The imposition of the 2023/24 contract onto general practice leaves practices in an extremely difficult position. Do they accept the imposed terms and find ways of reducing their cost base to manage the reduction in income, or do they take industrial action in an attempt to improve the terms of the contract?

This is something of a Hobson’s choice, in the sense that it necessitates choosing between two equally objectionable alternatives. There are no more easy cost-cutting measures available to us, and industrial action (whatever form that may end up taking) contains no guarantee of success.

In this month’s Practice Index Practice Manager podcast, we discussed the steps that practices might have to take in response to the contract imposition. It doesn’t make for easy listening! 70% of practice costs are staff costs, so the impact of any cuts on practice staff is inevitable.

What can practices do? They can cancel any vacancies. But then who’s going to do the work left behind by that vacancy? Are we expecting already overworked and pressured staff to take on even more?

Or do we change working hours, so that we reduce the total amount of staff pay? Of course, the same challenge will then remain; even though we’ll have the same number of staff, we’ll need each person to get through more work per hour. Is that realistic?

Or do we change terms and conditions, potentially reducing maternity, sick and redundancy pay down to statutory levels? Maybe we should go as far as firing and rehiring our staff to impose the new terms on them. But if we decide to do this, how can we do it without a complete collapse in the goodwill on which much of the operation of practices relies?

Or do we need to go as far as announcing redundancies? If the financial situation becomes really dire, we may not have any choice. On the podcast, Susi talks through the process we would need to follow if we were to go down this route, but it will take a firm resolve to see the challenges of such an action through to the end.

Cost-cutting on the kind of scale that’s likely to be required will be difficult and there are no easy solutions. But what are the alternatives?

Maybe we can do things differently? During the podcast, Robyn exhorts us to not lose focus on what general practice is good at, and to think innovatively and work together to find ways of at least protecting the team we currently have.

The only other alternative is to take the government on. Here, the option is to work with the GPC and identify and take the necessary action to attempt to force the government’s hand and increase the core funding coming to practices. The GPC is currently holding webinars with the profession to determine what the next steps might be.

Industrial action brings no certainty of success, and delays in making cuts could mean that the cuts would then need to be deeper than if they were made earlier. These are difficult times for practices, and there are no easy answers. You can listen to our discussion here: