Almost nine in 10 practice managers want staff costs to be ringfenced and funded separately to the global sum as part of negotiated changes to the GP contract, a survey has revealed.
A total of 70% strongly agree this should be the case while 18% said they ‘somewhat agreed’.
Practice managers were asked what outcomes they would like to see from the current negotiations between the BMA and Government for a new wholesale national contract, which the BMA is aiming to be agreed by the end of next year. A total of 233 practice managers participated in the poll.
The results showed that 85% think the Carr-Hill funding formula needs a major overhaul. And 44% want QOF to be scrapped – although 34% said it should remain.
The survey also found that:
- There is an even split among the profession about whether primary care networks (PCNs) should be axed, with 39% saying agreeing and 40% disagreeing.
- A clear majority (67%) disagree that there should be a move away from partnerships to a salaried GP model.
- Half (50%) disagreed with the statement that the responsibility for urgent and on-the-day appointments should be taken away from general practice. Although 34% agreed.
One practice manager (PM) based in the South West England who strongly agreed that staff costs should be ringfenced and be funded separately to the global sum commented that ‘well-staffed practices struggle’.
They also said they believed PCNs should be scrapped as they represent another layer of bureaucracy and ‘means practices aren’t kept in the conversation on plans as [an] ICB thinks telling a PCN ticks the box’.
However, another practice manager respondent from Worcestershire questioned what would happen to staffing if PCNs were scrapped. ‘For us we could not afford to fund the roles in house,’ they said.
Meanwhile, a PM based in Coventry said that their practice is ‘affected by negative weighting’, adding that they ‘don’t disagree with the Carr-Hill formula but that no practice should be funded for fewer patients than they have registered’. They also said: ‘I feel that if the CH formula identifies a lower weighting then the practice should be paid their raw list size, and higher weightings be paid the higher weighting.’
The PM agreed that PCNs should remain but be properly funded since ‘its funding does not reflect the actual cost of running or being part of a PCN’.
A handful of practice managers commented about the issue of urgent and same-day appointments.
One respondent said: ‘Patients like to see their own GP who they know and trust. Moving urgent and on-the-day appointments would cause stress for a lot of patients.’
Another said: ‘Some on the day appointments aren’t necessarily urgent or emergencies but are appropriate to be dealt with in general practice.’
And a third practice manager said: ‘Continuity of care is a very important factor in preventing hospital admissions and also in providing good care. We know 75% of the appointments made by our “frail” patients are urgent care.’
Kay Keane, chair of the Institute of General Practice Management (IGPM) said she wasn’t surprised that just under half of respondents want to see QOF scrapped.
‘Some of our members feel it’s become a tick box exercise – more about data gathering than patient care’, she told Management in Practice. ‘Managers and staff spend hours ensuring correct codes are added, which doesn’t always feel like it improves outcomes for patients.
She added that: ‘Practices in deprived areas may also struggle to meet QOF indicators because of population challenges, they are the ones that need the income the most but often fall short. We should be supporting them more.
‘Meanwhile, missing QOF points can mean a significant loss of income, adding stress in a system that is already on its knees.’
She also pointed out that QOF was designed in 2004 but that general practice is no longer operating in the same system.
‘We now have digital care, holistic approaches, trauma-informed and team-based care.’
On PCNs, Ms Keane said the simple answer would be for the Government to ‘to fund general practice properly and let us decide on how to collaborate.’ She also highlighted that much of the workload burden can fall to practice managers.
‘Our members tell us that sometimes it’s practice managers who are the ones holding together the PCN, recruiting for ARRS roles, managing payroll, chasing IIF targets and dealing with even more reporting systems, Ms Keane said.
‘It can feel like a full-time additional job on top of running a practice.’
However, she further explained that the IGPM, which also represents PCN managers, is aware that there are great examples of ‘partnership and collaborative working, of innovative services and care’.
Ms Keane said: ‘This is shared across our membership channels and we can see that where PCNs are good they are working well.’
The survey results in full
Respondents were asked: The BMA and the Government are set to negotiate a major new contract before 2028. How do you feel about the following statements with regards to a new contract?
The Carr-Hill funding formula needs a major overhaul
59% strongly agreed
26% somewhat agreed
7% neither agreed nor disagreed
2% somewhat disagreed
0% strongly disagreed
5% didn’t know
Staff costs should be ringfenced and funded separately to the global sum
70% strongly agreed
18% somewhat agreed
4% neither agreed nor disagreed
6% somewhat disagreed
2% strongly disagreed
0% didn’t know
PCNs should be scrapped
18% strongly agreed
21% somewhat agreed
20% neither agreed nor disagreed
19% somewhat disagreed
21% strongly disagreed
1% didn’t know
The QOF should be scrapped
16% strongly agreed
28% somewhat agreed
22% neither agreed nor disagreed
22% somewhat disagreed
12% strongly disagreed
0% didn’t know
We should move to a salaried GP model
7% strongly agreed
10% somewhat agreed
14% neither agreed nor disagreed
12% somewhat disagreed
55% strongly disagreed
3% didn’t know
The responsibility for urgent and on-the-day appointments should be taken away from general practice
13% strongly agreed
21% somewhat agreed
16% neither agreed nor disagreed
24% somewhat disagreed
26% strongly disagreed
0% didn’t know
This survey question received a total of 233 responses from practice managers. The survey was conducted between 31 March and 14 April 2025, collating responses using the SurveyMonkey tool. The survey was advertised to our readers via our website and email newsletter, with a prize draw for a £200 voucher as an incentive to complete the survey. The survey was unweighted, and we do not claim this to be scientific – only a snapshot of the practice manager population
