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GPC England's LMC Update: 9 February 2024

GP contract 2024/25

 

GPC England has rejected the formal contract from the DHSC and NHS England (NHSE) for the General Medical Services (GMS) contract for 2024-25.

 

After consideration at its meeting on 1 February 2024, the committee unanimously voted that the current proposal, including a 1.9% uplift, is unacceptable. The committee was clear that in order to prevent practices from reducing services or closing down altogether, a contractual uplift sufficient to keep practice finances stable for the ‘stepping-stone’ contract year ahead is imperative. The proposal as it presently stands ignores the compelling evidence presented by the BMA GPC England officer team, which quantifies the attrition in the item of service fees for vaccs and imms; the reimbursements eligible under the SFE and the contract value since 2019.  A contractual uplift of 1.9% to the global sum would also be disastrous for the employees of practices, including salaried and locum GPs and GP nurses.

 

Details of the contract come at a time when a BMA survey of 10% of practices in England found almost two in three(64%) report being concerned about their short and long-term viability, and more than half (57%) have experienced cashflow issues within the last 12 months. We had estimated that up to one in four GP surgeries would need to reduce their services to ensure they can remain open for patients, yet this was before this year’s derisory contract position and proposed below inflation funding uplift. GPC England was unanimous in providing us with a mandate to return to the DHSC, NHSE and ministers in Government to continue urgent talks ahead of a final position, which the profession will be asked to vote upon, in a referendum next month.

 

We’ve said from the beginning, our door will always be open to ministers and their teams. We’re willing to do all in our power to find a solution. As such, GPCE officers will now seek further discussions with the Government and NHS England to improve the GP contract to bring back hope, safety and stability to all GP practices across England.

 

Referendum and next steps


We have produced a webpage with everything you need to know about the current GP contract changes and what we plan to do next. Remember, whatever is on the table come March 1st will be put to you in a referendum which will enable the profession to decide whether the offer sufficiently supports general practice in England for the forthcoming financial year, or not.  to decide whether the suggested changes sufficiently support general practice in England for the forthcoming financial year, or not.

 

To be eligible to vote in the referendum, you need to be a member of the BMA to have your say.  This means making sure your details are up to date and spreading the word to colleagues about joining the BMA. The referendum won’t prevent the Government from imposing changes to the contract, but it will give us vital insight into how the profession feels, and where we go next.

 

Update your member details on www.bma.org.uk/my-bma and share this email with your colleagues and encourage them to join the BMA today to have your say. Visit our GP contract page here

 

Pharmacy First

Last Wednesday (31 January), NHS England launched the Pharmacy First initiative, whereby patients in England will be able to get treatment for seven common conditions at their high street pharmacy without needing to see a GP.

 

Community pharmacists can play an important role in delivering non-urgent basic care, which in theory can help reduce our incredibly busy workload as GPs. However, there are concerns that this scheme is being rolled out too quickly, and will rely on an inadequate IT infrastructure that will ultimately increase the administrative burden on practices, not lessen it. With almost 2,000 fewer fully qualified, full-time GPs than in 2015, this will put further pressure on a system already close to breaking point. 

 

What patients want, and have always wanted, is the ability to access what they need from their local practice in a timely manner, and this must remain a priority. This remains in the Government's gift; we urge them to allow existing ringfenced funds, currently used to employ non-medical practitioners, to be used more flexibly so that practices can hire more GPs and nurses who are ideally placed to manage simple conditions.

 

GPCE letter to NHSE regarding the Measles outbreak


GPC England wrote to NHS England last week highlighting our serious concerns around the current Measles outbreak and the need for urgent support and resources in general practice.

 

The communications from NHSE and UKHSA show the lack of accompanying infrastructure, planning and resources to help address the outbreak within general practice. We have explained how the increase in workload generated by patient queries, requests for vaccination history cross-checking, and unresourced catch-up vaccination clinics, seriously risks impacting upon practice service delivery. We reiterated our request and belief that lowering the thresholds for vaccination QOF payments would enable greater coverage, rather than the current financially punitive approach that is in place.

 

We have requested an NHSE-mandated urgent rollout of time-limited packages of support for ICBs, and a Measles Vaccination Enhanced Service. The enhanced service would also cover the inherent costs to set-up and staff necessary clinics to limit the impact on normal day-to-day care.

