The NHS Confederation has published a new document entitled, “Supporting General Practice At Scale: Fit for 2024/25 and beyond”.  In it they have, “identified a set of tangible recommendations for the upcoming GP and primary care network (PCN) contracts for 2024/25”.  What are they saying, and what might this mean for next year’s contract?

The first question is why the NHS Confederation are producing such a document at all?  It seems the answer to this lies somewhere in the midst of the fact that discussions between NHS England and the BMA/GPC have not progressed over the last two years (hence two years of imposed contracts) and so NHS England has started to turn elsewhere to have conversations about the future.

Whether the NHS Confederation, an NHS membership organisation that within primary care has PCNs and GP Federations as its members, has legitimacy to talk on behalf of core general practice is questionable, but that hasn’t prevented the publication of this report, and someone, somewhere is funding this work.  The NHS Confederation Primary Care Network is clear that its aim is to “drive the future direction of primary care”, and the report explicitly states that NHS England and DH participated in its production (p9).

The report talks about contracts for practices and PCNs, as if the two are separate.  At present the PCN DES is a part of the national GMS contract, but without explicitly calling for the two to be separated the report does treat them separately.   Are PCNs a group of practices operating together and so an extension of practices, or are they separate entities in their own right?  The gap between at-scale GP organisations and their member practices is what ultimately has caused most of them to fail, and such a separation will likely have disastrous consequences for both practices and PCNs.

The report reinforces the now prevailing belief that next year (2024/25) will be a “stepping stone” contract (p8), ie one with limited change but which will start to point towards a future direction.  It talks about having “Pathfinder” PCNs in 2024/25 to model new ways of working for PCNs that can “demonstrate a level of maturity and innovation” (p19).

The document lays out the “asks” that it says will underpin the future direction for general practice.  Some of these are very specific, including to explore limited liability partnerships holding PMS and GMS contracts, and the contract to rise with a new pay uplift clause.  It also has this as a short term ask, “Explore proven delivery models that will improve practice resilience and sustainability, enabling a mixed economy that continues to support access to services for patients” (p13).  It is not clear what this actually means, but it could be read as a pointer to NHS organisations running practices.

There is also an ask that, “National primary care contracts should be streamlined, retaining a core national focus on areas of high impact” (p19).  Again, it is not clear what this means.  It could mean less prescription on what is required, or it could mean shifting funding out of the national contract and into local contracts, and the problem is people will hear what they want it to mean.

The report contains many of these “asks”.  The report is worth reading to see what they all are.  Many are sensible, some less so, and some have an obvious bias towards at-scale general practice.  The biggest problem, greater than the lack of clarity as to what some of the asks actually mean, is understanding who is asking whom for these things.  Implicit is that primary care is asking NHSE/DH, but there is some considerable distance between the asks in this report and the ‘Call to Action’ document produced by the BMA earlier this year.  I suspect a substantial number of these asks would struggle to gain support if they were presented at the national LMC conference.

But NHSE and the DH want to move forward with their plans for general practice, and if the BMA will not engage with them in a conversation about these plans it is hardly surprising that they are turning to those that will.  This in turn means that despite the mandate issues around this document it potentially could have very significant implications for next year’s contract, and this is probably our first glimpse of the types of things we can expect to see coming.