because of the perception that general practice got more funding as a result of the 2019 contract.
The lack of investment was cited by GPC England as the main problem with the 2023/24 contract imposition, and BMA leaders have warned that they will look into potential industrial action as a result.
Dr Vautrey told delegates at Pulse Live that industrial action would involve a ‘number of issues’ for GPs, but doctors’ leaders around the country have told Pulse that GPs might be willing to provide ‘only emergency care’ only as part of potential action against NHS England.
Treasury funding commitment
Answering a question about the next long-term contract, set to be implemented in 2024, Dr Vautrey said that NHS staff in other parts of the system saw general practice receive higher levels of investment than they did as a result of NHS England’s policy, highlighted in the Long Term Plan, to ‘preferentially invest in primary and community care’.
He said, however, that this changed during the pandemic when secondary care received more funding, and in fact there remains ‘an urgent need’ for further investment in general practice.
He said: ‘I think the key is what happens next year. I think we knew what was likely to happen this year in terms of the trajectory of the 5-year plan that we’ve had.
‘The key is – is there any commitment from Government and particularly from Treasury, to invest in general practice next year?’
He added: ‘In reality we just need to remember that some other sectors of the NHS still look at our five-year plan and think “actually they got far more than we got during that period of time, and now it’s time for us to get a share of the cake this time round”.
‘We can’t have that in reality, we have to see a real commitment to levels of investment. It’s then, maybe, that we’ll have real decisions about what the future of general practice looks like.’
Dr Vautrey also said there are concerns in Government that productivity has not increased in secondary care despite investment, whereas productivity in general practice has in fact gone up while its workforce has gone down.
Contractual landscape
Dr Vautrey’s presentation at Pulse Live focused on the current contractual landscape for general practice following NHS England’s imposition of a new contract earlier this month.
The contract changes included more stipulations around access, such as GP practices no longer being able to request that patients contact them later, but no extra funding.
The BMA is currently considering next steps and its list of potential industrial action options included full practice closures for a day and closure of patient lists.
When asked about the prospect of industrial action at Pulse Live, the ex-GPC chair said there are ‘lots and lots of issues’ for GPs, including who they actually take action against and ‘putting your own livelihood at risk’.
Last month, the BMA confirmed that fully closing GP practices for a day ‘would be challenging’ but is ‘on the cards’ as part of industrial action plans, after NHS England’s contract imposition.
Other options for industrial action also included closing patients lists, establishing lengthy GP consultation waiting lists similarly to secondary care, severe capping of daily consultations and submitting undated contract resignations.
Support for industrial action
A recent poll by Leicestershire, Leicester and Rutland LMC found that, of 123 local GPs and practice managers, 95.9% were dissatisfied with the imposed contract and that 76.4% ‘would be willing to take some form of industrial action.’
Dr Grant Ingrams, who chairs the LMC, said that 61.4% are willing to provide an ‘emergency only service’ for one or more days, and 43.1% are willing to stop all services.
Dr Ingrams said: ‘Due to a decade of disinvestment in general practice, and being inappropriately pilloried by parts of the media, general practice in LLR is in a crisis.
‘This latest imposed contract will be the last straw for many more GPs who will leave the profession.
‘This will mean even fewer GPs left to provide services to patients. Unless the government changes their approach and treats general practice with respect, universal NHS general practice could disappear within a decade.’
Dr Ann Robinson, a GP partner in Lancashire, told Pulse that closing her practice for a day is something she never imagined to have to do.
She said: ‘I have been a GP for 25 years and a partner for 10, I never imagined a day that we could be talking about closing the practice for industrial action.
‘But I believe that this government is just not listening to any reasonable discussion about the future of general practice.
‘It is not any easy decision for me, as the best interests of our 5,550 patients come first. I agree, it is challenging, but through no fault of ours.’
Dr Selvaseelan Selvarajah, GP partner in East London and representative on BMA Council, said it is time for GPC to ask its members what they would be prepared to do.
He said: ‘I would want the GPC to ask membership exactly what they want to do: the junior doctors were asked and the consultants have had an indicative ballot.
‘So I would want the GPC – this is a personal view, not an organisational view – to tell the GP membership exactly what the options are available to them and ask for their opinion about how they want to take it forward.
‘I think that the options that have been floated before would be viable if there’s consensus among GPs. So if we work to together, I think all options should be on the table. It needs to be done legally and with consensus.’
