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NHS England imposes new GP contract with focus on access

by Jaimie Kaffash
7 March 2023

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NHS England has imposed a contract on GPs to start next month, which includes more stipulations around access, but no extra funding.

The contract letter, which was sent to practices yesterday (Monday 6 May), was not agreed with the BMA GP Committee, who have said they are entering ‘serious discussions’ with the profession to decide on next steps, which could include industrial action.

Under the new contract, GP practices will have to offer patients an ‘assessment of need’ on first contact and will ‘no longer be able to request that patients contact the practice at a later time’.

The GPC’s main problem with the contract offer was the lack of funding beyond that already agreed in 2019, as part of the five-year deal, but the final imposition doesn’t include any uplift in practice funding.

NHS England has also said it will be consulting on the future of the QOF for 2024 onwards, but it has announced a number of changes to the framework this year.

Practices have also been told they will need to offer automatic access to future patient records through the NHS app.

The main changes in the contract include:

  • An update to the contract to ‘make clear that patients should be offered an assessment of need, or signposted to an appropriate service, at first contact with the practice’
  • The majority of the IIF – worth £246m – will be entirely focused on improving patient experience of contacting their practice and providing appointments within two weeks;
  • Changes to the childhood immunisations payment system, with lowered thresholds for the QOF targets;
  • The number of indicators in the IIF to be reduced from 36 to five (worth £59m), focusing on flu vaccinations, learning disability health checks, early cancer diagnosis as well as the two-week access indicator;
  • Changes to the additional roles reimbursement scheme, including adding advanced clinical practitioner nurses to the reimbursable roles, increasing the cap on advanced practitioners to three per PCN and removing the caps on mental health practitioners.

NHS director of primary care Dr Ursula Montgomery said: ‘GP teams have worked hard to deliver record numbers of appointments with half a million more delivered each week last year compared to pre-pandemic, and this new contract aims to build on this further with more access for patients. 

‘As well as providing same day care to more than two fifths of patients, GP teams will also step-up preventive action against heart attacks and strokes over the next year, with health professionals encouraged to prescribe statins alongside other preventative measures such as exercise to a much wider number of patients with heart disease, arterial disease and those who suffered a stroke or who have high levels of cholesterol.

‘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.’

Acting GPC chair Dr Kieran Sharrock said: ‘This hasn’t been properly considered, ramping up GP workload, and without the support needed, will lead to more GPs leaving the profession. 

According to Dr Sharrock, the GPC had hoped to collaborate on contract negotiations, but has been repeatedly disappointed with the lack of support for struggling practices. 

Last month, the Committee rejected a version of the contract, calling it ‘insulting’.

Dr Sharrock added: ‘General practice can no longer be expected to take whatever is thrown at it, and the Committee’s recent rejection of the contract offer still stands. 

‘We will now look to enter serious discussions with our membership and the wider profession on what action we take next.’

A version of this story was first published on our sister title Pulse.