As 2024 draws to a close, Pulse looks at the big issues in general practice this year, such as collective action over the 2024/25 GP contract.
The year started out with the GPC announcing it would put the Government’s offer for the 2024/25 GP contract to a referendum of GPs, regardless of whether there was an agreement or not between the BMA and NHS England. This was part of the strategy of new GPC England chair, Dr Katie Bramall-Stainer, who had been an outspoken critic of the lack of accountability for GPC negotiators, especially when she was chair of the LMCs Conference.
Negotiators were tight-lipped around the talks, but Dr Bramall-Stainer did tell Pulse that GP negotiators were pushing to add GPs to the additional roles reimbursement scheme (ARRS), and this would be a ‘red line’ in negotiations.
Though it was originally thought that the 2024/25 contract would bring huge change to general practice, we soon discovered that it would act more as a ‘stepping stone;’ with NHS England saying it was not able to negotiate a new five-year GP contract because of a lack of funding commitment.
It turned out there was no agreement anyhow. A Pulse exclusive reported that the Government’s initial offer for the contract included a 1.9% uplift to GMS baseline funding; at the same time as other parts of the health service received funding uplifts of 6% to cover inflationary costs. The following day, the GPC voted down the ‘derisory’ contract offer and instructed negotiators to continue talks with the Government.
That 1.9% did not increase in the Government’s offer. The BMA gave them 48 hours to improve said offer, or otherwise face the threat of ‘regrettable events.’ Suffice to say, there was no substantial improvement, and the ball was set rolling for collective action, with a timeline released by the BMA.
The promised referendum opened to BMA members in early March. Considering the lack of agreement between the GPC and NHS England, this was only going to go one way. When the results came through, it was unsurprising that 99% of the 19,000 GPs and registrars who took part voted against accepting the imposed contract. This marked the beginning of the GPCE officially being ‘in dispute’ with NHS England.
GPC England then voted to hold a ballot of GP partners on ‘collective action.’ It was promised that any proposed action would not breach contracts. Dr Bramall-Stainer also mentioned that the GPC negotiators would not accept another multi-year contract deal, stating that the 2019 agreement – which set funding increases at around 2% for the following five years – had contributed to pay erosion for GPs.
When the DDRB recommended a 6% uplift for all GPs (including salaried, partners and all practice staff) in July, the GPCE said that this would still not be enough to alleviate practices’ financial issues.
On the eve of collective action, the health secretary announced that ARRS would be expanded to include GPs. This did little to stop the movement; Pulse’s snapshot survey showed that almost half of England’s GP practices were taking part in collective action within its first two weeks, and a further 20% said that they were planning to do so. It also revealed that an increase in overall funding was the predominant priority for those engaging in collective action.
It caught the eye of national media, and was certainly noticed by the Government. The health secretary accused the profession of ‘sabre-rattling’ with collective action and asked GPs to ‘stand down’ whilst pledging to end workload dump.
In October, the GPCE set out a list of demands for the Government to meet in order to end collective action. The document called for the implementation of a new national GP contract and for core funding in England to rise by at least £40 per patient for 2025/26.
There have been murmurs of stepping up the action to industrial – essentially breaching contracts/potentially shutting doors. The BMA threatened an escalation over the safe practice guidance of physician associates in October. Over 40% of practices are limiting appointments – one of the 10 options from the ‘menu of actions’. Both Scottish and English GP leaders voted on measures to urge the BMA to take (further) industrial action at their respective LMCs conferences.
The BMA demanded for a new GP contract as part of the Government’s 10-year plan, saying it was necessary to ‘revitalise’ general practice. The Government put forward its submission to the DDRB for the 2025/26 pay rise, offering a maximum rise of 2.8%.
Earlier this month, the Government revealed the first details about the new GP contract. It includes an extra £889m ‘on top of the existing budget’ for general practice as well as adding practice nurses to the ARRS, reducing QOF targets and ‘bringing back the family doctor.’
Dr Bramall-Stainer said that the GPC hopes that this announcement will be looked back on as ‘a positive starting point for an evolving conversation.’ The Government will consult with the BMA’s GP committee on its proposals over the coming weeks before revealing the full contract in spring 2025.
When announcing the contract, Mr Streeting called on GPs to work with the Government and bring an end to collective action. Collective action is still ongoing and the threat of escalation could be used as leverage for negotiations in the next contract. While there is hope in the air for a change, the BMA – and the profession – will still need a little more convincing.
