Changes to the GP Contract in 2023/24
In what appears to be the new norm, negotiations between NHSE and the BMA around the 2023/24 contract failed to result in any ‘offer’ that could be seen to meaningfully address GPC England’s concerns regarding the workload and workforce crisis facing general practice.
As is customary at the end of a negotiation period, on Friday the BMA GPC Executive met with Steve Barclay, Secretary of State for Health and Social Care, and Neil O’Brien, Parliamentary Under Secretary of State (Minister for Primary Care and Public Health) to discuss the final contract offer on the table which the BMA made clear was not acceptable. The meeting concluded without any further offer.
Amongst other things, the BMA had been asking for an inflationary uplift to the core contract and enhanced services, pausing or withdrawing pay declaration requirements, and significant reduction of QOF and IIF targets.
We understand that NHSE contacted the BMA on Monday with their imposed contract and then published it.
This is their letter https://www.england.nhs.uk/long-read/changes-to-the-gp-contract-in-2023-24/
The contract serves to reaffirm this governments obsession with ‘access’ despite it being obvious to all that the main issue isn't access, it’s capacity. In January 2023, 88 GPs left the NHS and there are 2078 fewer fully qualified GPs than in 2015. At the same time, each GP now has 2283 patients to care for, which is 18% more than in 2015. It is no wonder patients are finding it difficult get appointments. It is ironic then that the contract letter begins by highlighting the fact that ‘In January 2023 General Practice delivered 30m appointments, an increase of 11% on January 2020, a testament to the incredible work of GP teams.’
The headline contract change that will likely cause most debate in the coming weeks is around access: To ensure consistency in the access that patients can expect, 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. A welcome reduction in the number of IIF indicators will apparently release £246 million to PCNs to achieve this aim.
In 2023/24, all the QOF register indicators points will be awarded to practices, based on 2022/23 outturn once finalised, releasing £97m of funding and reducing the number of indicators in QOF from 74 to 55 (a reduction of 25%). We await the further detailed guidance from NHSE on what this and other aspects of the contract changes will really mean for general practice. While QOF register income protection would appear to be positive it is not yet clear what this actually means.
The most disappointing outcome of this contract is the failure to offer anything other than the previously agreed 2.1% financial uplift to the core contract. This will result in significant financial pressure for many practices at a time when we are trying to support workforce salaries to reflect new national living wage rates, inflation, and cost of living increases.
There are some small wins in the new contract, such as the permanent removal of the four session cap for retainers, including Advanced Clinical Practitioner nurses in the additional roles reimbursement scheme and removal of the Vaccs and Imms repayment mechanism so removing the payment clawback for practice performance below 80% coverage across routine childhood imms.
It’s fair to say that this contract offer will leave many of us wondering what the government really want in terms of General Practice services in a future NHS.
There will be much discussion nationally and regionally in the coming weeks about what we do as a profession in response to this contract imposition and the current crisis facing general practice. We would encourage you to have this discussion at a practice level too. It is important that the LMC hear your views so that we can represent you. We have no doubt that the BMA will also be seeking your opinion and appetite for meaningful action.
https://www.bma.org.uk/pay-and-contracts/contracts/gp-contract/gp-contract-changes-england-202324
