Dr Kamal Sidhu scrutinises the details of the new GP contract and asks just how helpful it will actually be for general practice
After many years of an imposed contract, the contract for 2025/26 was agreed last week. Whilst the headlines and the sentiment has been positive from DHSC and the BMA General Practitioner Committee (GPC), the initial optimism quickly fades as one digests the detail.
Nearly half, if not more of the promised funding will be swallowed up by the cost of the NI changes, inflationary pressures, the national minimum wage rise and the resulting adjustments practices must make to keep staff differentials. Yet, the Government narrative paints a very different picture—one of a significant cash injection into general practice, supposedly easing access for patients. The reality is starkly different. Rather than improving conditions on the frontline, this funding will barely keep practices afloat, further fuelling the misguided perception that GPs are failing their patients. I fear that this will only exacerbate the vilification of general practice and GPs. The so-called new deal for partnerships pales in comparison to our consultant or junior doctor colleagues secured last year.
It has been suggested that the bureaucracy has been reduced with retirement of 212 points from QOF. Requirement to keep registers of some chronic conditions has been removed. But this does not meaningfully reduce the administrative burden. Coding remains crucial for capturing patient prevalence and ensuring appropriate funding through its influence on ‘weighting’. Practices cannot simply abandon these processes despite the official ‘removal’ of 32 indicators. Most of us would review patients with cancer and depression and SMI or mental health reviews remain essential for most ICBs and have national targets around these.
If anything, QOF has just become harder as stricter cholesterol and blood pressure targets will require even greater effort from overstretched practices. The shift toward an increasingly outcomes-driven QOF framework is not new—it has been a steady trajectory over the last two decades. NHSE will undoubtedly welcome this continued focus, but for frontline GPs, it means more pressure
The long overdue increase in childhood immunisation is a win. Many practices lose thousands of pounds every year and will continue to do so due to no reprieve this year as was widely expected. This is due to the punitive and rigid targets which do not allow for factors beyond practice control e.g. parents declining vaccination etc. This really is a brutal blow for practice teams who put tireless efforts in maintaining high vaccination rates.
ARRS GP recruitment criteria remain inflexible and though practice nurses have been added into the mix, majority of the PCNs have tried to make use of all the funding available despite reservations and lack of evidence of effectiveness of some of these roles. Practices or PCNs are not in a position to make staff redundant to replace them with GPs and nurses.
A long-standing demand from the profession has been fair remuneration for the increasing workload shifted from secondary care onto GPs, particularly through advice and guidance (A&G) mechanisms. The contract acknowledges this but falls far short. The remuneration does not even cover administrative and clinical time spent managing further investigations, let alone direct patient contact. Many hospital specialties already routinely reject and triage referrals in violation of their contractual obligations, with ICBs failing to hold them accountable. There is a real risk that this tokenistic A&G payment structure will become another tool for commissioners to impose rigid pre-referral criteria, ultimately legitimising referral rejections rather than addressing the core problem.
The introduction of the ‘Patient Charter of Expectations’ sounds promising in principle. However, such initiatives often set unrealistic public expectations without the necessary system-wide support. The NHS has already seen how ineffective ‘Right to Choose’ and treatment time targets have been when implemented in a system suffering from chronic underfunding. Without a corresponding ‘Charter of Responsibilities’ that ensures appropriate resourcing when services are commissioned, this new charter risks worsening tensions between patients and their GP practices.
The biggest win perhaps is the commitment of a new contract in this parliamentary term though in the current economic climate and if the ‘powers’ do not recognise the effectiveness of partnership model in general practice, I worry that may well backfire.
Sadly, we continue to promise the moon when the system is at its knees. We all need to be honest to the population we serve. It is difficult to see how this contract will meaningfully improve patient experience or staff wellbeing. ICBs have made it abundantly clear that they are cash-strapped, and we have yet to see any real shift of resources from hospitals into primary and community care, despite the relentless transfer of workload.
Despite some initial confusion that collective action has been stopped, a reinvigorated collective action remains the only viable hope of a substantial recognition of the mismatch in demand and capacity in any and improved national and local contracts that we all want for the sake of both patients and the general practice teams.
Dr Kamal Sidhu is a GP partner in Durham
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Is it time to tell patients that they need to go out there are fetch all unvaccinated children in to the imms clinic if they want the surgery to stay open on Wednesday afternoons ?
Spot on Dr Sidhu. How is this claimed to be a good deal for General Practice? Most of the increase is immediately swallowed up by cost increases for NI and new minimum wage, and for most practices this is a lot more than half the proposed increase. ‘Retired’ QOF funds of nearly £50k for the average sized practice are being used to support this increase, so not an increase at all, rather a recycling. And in a few months time all salaried GPs are going to demand the headline 7.2% increase supported by the BMA once again inflicting the cycle of financial pain on partners. How is the BMA and GPC lauding this? As a negotiated settlement rather than one imposed, but honestly it is such a whitewash that I for one would prefer imposition than the proposed with all the additional hoops to jump through without any meaningful supportive additional funding. Thanks once again GPC and BMA for facilitating the annual shafting of General Practice.
“the resulting adjustments practices must make to keep staff differentials” This statement is what this deal rises or falls on, no one said it offered a 6.7% pay rise for everyone – which is the uplift in National Living Wage – if YOU as Partners decide to uplift all staff by this, the numbers fail, and the Budget announcement never said a 6.7% rise for everyone. At best, other staff should be offered 3% or around inflation, the whole point is to narrow the gap, not maintain it. This deal was NEVER about giving all staff members a 6.7% rise and will not fund that.
Sorry BM, but he BMA have trumpeted this as ‘ the deal represents a 7.2% cash growth in contract funding’ . This deal is not being announced as a real terms at best 3% increase (which I struggle to see how we would achieve – much more like just over 2%). My staff and salaried colleagues will see the headline figures and I am pretty convinced the same BMA that negotiated this will advocate a 7.2% increase for salaried GPs. Much as they advocated a 6% increase in 202, again lauded by the BMA as a resounding negotiation success, but based on completely erroneous staff cost assumptions that we as partners continue to have to fund out of shrinking practice profits.
*2023 not 202
We “signed” this ?
It’s over. Salaried is the way. Or retirement if you’re fortunate enough to be the right age.