 

The letter was also shared in a meeting with the parliamentary under-secretary for primary care, Andrea Leadsom.

 

GPC England Response to The Times Health Commission report


The Times Health Commission report was published this week, making some key recommendations for immediate future NHS commissioning, with a lot of attention focused on how IT and data isn’t able to link up across NHS organisations. A seductive vision of all shared health and care records and data in one place sounds good, but fundamental missing steps along the way risk making that distant dream an impossibility.

 

To free up millions of appointments, we need hospitals to be able to produce electronic prescriptions, and to be able to explain to a patient where they are in a queue after disappearing down a referral ‘black hole.’ Hospitals should be following a patient; the same way online shopping follows a parcel.

 

Those of us working on the ‘shop floor’ of the NHS, stand ready to suggest many practical ways to improve financial efficiency and operational productivity (that won’t cost us millions to implement) but which will need genuine integrated thinking outside of the acute hospital model. This is what we need, which we are glad to see recognised in this report.

 

The elephant in the room is resource, and we note difficult requests for detailed capital investment requirements are not outlined, which is a missed opportunity. GPC England believes that the million patients which GPs see every day recognise that if we are to make any progress, we need additional funds for additional activity, serving additional patients. We also need to recognise the forgotten millions on mental health waiting lists who aren’t included in media headlines but who GP and community teams feel are being ignored, especially children and adolescent mental health need.

 

Access to records – ICO response to DPIAs


Following DPIAs being submitted by many practices relating to the accelerated access to records programme, the ICO (Information Commissioner’s Office) this is a reminder that the ICO published its advice last month. The ICO is content that ‘potential data protection risks have been identified, and that sufficient mitigations are in place.’ Practices that haven't completed a DPIA are encouraged to do so and make their commissioners aware.  If practices identify particular data protection risks associated with providing online access, which they do not consider to be mitigated, they should consult and engage with the ICO and their commissioner to find a way forward.

 

The ICO is technically correct that in theory, a practice could expend whatever infinite resource it wished in order to comply with the contractual requirement to give access. Because a practice could theoretically mitigate (at enormous cost) the ICO is content that the Data Protection Act will not be broken. 

 

It's what the ICO has not said which is telling. Reading between these lines, one may infer that if mitigations were not in place (i.e. access was blanket switched-on, as may have happened in many cases) there may be questions over the legality. Hence the BMA's advice is that as a practice you must still construct a DPIA and keep your commissioners updated. If you are facing local issues, let us know and be sure to include your LMC in such discussions.

 

Workforce data


Our BMA teams collate monthly workforce and appointment data on the pressures in general practice data analysis webpage, which is a great resource for signposting PPGs, local press and MPs.

 

The overall number of GPs has seen little growth since 2015, with the number of GP partners declining significantly over that time. As of December 2023, there were 37,068 fully qualified GPs working in the NHS in England, with around 7.8 GPs per 10,000 people, and would need an additional 16,700 GPs to be on equal footing with the OECD average of 10.8.

 

Despite the Government’s promise to recruit an additional 6,000 GPs by 2024 to reverse the stasis in GP workforce numbers, there are now the equivalent of 1,877 fewer fully qualified full-time GPs compared to September 2015.

 

 

We urge practices to continue to use our safe working guidance to limit contacts to 25 per day in order to prioritise safe patient care, within the present bounds of the GMS contract.

 

 

COVID-19 vaccination programme update


NHS England have published an extension to the COVID vaccination service specification ahead of the proposed spring/summer booster programme.  The specification remains mostly unchanged from the current Autumn/Winter programme, however, following discussions with GPC England, there will be an additional £2.50 payment per vaccination for vaccinations from April-August 2024, in addition to the £7.54 Item of Service fee.  Whilst this move is welcome, we retain strong concerns about the future financial viability of the programme, and we again recommend that practices and their partners make a full assessment of whether delivery of the vaccination programme remains viable for them.

