I have been surprised by the relatively limited reaction there has been in many quarters to the government’s announcement that it will no longer be negotiating the GP contract solely with the GPC.  I can only see the consequences of such a move as being deeply damaging for GP practices.

It has been made claimed that the GPC has acted unreasonably and it is as a result of this the government wants to “widen the consultation” on the GP contract.  Secretary of State Wes Streeting wrote to all practices and made a personal attack on GPC Chair Dr Katie Bramall-Stainer, claiming her actions were “deeply unprofessional and unbecoming of a professional representative body”.

Has this incarnation of the GPC acted unreasonably?  While the government find it easy to forget, practices will recall that Dr Bramall-Stainer inherited a position of multiple years of imposed contracts at below inflation levels of funding.  Despite the financial challenge the new government then created for practices with the huge employer NI contribution and the 4% pay awards for staff, she managed to get agreement from the profession to a contract that was only just about acceptable and did little if anything to address the underfunding of the previous years.

There was even talk of a vote of no confidence in her at the LMC conference in September, although happily this never materialised, but it shows the tightrope she is having to walk.  The government’s refusal to put in place the promised safeguards before insisting upon online access throughout core hours was a step too far for the profession, hence the response.

The GPC has not acted unreasonably.  On the contrary, it has worked hard to try and find agreements in what are undoubtedly extremely testing circumstances for practices.  So if the GPC is not being unreasonable, what is the problem?

The origins of the current issue can be traced back to a period before this government.  After Covid and the departure of Nikki Kanani there was a marked shift in approach by NHS England towards general practice.  This shift was away from working in partnership and towards using the contract as a tool by which to control the profession and make it comply with national wishes.

At first the contract agreed in 2019 was used as a mechanism to ensure real terms funding cuts were endured by general practice.  Starting in 2022 NHS England simply refused to agree any uplifts despite inflation running as high as 10% and instead imposed a contract agreed when inflation was 2%. Emboldened by the success of this approach, NHS England has since used the contract as a lever to enforce changes to access to practices.

In 2023 the (then Conservative) government took the highly unusual step of laying legislation before parliament to change the core GMS contract, stipulating how practices need to respond to contacts made by patients, most likely on the advice of NHS England.  This year they included the requirement of practices to open online access during core hours in the contract, something they are adamant they will not back down on.

The GPC has no choice but to push back against this increasingly directive and contractual approach.  If it did not, it would not be doing its job.  This is not the GPC being unreasonable.  It is the profession refusing to be bullied.

The response of the government is that it will no longer solely consult with the GPC (it is noteworthy that the government no longer “negotiates” contracts, but instead “consults” on them).  It will now also consult with the RCGP, the National Association of Primary Care (NAPC), Healthwatch England, National Voices and the NHS Confederation.

The contract changes that will be proposed will almost certainly be unpalatable to practices, and therefore to the GPC.  However, the government and NHS England will be able to gain more support for these changes by seeking feedback from a wider range of stakeholders, the majority of whom will not directly suffer as a result of the proposals.

There is no doubt in my mind that this move is extremely bad for general practice.  It is a deliberate misdirection by NHS England and the government to claim that this is a result of the behaviour of the GPC.  It is not.  It is a move to continue the move towards more contractual control and to establish even more radical changes into the contract, by weakening the ability of the profession to prevent or even ameliorate them.