Almost 99% of GPs in Wales have voted in favour of rejecting the Government’s GMS contract offer in a referendum of the profession, the BMA has revealed.
Of 1,093 GPs taking part in the vote, 98.7% rejected the offer made by ministers last month for 2024/25.
The union’s Welsh GP committee will now take this mandate to the Welsh Government and ask that they ‘urgently improve’ the terms on offer.
It warned that should the Government choose to ‘ignore’ this, the union will continue with preparations for collective action by GPs.
The contract negotiations for the current financial year had encountered several delays and Welsh GPs said they were ‘actively evaluating all available options’ for dispute against the Government due to the delays.
Welsh BMA leaders had encouraged GPs to reject the offer as the financial proposals put forward by the Welsh Government fell ‘significantly short’ of the costed expectations the BMA presented in their negotiations.
GPC Wales had asked the Welsh Government for an investment of £10.8m into contractor GP pay, an overall investment of £27.2m for staff pay and an expense award of £8.9m to allow practices to cover ‘unavoidable’ practice costs.
However, the Government offered £10m of investment in GP contractor pay, £12.1m in salaried GP and staff pay and £1.8m in general expenses (see also box below).
BMA Cymru Wales said that the proposal does not feature any of the asks put forward by GPC Wales, which were ‘formulated and fully costed’ to address the ‘pressing needs’ of practices.
Some of the requests excluded were:
- Uplift and extend the reimbursements within the SFE for parental leave, sick leave and suspended doctors.
- Uplift to the partnership premium scheme to keep pace with inflation.
- Consider embedding a ‘population growth factor’ calculation to allow the GMS budget to keep pace with Wales’s rising population.
- Uplift the value of vaccinations and immunisations fees to take account of multiple years of inflation
- A political commitment to resource restoration toward general practice, redressing years of historic underfunding.
The current proposal would mean that the global sum per weighted patient would be approximately £124.73 or around 34p per patient per day.
But GPC Wales warned that the impact of statutory wage increases has not been fully funded and that this would ‘significantly erode’ the intended pay award for GPs and could even put the financial viability of practice finances at risk.
The union said that the referendum saw more GPs in Wales join the BMA than ever before, ‘reflecting the strength of feeling’ among the profession.
BMA Welsh GP committee chair Dr Gareth Oelmann said that accepting the offer would have meant more practices ‘undoubtedly’ closing their doors.
He said: ‘The profession has delivered a clear message with this result. We simply cannot keep services going and meet the needs of our patients with less money and fewer resources.
‘If we accept the offer as it is more practices will undoubtedly close leaving patients in greater peril, that’s why GPs from across Wales have taken a stand.
‘For years, the service has been starved of adequate funding which has led to the closure of 100 surgeries since 2012.
‘This is having a devastating impact on general practice. A recent survey of our members showed that 91% of GPs are routinely unable to meet patient demand due to unsustainably high workloads.
‘With fewer surgeries available, GPs are now seeing up to 35% more patients each, leading GPs to burnout, reduce their hours or leave. This is neither safe nor sustainable.’
A Welsh Government spokesperson said: ‘We acknowledge the strength of feeling following the BMA Cymru Wales referendum and are committed to continuing to work with the profession to secure a sustainable future for general practice.
‘Our offer met the independent pay review body recommendation for a 6% increase to GP pay and would have also seen that uplift applied to pay for all members of the practice team. This offer was made within a very constrained budget environment, which has required very difficult choices to be made.
‘We recognise the pressure GPs face in terms of workload and are investing in new ways for people to access primary care services, including community pharmacy and the 111 helpline, to help relieve some of that pressure.
‘We look forward to continuing discussions with GP representatives to ensure our GP services remain sustainable, providing vital local care now and in the future.’
Earlier this year, the Welsh Government accepted recommendations from the Review Body on Doctors’ and Dentists’ Remuneration (DDRB) on GP pay in full, following several delays.
In July, BMA Cymru Wales presented survey findings to the Government revealing that eight in 10 GPs had ‘significant concerns’ about whether their practices can survive financially.
The Welsh Government’s contract offer in full
Access Standards
To review and amend the practice requirements and measures under the Phase 2 GMS Access Standards for 2025-26, and to make a recommendation on future contractual change that embeds the Access Commitment and Phase 2 standards into the core contract from 2026 onwards.
Anti-viral medicines
Change to the treatment pathway that will enable eligible patients to contact their GP practice (or the GP Out of Hours Service) when/if they test positive for Covid, to be clinically assessed, and for Paxlovid to be prescribed and dispensed from within primary care, if deemed appropriate.
Repeat prescriptions
Adoption of longer prescribing intervals, where clinically appropriate for the patient, in all non-dispensing GP practices. Typically, this would be consideration of a 56-day prescribing interval, however longer intervals for individual patients may be clinically appropriate.
Continuity of care
Practices adopt the RCGP Continuity of Care Toolkit and calculate continuity of care at practice level using agreed measures, uploading this data monthly via PCIP. This data would be shared with health boards as part of the activity data metrics.
Frailty and ethnicity
A contractual requirement for GPs to include agreed equalities data questions (using consistent ethnic group categories) within their new patient questionnaires, and to record this information on the patient record. Practices to also proactively identify people who are living with severe or moderate frailty using an evidenced based tool.
Learning disabilities
To agree a definition of learning disabilities (LD) that qualifies a person to be on the GP LD register and to describe in the GMS contract regulations the primary medical services that all people with LD should expect to receive under the unified contract.
This includes, as part of unified services an offer of an annual patient care review that should be conducted by the contractor.
Additional Capacity Fund
A rapid review of the Additional Capacity Fund to determine funding from 2026 onwards. This review should consider whether the £12m investment to date has had a positive impact on access to appointments and has been utilised to support the delivery of services.
This year’s investment offer into GMS conditional on these areas of work being progressed with information and guidance issued to practices on any subsequent contractual changes:
• A 6% pay uplift to GP pay, extended to all practice staff.
• £1.8 million for other practice expenses.
• An extension of the Additional Capacity Fund for 2025-26, meaning an additional £4 million investment next year
Source: BMA
A version of this article was first published by our sister title Pulse
