The Government has given up the pretence of caring

With no promise of a funding increase in the contract imposition, Jaimie Kaffash fears how far the Government will allow public services to decline

NHS England’s contract imposition came as no surprise. The BMA expected it and it was clear that no one from the other side was willing to make any meaningful concessions.

After spending days immersed in this contract letter, I am going to take the unusual step of disagreeing with Copperfield. Because, to me, this contract wasn’t a declaration of war from NHS England. It was a ‘let them eat cake’ moment from the Government.   

I don’t actually think this contract will make any difference to the lives of GPs in a positive or negative way. I might be wrong, but the headline stipulation that practices will ‘no longer be able to ask patients to contact them at a later date’ is so ambiguous as to be meaningless and I doubt that the final contract document will shed too much light on it. I can’t see how such a demand can be implemented or enforced. This is designed for headlines only.

The same can be said for the access requirements in the IIF, and the QI modules around signposting  in QOF. We haven’t seen the detail, but I suspect smart PCNs and practices will able to fulfil any criteria fairly easily. The requirements around automatic patient record access will be onerous, but everyone knew this was happening – if it wasn’t implemented in the contract, they would have issued a decree later.

This doesn’t take away from what an awful move this contract imposition was, however. They might not be kicking the patient in anaphylactic shock (even if they are telling their mates in the media that they are). But the patient still needs an adrenaline injection, and this contract certainly doesn’t provide that.

What GPs needed was an increase in funding. Without devaluing the demands of other striking professions – who should absolutely be entitled to inflation-level pay rises – a below-inflation uplift for general practice is arguably worse. It doesn’t only mean a real-terms decrease in GP partners’ take-home pay as it would for nurses or junior doctors. GP partners still have to pay inflation-level prices for overheads and potentially staff, too. After these hikes, they would be taking home less than before at a time of inflation. 

But of course an increase in funding was never going to happen. Because the main problem here isn’t NHS England: it is a government that has given up even the pretence of caring whether public services are functioning well. If there is a war, it is on all public services, with general practice simply one frontier. If the Government is unwilling to increase pay for junior doctors, nurses and ambulance staff – all of whom have more sympathy in the media than GPs – they won’t uplift funding for general practice, even if it is needed more. Especially as the funding was already agreed in 2019.

This is of no comfort to GPs, who will continue to deteriorate without a major shot of adrenaline. But nothing is going to change while this Government continues to focus on easy headlines around small boats rather than the tough task of sorting the dire state of public services and household finances.

There is no major light at the end of the tunnel. I have no love for the Labour health team, but my only hope is that if and when they get into power, they will at least have to outwardly show they care about public services, or they will be removed after one term in office.

But right now, I fear how far the Government will allow public services to fall.

Jaimie Kaffash is editor of Pulse. Follow him on Twitter @jkaffash or email him at editor@pulsetoday.co.uk