The Hewitt Review was published on the 4^th April, and the key takeaway for general practice from the review is that the national GP contract is now very much under threat.

There is an important distinction between the independent contractor model, i.e. GP practices working under a contract with the NHS, and the single national contract, which means that the majority of the work of GP practices is negotiated and agreed via one nationally negotiated contract.

The Hewitt Review, and I would suggest at present the majority of the NHS in general, does not like either of these things.  The independent contractor model prevents the NHS being able to dictate to practices what they have to do (the way it operates with all other NHS organisations).  Instead terms have to be put into a contract in order for a change to take place.

But the review does not go as far as both Wes Streeting and Sajid Javid (when he was Secretary of State) have previously gone in calling for the independent contractor model to be abolished.  Instead it turns it sights more squarely on the single national contract.

This move against the national contract featured heavily in the Fuller Report, which called for more general practice resources to come under the control of local Integrated Care Boards (ICBs).  The Hewitt Review picks up this mantle,

“The contract held by GP contractors for ‘general medical services’, which is negotiated nationally between government and the BMA, provides far too little flexibility for ICSs to work with primary care to achieve consistent quality and the best possible outcomes for local people.” 4.11 p66.

What is it about the national contract that local leaders dislike so much?  The example given in the document is illuminating.  It reports that pharmacists choosing to work in general practice in some areas is now exacerbating shortages in local pharmacies and acute hospitals.  So, one assumes, the argument is that left to local discretion the ARRS role that the majority of practices find is adding the most value would not be permitted in certain areas.

The question, then, is whether shifting from a single national contract to locally negotiated contracts would make things better for general practice, or would it simply prevent any shift of resources into general practice ever taking place?

The reality is that the national contract ringfences resources for general practice.  If a local system is under financial pressure it cannot remove resources that have been agreed within the national contract.  It can (and some areas have) stop any locally agreed resources, such as local enhanced services, but at present that is the limit of what it can do.  Many local system leaders think general practice is unfairly protected from taking its share of system ‘pain’ when local cuts need to be made.

Most local system leaders do not understand general practice, and how it operates.  The majority would have no clue what an enhanced service or an APMS contract is.  There is no understanding that while NHS trusts can simply post a deficit (that is underwritten by the NHS) and continue on pretty much as normal, GP practices have to remain as going concerns to be able to keep the lights on.

Given this environment in the majority of local areas, I do not believe that promises of local flexibility from locally agreed contracts would be worth the risk that giving up the protection that the national contract affords to general practice resources would entail.

The main recommendation of the Hewitt review when it comes to general practice is “that work should be undertaken to design a new framework for General Practice (GP) primary care contracts” (p8).  The national contract, and all the protection it affords, is very much now under threat. NHS leaders want the un-ringfencing of general practice resources, and the ability to be able to dictate directly to practices what they do and don’t have to do (particularly when it comes to access).  The national GP contract is the best protection the service has against this, and I would suggest the profession would be wise to strive hard to protect it.