 

Cloud based telephony


GPCE has written to NHSE to raise concerns over the rollout of CBT (cloud-based telephony) and the financial and workload impact this is having on practices along with pressure to sign complex contracts on very short deadlines. NHSE advised last year that there would be no increased costs to practices for their monthly contracts. We have relayed concerns raised about these issues and are seeking an urgent meeting with NHSE while calling for a pause of the roll-out of this contract mandated procurement exercise.

 

Tweet your MP and local 2024 general election candidates about #WhyCantISeeMyGP


A new book by Cumbria LMC member Dr Ellen Welch highlights the crisis facing general practice today.  is already listed as a best seller on Amazon and is being reprinted. Dr Welch said: “This book shines a light on how general practice holds the NHS together. We urge anyone with a stake in the NHS – staff, patients, leaders – to take a read. If general practice fails, the NHS fails so we need both understanding and investment from our government.”

The book is full of personal accounts from GP leaders including GPC England deputy chair Dr David Wrigley. Katie Bramall-Stainer, chair of GPC England, said: “As the saying goes, ‘you don’t know what you’ve got ’til it’s gone’. Thankfully this book presents us with solutions, and I gifted an advance copy to Minister Leadsom for Christmas!”

 

Please use the resources on this page to write to your MP and spread the word on social media.

 

BMA divisional elections


Elections are taking place within BMA divisions to choose local representatives to attend the BMA 2024 ARM (annual representative meeting). The ARM debates important policy issues that affect the whole profession and conducts elections to many BMA committees, so a strong GP voice and influence is important. All GP colleagues are encouraged to review the local nominated candidates in their divisions and vote accordingly. Voting closes noon, 13 February. Access the election portal >

 

GPC UK Regional Elections


Nominations are now open for seats to the General Practitioners Committee (GPC) UK in the following regions:

 

·       Norfolk/Suffolk/Great Yarmouth & Waveney

·       Enfield & Haringey/Camden & Islington/Barnet/Kensington & Chelsea/Westminster

·       Merton, Sutton & Wandsworth/Kingston & Richmond

·       Sefton/Liverpool/Wirral

·       Salford & Trafford/Manchester/Stockport

·       Durham/Cleveland

·       Somerset/N & E Devon

·       E Sussex/W Sussex

·       Derbys/Notts

·       Herefordshire/Worcs/Warks/Coventry

·       Birmingham/Solihull

·       Forth Valley/Fife/Lothian/Tayside

·       Gwent/Bro Taf/Morgannwg

·       Grampian/Highland/Orkney/Shetland/Western Isles

·       Northern Ireland

 

To be eligible to stand in a constituency, you must be a BMA member and one of the following:

·       a GP engaged in providing NHS primary medical services for a minimum of 52 sessions distributed evenly over six months in the year immediately before election

·       a GP on the doctors’ retainer scheme

·       a medically qualified LMC secretary

 

To submit your nomination for any of the above seats please visit https://elections.bma.org.uk/ by the deadline 12pm, 4 March 2024. For any questions relating to the role or GPC please contact info.gpc@bma.org.uk and for any queries regarding the election process elections@bma.org.uk

 

LMC Secretaries Conference 2024


The LMC secretaries conference is taking place on Friday 15 March 2024 at BMA House in London. To register to attend please use the online application form available here, each person attending the conference must register by completing a registration form regardless of how they are planning to attend i.e. first, second or observer, the closing date for registration is 23 February 2024. 

Please contact the GPC office at info.lmcconference@bma.org.uk with any queries.

 

UK LMC Conference 2024 - deadlines


The deadline for submitting motions for the UK LMC Conference is noon, 1 March 2024 - submit your motions here. The deadline for registration is 1 May 2024.  Please note that even if you've booked your hotel you will still need to register for the conference here - although booking the hotel does not mean you are registered for conference.

For any questions, please email info.lmcconference@bma.org.uk.

 

Updating LMC contact details


A reminder for LMCs when updating any contact details, or any changes to personnel, to please email Karen Day kday@bma.org.uk.

 

GPC England committee pages and guidance for practices


Read more about the work of GPCE and practical guidance for GP practices. See the latest update on X @BMA_GPand read about BMA in the media. Contact us: info.GPC@bma.org.uk

 

Read the latest GPC England bulletin

 

Read the latest sessional GPs newsletter

 

Dr Katie Bramall-Stainer

GPC England chair

X: @doctor_katie

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