NHS England has issued an update on next year’s contract. For the second year running no deal has been reached between the GPC and NHS England, and as a result the 5th year of the contract agreed in 2019 will be imposed on the service. The update essentially outlines the changes within that contract that NHS England is able to make without it being a formal variation of the contract.
The changes that have been made by NHS England are not the real issue. What is important is what is missing from the contract. It is easy to be distracted by the headline noise around access, but the main problem with this contract is the lack of a funding uplift.
The 5 year contract was agreed at the start of 2019. The inflation rate at the time was 1.8%, and at that point inflation had been low and relatively stable for some time. The rises to the core practice contract (ie excluding the PCN DES) were set as follows (p51), based on predicted inflation levels:
Of course what has happened over that time period is that the cost of living has risen significantly beyond what was predicted back in 2019. Inflation had risen to 8.5% in March 2022, peaked at 11% in October 2022 and currently remains above 10%.
The number one and overriding issue is that the imposition of the contract last year meant a 7-8% real terms cut in funding for the service last year, and means a similar cut this year (because of the difference between the rate of inflation and the agreed rise to the core contract).
The agreed NHS pay rise this year was 4.5%-9.3%, depending on your starting salary. The little over 2% that was provided to general practice does not cover this kind of rise. So it is not just GP partners it is all practice staff who are suffering as a result of the refusal of NHS England to negotiate a reasonable level of uplift.
I am sure the counter argument will have been that additional funding beyond the increase to the core contract has been provided via the PCN DES. But practices know better than anyone else that PCN funding does not pay the staff, or any of the other eye-watering practice bills that are dropping through the surgery door.
General practice cannot survive this year on year cut in funding levels. All the discussion about access is just noise, obscuring this core issue. General practice is agile and nimble and can manage the access changes. There are plenty of solutions out there (e.g. here). The bigger risk is that the access issue, for which general practice will have little or no public support, is allowed to obscure the lack of funding to meet inflation issue, for which support is likely to be much greater.
It is up to the BMA team and national GP leaders to keep the issue focussed on the money, and away from discussions about access. Losing sight of this is the biggest error general practice could make right now.
A lesson for general practice must also be that 5 year deals have to become a thing of the past. NHS England have demonstrated quite clearly that they cannot be trusted with the level of variables that 5 years creates. A trustworthy contract partner would have recognised the discrepancy between predicted and actual inflation and made good on the gap. Now we know this won’t happen all future deals need to be kept short term.
We wait to see how the GPC and national GP leaders encourage the service to respond to the imposition of next year’s contract. I don’t think the same quiet acceptance that we saw last year is likely this time round. A key part of getting the response right will be making sure that whatever it is it is clear, simple to understand and focussed on the cut in funding.
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