The BMA says it is “bitterly disappointed” with changes to the GP contract in England announced today, which fail to help patients and support practices at this critical time – and will impact GP services in Lancaster and Morecambe.
Despite negotiations between the BMA and NHS England, the changes, laid out in a letter from NHS England, and which come into effect from 1st April 2022, have not been agreed or endorsed by the BMA.
The BMA and NHS England began negotiations this January over annual amendments to the five-year contract deal agreed in 2019, and discussions around what further support was required for general practice as it faces unprecedented pressures and pandemic recovery.
During negotiations, the BMA consistently laid out a number of solutions to address some of these pressures, enabling practices to support patients.
These included: additional funding to cover increased employers national insurance contributions (due in April) as well as the increased pressure from rising inflation. Without resources, practices will lose staff for frontline patient care; flexibility for Primary Care Networks to hire the professionals that they need locally based on the needs of their patients, and not be bound by rigid, prescriptive job roles; and a funded pandemic recovery plan that reflects the emphasis and urgency placed on the elective recovery plan in secondary care.
These negotiations reached a stalemate in mid-February when it became clear that NHS England would not be offering an update that would impact meaningfully on patient care.
Further conversations emerged between the BMA and government, and culminated in a meeting with the Secretary of State for Health and Social Care. Yet today’s letter, presented to the BMA just hours before being sent to the profession, fails to make progress in any of the key areas outlined above.
“We are bitterly disappointed that NHS England has chosen to ignore the appeals from the profession and the needs of patients in today’s letter,” commented Dr Farah Jameel, BMA England GP committee chair.
“Despite our best efforts to outline a number of positive and constructive solutions that would make a difference to practices’ ability to improve care for patients, NHS England has instead decided to follow a path laid out three years ago, long before the arrival of Covid-19, and roll over a contract that fails to address the current pressures faced by general practice.
“Failing to offer practices something as simple as reimbursement to cover additional costs for national insurance contributions means they are losing funding that should be going towards looking after patients. Therefore, a tax aimed at funding the NHS, has become a tax on the NHS itself. The result will be fewer members of staff to care for the growing needs of patients.
“Today’s letter attempts to sell the changes as stability. Whilst stability is important, the reality is that general practice needs an emergency rescue package. Without this emergency life support, patient care will suffer. The waiting lists currently seen across the NHS are now going to become more of a reality in general practice.
“We approached this year’s negotiations in good faith, recognising the need to uphold previous agreements but striving for improvements in patient care. Today’s letter, presented to us with only a few hours’ notice, defies everything we were aiming to achieve in building a constructive relationship and sits at odds with positive conversations with government.
“GPs and practices will see today’s changes as devaluing their goodwill and demolishing their spirit. The letter does nothing to capture the scale of changes needed nor safeguards patients, and further highlights the need for a new contract that delivers high quality safe care in the new world we live in.”
The BMA is a trade union and professional association representing and negotiating on behalf of all doctors in the UK. A leading voice advocating for outstanding health care and a healthy population. An association providing members with excellent individual services and support throughout their lives.
Council concerns about local health care provision
Lat year, Lancaster City Council discussed its own concerns about local health care provision, with residents frustrated at the service provided to primary care patients since the merger into one of several hitherto independent primary medical practices in Lancaster.
In a motion agreed by Council last September, it was agreed, among other points, to investigate the establishment of new primary medical care facilities for NHS patients within a new practice, independent of existing practices within the Lancaster district.
The Council also agreed its own Overview and Scrutiny Committee would establish an annual meeting to discuss healthcare matters in the district, to which should be invited representatives of relevant NHS bodies, including the local Clinical Commissioning.
Lancaster City Council Conservative group leader Coun Richard Austen-Baker, who proposed the motion, said problems with primary medical care system must be addressed, especially as the city grows in coming years.
He described the current primary care system for doctors practices is “dysfunctional” and the current NHS competition system “does not work”, LancsLive reporting that the councillors were told recruitment to new NHS developments in the district is difficult, such as blood services and mental health staff.
“After the merger of six practices, patients began to experience a considerable diminution in the quality of service,” Coun Baker told the meeting. “The ability to get an appointment. was typically taking two weeks or people were asked to call back the next day. Previously it would typically have been two-days to get an appointment. Repeat prescriptions now have to be done on-line or, if done in person, then you can be waiting a week. It used to be two days.
“We have got quite a problem,” he felt. “In this country, doctors are paid for how many patients they have on a list. In other countries, they are paid on how many patients they see.”
He appears to have cited figures from a report in The Times suggesting more doctors now work part time, but neglected to note that in 2004, the government removed the requirement of GPs to provide 24-hour care from GP contracts. That report seems at least in part to draw on a 2014 government study of GP practice data, which of course is now skewed by changes in GP healthcare during the pandemic.
General practice in crisis?
COVID-19 has meant activity in general practice has changed dramatically over the last two years. In a report published just last month, The Health Foundation – an independent charity, committed to bringing about better health and health care for people in the UK – noted how practices have moved rapidly towards remote triage and care delivery to reduce risk of infection.
Many have also delivered a large proportion of the COVID-19 vaccination programme as part of Primary Care Networks (PCNs), alongside their usual patient care.
The Foundation says limitations on current data available mean we don’t know enough about activity and workload in general practice. Data about appointments and referrals provide some insight, but have constraints. There are other areas of general practice activity, such as administrative work or clinical supervision, where available data tell us very little.
“Understanding the total workload of general practice is vital for planning, research and supporting practices under pressure,” the Foundation notes. “However, the data we have on activity in general practice are limited, especially compared with hospital data. This has made it challenging to accurately track the ongoing impact of COVID-19 on general practice.”
In February 2020, the Government announced a drive to recruit an additional 6,000 GPs by 2024, some 1200-1500 extra doctors in general practice per financial year by the end of 2024. In fact, numbers grew very modestly, between June 2020 and July 2021 by 192 Full Time Equivalents.
Last year, the Social Market Foundation noted the work of the average GP has become more complex and demanding, despite the removal of the burden of 24-hour care responsibility in the 2004 GP contract.
“There is evidence of rising list sizes, rising demand in consultation rates,” wrote GP Doug Russell, “more co-morbidities being managed by GPs with transfer of care that used to take place in hospital to general practices. There is the introduction of more and more guidelines, targets, disease registers and an explosion of electronic communication between practice team members, the wider community care services and the hospital. This can easily reach 150 individual tasks per working day – before beginning to deal with individual patients.”
• The BMA is online at www.bma.org.uk
• BMA: Pressures in general practice data analysis
GP practices across the country are experiencing significant and growing strain with declining GP numbers, rising demand, struggles to recruit and retain staff and knock-on effects for patients. They have been at the forefront of the NHS’s response to the COVID-19 outbreak, delivering vaccines whilst maintaining non-COVID care for patients throughout.
This page on the BMA web site provides analysis on the pressures in general practice and is updated monthly with new data.
• The Health Foundation: Understanding activity in general practice: what can the data tell us?
This article has been updated in response to a response to this article’s presentation on our Facebook page by Graham Jackson – my thanks to him for referring us to last year’s City Council resolution