Even though the GP contract for this year has been billed as the imposition of Year 5 of the existing five-year contract agreed in 2019, the reality is that it contains some significant changes. So significant, in fact, that the government had to take these changes through parliament to put them in place. Essentially, practices are now required to respond appropriately to contacts made by patients to the practices on the day the contact is made (read the BMAs guidance here).

In this month’s Practice Index podcast, we discussed this change and the impact it’s having on practices. It’s interesting that despite this change being unfunded, it’s creating far more challenge and concern for practices than the production of the required PCN plan (although you could argue that the Capacity and Access payment received via the PCNs is actually to support practices with this, despite there being no explicit link made nationally between the two).

Either way, as our panel point out, there’s no actual new money for the contractual change because even the Capacity and Access payment is simply the IIF money rebadged as something else.

This government seems to prefer policy announcements to actually making any changes. So, just as the stream of announcements about the “40 new hospitals” was more important to the government than any actual bricks and mortar, so GP practices have suffered with the government announcing the changes to the contract without giving practices any time to respond. Not only did a new, unfunded contractual requirement appear on 15 May, so did a stream of patients on the telephone to each practice across the country demanding their “right” to a same-day appointment be upheld.

Responding to the new requirements has been challenging for many practices. Of course, there are some (such as Jo Wadey’s practice in Worthing, as featured in February’s podcast) who are already compliant. There are others who are making the changes outlined in the Delivery Plan for Recovering Access to Primary Care document where it talks about implementing “Modern General Practice Access” (p21). Then there are others, where such a model isn’t going to work, who are trying to find their own way through it.

The BMA’s response to all of this is not super helpful. They’re basically taking the contractual approach used by the government and NHS England and encouraging practices to do the GP equivalent of work to rule. It has called for practices to introduce safe working in general practice, which limits individual GPs to a maximum of 25 patient contacts per day and 15-minute appointments, and for the excess demand to be either referred on to 111 or A&E, or placed on a waiting list. For most practices, this would quickly result in very long waiting lists!

As a result, practices are in a difficult position. Do they prioritise the needs of their patients and work to meet the needs of their local population as best they can with the resources they have, or do they prioritise their staff and try to put sustainable workloads in place? Our panel reflect that there are no easy answers, and it’s often the practice managers and front-line reception staff who are bearing the brunt of whatever direction the practice chooses to take.