Dr Katie Bramall-Stainer, chair of the BMA’s England GP Committee, responds to the primary care minister’s plans for general practice
Minister Dame Andrea Leadsom is right to describe general practice as the beating heart of our NHS, but she has failed to acknowledge that general practice in England is in crisis. I personally warned the DHSC (Department of Health & Social Care), NHS England and Minister Leadsom’s predecessor, Neil O’Brien MP, about the impending employment crisis late last August, but no action was taken. The current GP contract has enabled and facilitated a toxic paradox of GP unemployment within a GP workforce crisis. Cost-neutral, evidence-based solutions were consistently proposed but repeatedly rejected. The dire situation today is a surprise to no one.
I wish to correct the false assertion that the BMA misrepresented the GP 2024/25 contract changes as final. In discussions with the DHSC and NHSE, we were informed of the 1.9% planning assumption uplift figure pending the DDRB (Doctors and Dentists Review Body) uplift due in July. We stated this would be woefully insufficient and I personally explained to the minister how GP practices work. With the help of accountants, practices budget for the next 6 to 12 months so if they don’t have enough funding now, they will have to consider handing their contracts back – before any additional DDRB uplift could save them. It’s clear to us that the DDRB recommendations, based on DHSC and NHSE declarations, will again fall markedly short of what is needed for these practices to remain able to provide care to patients. The root of the problem lies in the Government’s reluctance to increase funding for general practice. Ultimately, it is evident that the ‘final’ offer will be inadequate, and I stand by that assertion.
Minister Leadsom highlighted that ‘the government sought to make the 2024/25 contract arrangements more flexible’ – but it’s important to note that while most people consider 40 hours a week as full-time, the baseline for GP contractors is 55 hours. It is only right that our earnings reflect this. We cannot expect GPs to work for free. We now have around 2,000 fewer GPs compared with almost a decade ago, when 6,000 were promised. How many GPs have qualified and then left the profession in the past decade? The Minister should consider the cost of this loss to taxpayers. We need to understand why the Government is so resistant to making changes that will bring significant improvements? How many patients have suffered as a result?
I appreciate that Minister Leadsom has only been in role since November, and that she seems to genuinely value the core principles of our profession; independent contracting and continuity of care. However, given that it is barely 18 months from the Health Select Committee’s commendable paper on the Future of General Practice – of which the current Chancellor is an author – I hope the announcement to have yet another Future of General Practice workstream will not be a cynical attempt to entrench flawed policies into the next government. Instead, we would encourage all parties to read the September 2022 Health Select Committee report, and keep an eye out for our own manifesto, being published next month.
GPs have navigated too many damaging policies imposed on general practice. The inevitable result is what we’re now seeing; thousands of GPs out of work, more than 1,000 practices lost in the past decade, and practices continuing to close at an alarming rate. Coupled with a crumbling wider NHS, this situation is heartbreaking, and patients are suffering. A line has been drawn and 99.2% of over 19,000 GPs must be heard. I implore Minister Dame Andrea Leadsom to stand by her promise to ‘fight to protect the principles of general practice’. An NHS free at the point of service requires a well-resourced and well-supported expert generalist gatekeeper. Without this, our NHS fails and that is what we are now seeing around us. We call on the Minister, the Secretary of State, the Chancellor, and Prime Minister to provide us with safety, stability and hope by adequately funding general practice and reversing this devastating trend.
Dr Katie Bramall-Stainer is chair of the BMA’s England GP Committee
Who is Leadsom?
I truly appreciate KBS’s passion and sincerity but expect GPCE will be eventually outmanoeuvred by the strategic ruthlessness of governmental politicking. Just read Leadsom’s polished but totally phoney article in Pulse, a master (mistress?) of the dark arts.
Who is Bramall-Stainer?
Government can safely ignore the BMA regarding primary care..
Only a minority of GPs are members, threats of industrial action are going nowhere, and the message is always the same – more money and no substantive NHS reform.
Quite why anyone remains a member is a mystery.
@dave.haddock, I find I totally agree with you on this 😁
Nurses are angels, doctors are arrogant and well-paid. GPs are well paid, money grabbing, arrogant and lazy and have no special skills that a paramedic cannot duplicate after six months of training. These are public perceptions, rather than facts. But perceptions are incredibly important. The Govt knows this, and knows they can do what they like to GPs and the public, in the main, are standing cheering in the background. This is the central problem that General Practice has, and until the GPC works out how to change these perceptions, the Govt can, and will, do nothing. [Muzzling the RCGP would obviously be a good start].