The  eagerly long-awaited GP Contract letter 2024/25 has been published. I’d like to say that I was shocked, except I’m not.

I don’t think I should be surprised really. The negotiations with the consultants and junior doctors have been the first clue to what was waiting around the corner. The 1.9% teaser headline a few weeks ago raised my suspicions further. Not to mention the fact that GP appointments contribute heavily to GDP. So there really isn’t any kind of an incentive to reduce the burden on general practice.

Apparently, NHSE and DHSC have listened and heard the views of general practice. I would suggest, M’lud, that they weren’t listening closely enough.

What wonderful suggestions do they have for us this year? Which of my three wishes have they granted? News flash: the answer is NONE!

They’re suspending and income-protecting about half of the QOF indicators, reducing IIF indicators and increasing the Capacity and Access Payment. Last year, the CAP document ran to 15 pages, so I’ll expect a bit more bedtime reading this time. Any increase in funding generally comes with more requirements in my experience. I’m not sure how this fits the brief of simplifying arrangements. It surely just moves the goalposts?

Paying the aspiration payments at 80% instead of 70% – well, it might help cashflow, but it isn’t any additional money in the pot, is it?

More flexibility over nursing in ARRS roles and removing caps on the other patient care roles. I’ve actually got a few issues with this one, you’ll be shocked to hear:

One, where are these staff coming from? I’m certainly not going to find it easy to recruit with the lack of pay increases and no AFC terms. I know, I know, we work core hours rather than 24/7 and there will be some for whom this will be enough incentive, but let’s be honest, the rest of the NHS is hardly drowning in staff. So, we’re just moving staff from one understaffed area to another.

Two, anyone else think we’re being sleepwalked into accepting that 50k is the operational scale and that the 10k practice will be no more?

Three, we’re losing the ability to decide what our practice teams look like. We can choose from a menu of “acceptable options” but with so much of our funding being tied to the list that they’ve decided on, we’re going to struggle in the long term to recruit a different skill mix if we want it.

Beyond that, we’ve already had practices making GPs redundant. While I love a multi-disciplinary team, I can’t see that fewer GPs is going to improve the situation on the ground, particularly when so many of our patients have complex needs.

Simplifying the DES requirements – call me cynical, but often “simplifying” and fewer rules, which are more difficult to achieve, go hand in hand.

Review the digital telephony data to better understand overall demand – great, we know there’s demand, and we’ve known it for years. We’ve staffed our teams differently depending on patterns of demand. So, what exactly do we think they want to do with the data? I can’t imagine, looking at the rest of the document, that it’s going to be anything particularly helpful to us. Understanding winter pressures seems to be the focus. Winter is hard; viruses make life harder, staff get ill, I’m not sure what more we can really say on the subject.

As for the DDRB paragraph – no longer in a pay deal so DDRB applies. Are they serious? 6% was the DDRB figure for last year. It was made clear that this applied to us (except the partners), we were funded (allegedly) for it, though I’d argue that most practices didn’t receive nearly enough to cover the matching bill. 2% projected for pay? The National Living Wage increase this year is 9.8%. A 2% increase to pay for a 9.8% uplift? I’m not quite sure that their sums add up! Not to mention that inflation is well above 2% still. They’re living in a dreamworld if they think we’re going to find this acceptable.

Once we move onto the next paragraph, the lack of understanding is obvious. We’re moving to a higher trust approach. Words fail me. It speaks volumes. On the one hand, I do think that higher trust is good; I think it’s fair to say I have massive trust issues in this relationship.

I think NHSE and the DHSC are massively miscalculating the depth of distrust created in the last few years. Funding does not match the level of funding seen in other areas, and a more significant offer than ‘we’ll trust you not to fiddle the figures’ was hoped for. They’re paying on historical achievement so it’s not a massive leap of faith, is it? Not to mention that as your prevalence figures and list size make a sizeable difference to income going forward, you need to carry out the work anyway; they obviously aren’t paying you by achievement.

Until 7th March, the Government are still consulting on the role of incentive schemes in general practice, so you might want to let your views be heard on that one.

I don’t know why they bother to pretend they’re asking for our opinions, because if the contract letter is anything to go by, they don’t listen to us anyway.