I had an inkling that the contract letter would be a bit contentious, given the protracted and somewhat painful mutterings of the BMA GP committee, but when I read it last night I was speechless. This is the second year a contract has been imposed on us without agreement.

We’re in the final year of a five-year funding deal. What they seem to have forgotten, or are wilfully ignoring, is that the landscape of the UK has changed beyond recognition in that time. The COVID-19 pandemic has decimated NHS capacity, with long waiting lists impacting all services including primary care. The increased workload in primary care is due in part to the massive backlogs in secondary care. Yet in general practice, we’re actually delivering more appointments with fewer GPs. According to NHSE’s own figures, that’s 11% more appointments in January this year than in the same month in 2020.

YES, we understand there isn’t an unlimited pot of money. YES, we understand the taxpayer ultimately foots the bill, but our staff are just as affected by the cost-of-living increases as anyone else. Our staff deserve fair pay along with the ambulance service, nurses and doctors, train drivers – to mention but a few. The DDRB review doesn’t look at the partners’ earnings as they’re part of a funding deal, and for salaried GPs, any change will be affected by the agreed and available funding. Few GP practices offer AfC terms, and while the nursing unions affected by AfC funding are up in arms, we’re mostly avoiding that issue. If the nursing unions secure a significant increase for their staff, then some general practice staff might decide to jump ship.

It seems incredible to me that despite the challenges we’re facing due to the pandemic, Brexit and inflation, there’s no movement from the government whatsoever. So, they’ve allowed a small temporary hiatus in the form of some income protection for QOF. As usual, they’re announcing increases in funding when all they’re really doing is playing shuffle cups with the money.

Prospective records access is being granted from 31st October, including changes to the contract wording about access to historical records to align with the GDPR. However, let’s talk about the elephant in the room…  

Access.

The new contract says “patients should be offered an assessment of need, or signposted to an appropriate service, at first contact with the practice”. But what does that mean in practical terms? Where can we signpost to? OOH? 111? Pharmacy? A&E?! Our reception teams are fantastic, but while they’re great at offering alternatives, how are we supposed to manage this? They can’t possibly signpost everyone!

So, do we have all staff on “assessment” each morning, or do we go back to the bad old days of turn up and wait? What do we do about the folk who need to arrange transport weeks in advance, or those who have childcare or other issues to work around? Is patient choice going to be allowed as an assessment of need?

We’re struggling for capacity, but how do I explain to our amazing GPs and nursing team that what we’re doing isn’t enough? It’s all very well saying that funding will be available, but the thing is, it’s NOT more funding; it’s the exact same funding they said we’d get five years ago when there was no pandemic and no exponential inflation.

Of course, there’s no need to panic because now we’ll be told where we can get our telephone services from, with a shiny new procurement system. After all, massive national procurement always delivers the BEST value.

We’ll have access to funding through the PCNs for ARRS staff. If your PCN is functioning well, that’s just fine. Inevitably, though, not all PCNs are running smoothly. What happens if you’re a tiny practice bobbing along in the wake of the giants that form the rest of your PCN? And while they’re busy encouraging us to recruit ARRS staff on permanent contracts, if necessary, what they’re not openly advertising is that the ARRS is due to be reviewed in 2023/24 to ensure it’s fit for purpose and aligns with future ambitions for general practice.

IIF funding is mostly being transferred to access too. Five of the current indicators will remain worth £59m including two indicators relating to flu, early cancer diagnosis, learning disability health checks, and two-week access. Another £246m, which includes the remaining money currently in IIF (total IIF funding of £260m in 2022/23), will be paid towards access. 70% will be paid as aspiration (similar to QOF) to the PCNs, and the remaining 30% will be paid at the end of March 2024 after assessment against “gateway criteria” “for demonstrable and evidenced improvements in access for patients”.

So, large amounts of cash are being freed up from other places to improve access. The issue with access isn’t just funding though – it’s staff. There aren’t enough of them, and they’re not always available in the places where they’re needed most.

Vaccination and Immunisation will see some small changes, with a change to the clawback from practices that don’t achieve 80%, and with some small changes to thresholds so that QOF points begin at 81% for some indicators. There will also be a personalised care adjustment added for those who registered too late to be vaccinated under the UK schedule. But this is cold comfort for those of us who struggle for various reasons, not always related to the lateness of registration.

Overall, there’s not much additional money, for what looks like a massive amount of focus on access. The financial penalties for practices who don’t meet the necessary criteria are likely to be significant, simply because of the amount of resource devoted to it. If you thought that the vaccs and imms criteria last year were punitive, I expect this will be much, much worse.

The icing on the cake though? QOF QI this year is focused on, yes, more access, but also on “workforce wellbeing”. You really couldn’t make this up!

Paula the PM