GP leaders have called for fundamental changes to the practice contract ahead of the end of a five year deal, warning of a collapse in doctor numbers.

The British Medical Association’s GP committee yesterday set out its terms for new talks on the contract. It follows a year of tortured relationships with NHS England and the government after ministers sought to blame GPs for difficulties in patient access during the pandemic. At one point GP leaders voted to boycott any more talks.

The BMA said the current five year deal, about to enter its last year, was no longer appropriate.
The GP committee called for a “refreshed, fit for purpose” contract, rejecting NHS England’s proposed amendments to the current contract, and warning of rapidly declining doctor numbers.
The GPs also voted to support continuing as independent contractors after Health Secretary Sajid Javid announced plans to encourage NHS trusts to take over swathes of general practice. Practice staffing data, published yesterday, showed a mixture picture for doctor numbers, with the capacity of fully qualified GPs continuing to decline in spite of increases in trainee numbers.

Committee chair Dr Farah Jameel said: Three years ago, general practice – as indeed the world – was a different place. For those of us working on the frontline, the pace and scale of demand we are experiencing every day, despite these being intense back in 2019, are now on a level we have never had to deal with before. As a result, every month we continue to haemorrhage GPs from the profession as evidenced with falling numbers of full-time equivalent GPs, which has a direct impact on the care patients can expect to receive. So, while the contract practices are currently bound to was agreed in good faith three years ago, it simply does not reflect the experiences and needs of GPs and their patients today.”

Dr Jameel added: “We continue to see a rise in demand from patients, many of whom are waiting too long for care as a result of the NHS being placed under demand across the board. This includes those who are on the now 6 million strong waiting list for elective surgery or procedures, with 310,000 now waiting longer than a year and in need of ongoing care in the community. Meanwhile we have seen practices in England lose the equivalent of more than 500 full-time, fully qualified GPs since the five-year deal was announced, despite repeated pledges from Government to recruit thousands more.

“We can’t ignore the profession’s sense of depreciating value within the NHS and in their communities, as professionals and individuals. Acts of abuse and aggression towards NHS staff add to this. We also can’t treat the profession as if the pandemic didn’t happen and wasn’t real for them. The psychological impact on their morale and wellbeing has been enormous. Going forward a ‘business as usual’ approach simply will not work, and with new leadership of our committee, this provides an opportunity to renew, reset and renegotiate a contract that delivers for both the profession and patients, and that addresses the key issue impacting general practice today: retention of our workforce.”

The NHS Digital data showed that in England there were 188 fewer full time equivalent posts filled in December than a year earlier – with 147 fewer working GPs. The total number of GPs, including trainees, increased by 874, reflecting successful recruitment to training programmes. There was also a 1.6% reduction in practice nurses over the year – with 372 fewer in employment in December than a year earlier. Practices were employing 2.4% more administrative and non-clinical staff, an increase of 2,353.

Dr Jameel added: “These figures paint a dark picture; they are a culmination of the detrimental impact that working in an over-stretched, under-resourced NHS is having on GPs across the country. Family doctors, exhausted and disenchanted, feel as though they have no choice but to leave a profession they love because of chronic pressures now made worse by the pandemic. The Government has repeatedly argued that the number of doctors is growing, but this isn’t the reality for general practice, and it begs the question: how many more have to go before something is finally done about it?”