GPC England is expected to hold a special meeting on 27 April to discuss next steps, after setting up a working group preparing for GP industrial action, understood to be floating options going further than before.
This week, a major Government review claimed that ‘national contracts’ present a ‘significant barrier’ to local innovation and recommended ‘a new framework’ for GP contracts.
Speechless
This is NOT leadership
If this is the best that he can say, better to say nothing rather than be an embarrassment.
Richard , I am sorry but think you have negotiator bias on this.
A five year deal that ties GPs to a 2% pay rise this year and sees most of the extra funding linked to staff who quite simply were not there to employ ?
Millions of unspent ARSS money going back to treasury!
The PCN DES is an absolute nightmare of bureaucracy and if it had actually been enforced by CCGs and implemented as per the original negotiated settlement would have been a disaster .
Most of the specs have been slipped or fudged many times .
Do you remember how the original deal you negotiated was so bad the 70% reimbursement only got changed to 100% when folk like I and many other GPs cried foul .
If the health select committee says General Practice is in crisis due to workforce and over bureaucratic QOF and IIF how can you claim others look on it with envy.?
I am sorry but if this has been accurately reported you are very wrong .
Don’t believe me? then ask a few other GPs ( and recently retired GPs)
Please reflect carefully , if you had put this to a ballot initially you could claim democratic legitimacy , but you never did till I brought the vote to LMC conference ,
You may have got the mandate then but only by threatening to stop negotiating the PCN DES , and now we have an imposed contract( so fat lot of good that did) . I respect a lot of what you have done but not this contract or the PCN DES !
Indemnity yes and sick pay ? yes, well done but sorry, this contract was not your finest hour!
can see why the government were not held to account when this person was in charge. Hoping for better this time round.
sorry Richard but this is just trying tpjustify what has been an abject failure. I know of no one envious of the 5 year contract and to be honest it has taken partnerships on the bring extinction with disinvestment in gms. You failed to see the wider agenda and I think primary care as we know it won’t exist in the next 5 years. Oh and the idea of industrial action by only dealing with emergencies? Totally unworkable and will have no effect. As far as patients are concerned everything from a broken toenail is an emergency! Cloud cukoo land trying to defend the indefensible as a negotiator.
Hear hear David,
not to mention two other issues:
The PCN ARRS and Manager roles working to national standards and national pay guidelines are sucking staff out of practices (and others such as the Ambulance service) and inflating salaries way above our 5 year 2% annual inflationary uplift. Many local practices are offering unfunded 10% pay increases just to keep their staff.
The failure of secondary care to respond adequately to appropriate referrals from Primary care has DRAMATICALLY increased our workload of dissatisfied patients unable to progress. Has anyone done a study on this , because it certainly impacts on my day.
I cant see any reason why anyone should envy our situation. My son , who originally wanted to be a UK GP, doesnt. He has changed his mind twice – and is now doing specialty training in Australia.
The Primary care House of cards is coming down but i have the option to retire, when i will become a worried patient.
Whitewashing of reputations and history. Perverse that Covid allowed the relaxation of all the PCN-DES contract specs that most of you signed up to and continue to complain about even if only partially delivered. Despite the complaints leveled at Richard and others, the bulk of the profession is complicit in allowing this gradual implosion of General Practice as the warnings detailed by various LMC’s in early 2020 gradually become reality.
We have not had a stable contract we have had new impositions every year.GP land is burning and those involved with the implosion are trying to deflect from their involvement.
PCN Clinical Directors and the RCGP are clear evidence that the least representative and most inept in my opinion of Primary Care Doctors are continually migrating towards leadership roles within General Practice and hence this is where we are!
Not sure which planet Richard is on. No doubt he was pleased with the 5 year fix he got on his ISA – 5 years ago at 0.5%!!
I don’t agree with Centreground though – sorry – not in my area. Our PCN directors work crazy hours to keep the ships afloat. It’s the ICBs and above where all the deckchairs on the Titanic are being shifted around.
Delusional
Well – if GPs only get 2% budget increase this year, and we have to fund 5% national living wage, 5% nurses ?% Salaried GPs, 5% ARR staff, 50% fuel bills, and 10%+ expense- we’re going to be getting a lot of GP closures.
I don’t think that’s a position that many will be envious of!
I look forward to seeing in the Daily Mail this man’s earnings as well as the earnings of the rest on the BMA Board, who are looking after us, the plebs, so well.
Envious of our massive five year contract in 19? Give me names and organisations!!