One of the big complaints the system has with general practice is that they say it is impossible to do with business with 6,500 different individual businesses.  Indeed, one of the main rationales around PCNs was to reduce that number down and create units of general practice that mapped onto local neighbourhoods.

But the reality is the system does not have to deal with 6,500 GP practices individually.  There is one contract for all of those practices, and so dealing with general practice is far more efficient than all of the local contract negotiations that take place individually with each of the provider trusts.

While general practice absorbs its own risk and never returns a deficit to the system, the rest of the NHS is running up debts of £1.5bn a year.  What general practice has to do is absorb its costs, often by partners, GPs and the staff working in practices having to do so much that their own health starts to be affected.  Despite the year on year cuts to funding with the recent below inflation contract impositions, activity across general practice has continued to rise.

An outsider might expect the system to be grateful.  At least one part of the system is living within its means and not adding to the wider financial woes of the NHS.  But that is not how the system is reacting.  Instead what we have is a purported offer to increase the core contract by 1.9% next year. This is well below inflation, and so represents a further cut on top of all those experienced in recent years.

A local commissioner would not get away with such an offer to its local hospital trust.  Threats of cuts to essential services and (if necessary) some gentle winding up of the local MP and newspaper would soon force the commissioner into a more reasonable offer.  Yet for some reason NHS England thinks it can get away with making this offer to general practice.

Why is that? Is it because each practice is so small that individually they are not able to make the kind of noise that actually matters?  Is it because the dispersal across 6,500 different practices means the individual impact is hard to quantify and turn into patient stories?  Is it because the pain of the junior doctor and consultant strikes is worse than any that is likely to be caused by GPs, and so general practice is seen as a soft target?

The government’s response to criticisms of its failure to invest in general practice is to point to its overall increase in investment in the NHS.  While the overspend is so big not everyone can receive additional money, and so it very much looks like general practice has been identified as an area where spending can be tightened to relieve pressures elsewhere.

So general practice has to stop being a soft target.  At present it is too easy to cut money from the service, because while it is the pain is only going to continue.

The way to do that is to stand together.  A voice that is spread across 6,500 practices is not powerful.  But a single voice across those practices is.  The system might think general practice is a diverse group, but practices come together every year via the GPC to negotiate a single contract.  And the stronger the unity across the group, the greater the negotiating power.

The system wants to move to local negotiation for general practice because it understands the latent power the national collective holds.  It has been quite some time since the service has exercised this power, but now is the time.  Practices need to make sure they are all members of the BMA (whatever they think of the BMA, because unity is power), and back Katie Bramall-Stainer and the leaders of the GPC to the hilt.  Now is the time to stand together, and demonstrate to the NHS that general practice is not a soft target.