BMA leaders have voted to oppose the government’s 10-year plan for the NHS. The vote, at a special meeting of BMA representatives, called on the government for safeguards to GP independent contractor status as well as addressing other concerns around workforce and digital plans.
Doctors have deep concerns that many of proposals in the plan will act to undermine and dismantle GP independence, lead to an increase in salaried positions and as a result impact on continuity of care and patient advocacy.
“General practice is the most efficient part of the health service,” Dr Tom Dolphin, BMA Chair told the meeting, “despite being scape-goated and neglected by successive governments, resulting in us having a smaller GP workforce today than we had in 2015…..Proposals to create new, sprawling Integrated Health Organisations are causing huge anxiety, with nine in 10 GPs who oppose their creation telling us that this plan poses an existential risk to the partnership model.”
“For a plan that wants to bring back the family doctor, alarm bells are sounding across general practice as to whether this will deliver for primary care or risk undermining it at such a crucial time.”
The results of a survey of 2874 grass roots doctors carried out by the BMA to inform the special meeting, show the high level of concern in the profession about the impact of the 10 year plan and the standards of care for patients.
Nearly 500 GPs responded to the survey and 89% believe the 10-year plan will lead to the decrease of autonomy for general practice. Some 87% also think it increases the likelihood of general practice becoming a salaried service. More than three quarters (77%) of GP respondents said it would lead to a decrease in the continuity of patient care and over 80% said it would decrease the independence of general practice.
Speaking at the BMA’s meeting, Health and Care Secretary Wes Streeting tried to address concerns that the neighbourhood health service outlined in the 10 year plan would undermine GP autonomy. He told the meeting that he has been ‘very clear’ that integrated health organisations would ‘not necessarily’ be ‘hospital-led’. Adding that he thinks there is ‘a real role for GP leadership in this space, and primary care to be in the driving seat.’
He also appeared to reassure GPs that they would not be forced to work under the two new contracts outlined in the 10-year plan, advocating for a gradual approach to try out new models of working, noting that ‘once something is proven, more people will be willing to follow and that’s the broad, broad approach to reform we’re taking.’
The two new contracts, which will provide an alternative to the GP partnership model, will be rolled out in 2026 and will be offered to GPs and hospital trusts. One contract will support the creation of ‘single neighbourhood providers’, typically covering a population of around 50,000 and the other will establish ‘multi-neighbourhood providers’, which will serve around 250,000 people and focus on delivering services that require coordination across multiple neighbourhoods, such as end-of-life care.
To avoid a dispute, the BMA is asking the Government to commit to favour GPs to lead the neighbourhood health service.
The BMA survey highlighted the concern doctors have about the planned neighbourhood health hubs, however, and found that many doctors do not believe the treatment they provide can be done in these hubs.
Dr Dolphin called on the Government to provide “transparent and independent modelling” about how the hubs will work, particularly in the light of the high number of vacancies in the NHS. Adding that the Government “will need to explain how fewer staff will be able to deliver more care through Neighbourhood Health Centres, open 24 hours a day, 6 days per week”
Over half of respondents to the BMA survey said that workforce shortages and a lack of training places were one of their top three concerns, and Dr Dolphin noted that “we surely cannot expect that even the slickest AI and the most impactful preventative programmes will fill that gap.”
Recent research published in the BMJ found one in three GPs in England do not work in the NHS, with increasing numbers seeking to move abroad or becoming a private contractor. The proportion of family doctors who, although qualified, do not provide care through the NHS has risen from 27% in 2015 to 34% in 2024.
The researchers noted GPs’ heavy workloads, increasing demands from patients and widespread frustration that they have too little time to care for patients properly are all fuelling the increasing dropout of GPs from the NHS.
Although the meeting voted to oppose the 10-year plan, in the survey 83% of grassroots doctors want the BMA to “engage with the proposals, while seeking improvements in areas of concern.”
Areas of concern which include the 10 Year Plan’s ambition to ‘train to task’, which Dr Dolphin noted is “based on a flawed understanding of medical education,” and the push to move from analogue to digital, when “over a quarter of respondents [in the survey] told us adequate IT and estates are a major concern for them and that these need fixing.”
In the push for the use of emerging technologies, although the majority of doctors in the survey supported the introduction of a single patient record, 63% fear the loss of patient trust if its introduction results in government agencies having control of patients’ data. There is also substantial concern over the security of patient data across settings.
Doctors are supportive of the Government’s plans to shift from treatment to prevention, but Dr Dolphin noted that such a shift “will require investing in decimated public health functions and public health staffing.” And “an independent voice for public health at every level of the health service.”
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