Dr Margaret Ikpoh looks beyond the 2025/26 GP contract and ponders how it will impact the general practice workforce crisis
Our practice’s daily 8am scramble involves ensuring that we have enough rooms for our staff to use. I lost the privilege of my own office six years ago when we merged with two other local practices to survive. Although the practice got bigger, the space to carry out the day job – including seeing our patients – got smaller. Hot desking and adapting to an agile workforce environment became the new norm.
So, news of the BMA’s agreement in principle for the 2025/26 GP contract has brought with it a degree of hope and cautious optimism after what has been over a decade of underfunding in an overstretched and workforce depleted system.
£889m plus £80m for advice and guidance are the headline figures that has had us dissecting and poring over the details since the deal was announced. There are several positives, including: the uplift in global sum and locum reimbursements which include previous years DDRB increases; retirement of QOF indicators; and the addition of practice nurses and GPs to the main ARRS scheme. However, we should be mindful of the double-edged sword nature to some of these criteria.
Surveys have shown that around 40% of GPs across all career grades are unlikely to be working in general practice in the next five years. The majority of GP registrars are also opting for portfolio working due to the intensity of workloads. Combined with the dearth of new-to-practice fellowships and mentorship schemes, many newly-qualified GPs remain reliant on the expertise and mentorship of those GPs who have already walked this road to recovery before them.
However, the proposed amalgamation of the ARRS scheme is potentially discriminatory by excluding mid-to-late career GPs who could potentially support them. The additional woe is the risk that a trojan ARRS horse could create a two-tiered system especially in the midst of GP unemployment.
What is clear is that this road to recovery will not be a walk in the park. In fact, it will be akin to a steeplechase before we start to see any tangible improvements in our workforce, premises (still little detail on this) and public trust in our ability to provide safe and effective care.
In the coming weeks and months, we will have a lot more detail to consider. Whilst these multiple contractual changes are clearly important for us to consider, it’s vital that we do not get caught up in a cognitive bottleneck that could distract us from adopting our recovery position.
So yes, let’s fix the front door; but we can’t leave the back door wide open by recruiting our way out of a retention crisis either.
Dr Margaret Ikpoh is a GP in Holderness, East Yorkshire. You can find her on X @docmagsy
I don’t believe we are the front door. We do over 90% of the work of the NHS. We are the whole house. Hospitals are our back yard with possibly a potting shed somewhere for the surgeons.
It’s not potentially discriminatory – I can’t see how else you would describe it.
Too late- General Practice has been a 2 tier profession for decades, but few wanted to see it, or else many wanted to push it aside as inconvenient to acknowledge. The salaried-partner divide has always been there to some extent. All the ARRS does is formalise that divide, and create an even bigger chasm within the profession…divide and conquer. And ARRS becomes all the more powerful as the Partnership model crumbles further, and those who have become reliant on its power scramble to hold on to the remnants of their investments.
ARRS is not the devil, it is the messenger…it is not the outside political hammer, it is the mirror that is showing crisply every blemish and wart in our profession that has been plastered over by layers of cosmetics to avoid facing the reality of age.