NHS England has enraged GPs by imposing a new contract, which includes more stipulations around access, but no extra funding. 

GP leaders completed a first round of contract negotiations “in the spirit of collaboration, hopeful that common ground could be found,” but when they received and rejected an “insulting” follow-up offer NHS England then abandoned negotiations and imposed a new contract, which starts in April.

Acting chair of the BMA’s England GP Council Dr Kieran Sharrock told Pulse magazine

This contract is the result of a failure to listen to what GPs actually need, and totally ignores the calls for any extra support to help practices meet the rising costs of keeping their doors open.

“Despite warnings from GPC England, it also introduces more bureaucracy and arbitrary targets that only set practices up to fail and take GPs away from direct patient care.”

Dr Sharrock has now written to health and social care secretary Steve Barclay, calling on him to reconsider the imposition of the contract and return to negotiations. 

Of four key points the BMA wants to see changed, the first two are demanding help with increased GP practice costs, including pay increases for staff, and withdrawal of the “access clause”. This relates to the stipulation in the new contract that GP surgeries will no longer be allowed to tell patients that available appointment slots are full, and that they should try the next day: 

“the GP contract will be updated to make clear that patients should be offered an assessment of need, or signposted to an appropriate service, at first contact with the practice. Practices will therefore no longer be able to request that patients contact the practice at a later time.”

With finite (and reducing) numbers of fully qualified GPs able to offer only a finite number of consultations, whether face to face or online, it’s not clear how NHS England imagines this could be achieved. The BMA argues bluntly: “This clause is unachievable without investment in workforce and infrastructure. We support the aim of this clause in the long term, but believe that the majority of practices will not be able to achieve this at this time.”

Despite all the odds and obstacles, a diminished number of fully qualified GPs (down almost 470 in the past 12 months and down by almost 2,000 since December 2016) has managed to increase numbers of appointments by almost 120,000 per day, 70% of them face to face and 40% on the same day as requested.

The new contract also gives GPs just six months to set up online access so new health information is available to all patients (unless they have individually decided to opt-out or any exceptions apply) by 31 October 2023 at the latest.”

NHS director of primary care Dr Ursula Montgomery said:‘This contract supports GP teams to provide what matters to patients, and later this Spring the NHS will publish the GP Recovery Plan on how access to care will be expanded even further.’

However the long-promised GP Recovery Plan on how access to care will be expanded even further is proving as elusive as the NHS workforce plan, and just how many GP practices will still be in operation to implement the plan is doubtful according to a recent Royal College of General Practitioners survey of 2,700 GPs, which found one in four said their practice was at risk of closing, with nine in ten blaming unmanageable workloads, rising demand and staff leaving the sector.

RCGP chair Kamila Hawthorne told Sky News: “I’ve certainly heard of colleagues of mine becoming so stressed during their days of work that they’re developing chest pain and needing to be seen themselves. 

“If you’re seeing 40 to 60 patients a day and making that number of clinical decisions, it is extremely stressful and worrying because each one of those clinical decisions is important.”

Having rejected the new contract, the BMA is contemplating the next steps, and “will now look to enter serious discussions with our membership and the wider profession on what action we take next.”


Heaping pressure on pharmacies is “irresponsible”

* Meanwhile another component of the primary care workforce, community pharmacists, are angry that NHS England has been waging an advertising campaign urging more people with minor conditions to go to pharmacies rather than to their GP, which threatens to weigh down pharmacists with extra, unfunded work. 

The community pharmacy negotiating body has warned that the campaign is ‘deeply concerning’, ‘irresponsible, ‘extremely unhelpful’ and ‘irritating’.

Pharmacists only get paid for their advice if patients are referred to them by GPs or by NHS 111.

Malcom Harrison, chief executive of the Company Chemists’ Association (CCA) warned that with pharmacists facing up to 30% cuts in their funding along with increased overhead costs, ‘The NHS policy of moving asking patients to visit their local pharmacy does not address the problem of delays to access in primary care, it simply moves it from one pressurized location to another.”  

Hopes of growing the market for private GP services focus on the worsening crisis in NHS GP services, with an estimated one in four practices questioning whether they can afford to go on or will close. 

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