General practice is used to uncertainty when it comes to what will be in the contract for the following year, but this year feels worse than any previous year that I can remember.  What is driving this uncertainty, and when might it be resolved?

There are three main drivers of the uncertainty.  The first is the government and NHS England taking such an aggressive stance towards the profession.  This is demonstrated perfectly by the unilateral decision they have taken this year to end the historic process of negotiating the contract with the profession (which it did through the GPC) and instead deciding right at the outset to impose the contract.

While the government and NHS England my dress this up as “consulting with a wider range of partners”, this is a move to a contract imposition from a contract negotiation.  This loss of the normal checks and balances that the negotiation can bring to changes that are being sought (which unfortunately consultation with a wider group of partners will not deliver), is rightly a source of huge nervousness across the profession.  Why would the government and NHS England take such an action unless it was planning changes that would most likely be unpalatable?

The second source of uncertainty is the review of the Carr Hill formula.  The government announced this review back in October but took the step of explicitly excluding the GPC, and therefore any legitimate profession representation, from the review.

Papers published just before Christmas did at least highlight the need for a transitional approach to be taken in any changes that are made to the formula because of the inevitability of creating winners and losers.  However, of greater concern was the requirement made that, “the review should also consider keeping a greater share outside the main contract and using it to directly incentivise staff participation and support enhanced services in the most challenged areas”.

So the outcomes of the review, which are due in the next couple of months, will almost certainly mean some practices will lose a chunk of their core funding, and/or that the core contract will be reduced and locally driven funding schemes implemented instead.  This only serves to increase practice anxiety over future funding.

The third source of uncertainty are the promised new neighbourhood contracts.  These were first touted way back in July in the 10 year health plan.  Then the medium term planning guidance published at the end of October promised details of these new contracts under the very flowery banner of a “systems archetypes blueprint” to come in November.

But of course, we are still waiting.  Nothing has come out since.  Rumours swirl as to what will and will not be included in these contracts, and who will and will not be able to hold them.  The very notion of shifting from “GP contracts” to “neighbourhood contracts” is in itself disconcerting, and the idea that the Chair of the GPC said had been floated that all enhanced services including the PCN DES could be included in these contracts is even more so.

So it is little wonder that practices are feeling more anxious about the future than ever before.  The only potential positive for next year is that we are already moving towards the end of January.  It now seems highly unlikely that any seismic changes will be introduced in 2026/27, as it is feeling too late for that to begin.  The government and NHS England also seem to be prioritising access over neighbourhoods at present, so next year’s contract is unlikely to be that radical.

However, the prospect of major change remains firmly on the horizon.  Eventually we will find out more concrete detail about what is actually being planned for the future, but this uncertainty is likely to continue for quite some time yet.