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The Royal College of GPs is concerned that NHS England’s changes to the GP contract for 2023/24 could worsen the “intense pressures” GPs are facing if additional resources are not provided.
The RCGP says the new contract increases the demands placed on general practice by asking GPs and their teams “to do significantly more without sufficient resource.”
Dr Kieran Sharrock, acting chair of GPC England at the BMA, said the contract is “the result of a failure to listen to what GPs actually need, and totally ignores the calls for any extra support to help practices meet the rising costs of keeping their doors open.
“Despite warnings from GPC England, it also introduces more bureaucracy and arbitrary targets that only set practices up to fail and take GPs away from direct patient care,” he added.
What is changing in the new GP contract?
The new GP contract introduces various changes, including adjustments to how services are accessed, how practices are judged on their delivery and quality of care and increased flexibility of Additional Roles Reimbursement scheme (ARRS).
NHS England says the goal of the new contract is to improve patient experience and satisfaction. The health service says it recognises that this will require both time and support to access, review and implement changes.
Access
The contract states that patients should be offered an assessment of need, or signposted to an appropriate service at first contact with their practice. Practices will therefore no longer be able to request that patients contact the practice at a later time.
The NHS will also make it easier for patients to access their health information online without having to contact their practice by ensuring that new health information is available to all patients.
Targets
Certain targets have also been reduced, and the NHS says primacy care networks will now focus on a small number of key national priorities: two indicators related to flu vaccinations, learning disability health checks, early cancer diagnosis and two-week access indicator. The NHS says this should free up time for practices and help to improve waiting times.
Patients should also be able to contact their GP and receive a response with an assessment and/or be seen within the ‘appropriate period’ (for example same day or within 2 weeks where appropriate, depending on urgency).
NHS England says this year’s Quality and Outcomes Framework (QOF) will be reduced by 74 to 55, and will instead focus on workforce wellbeing and optimising demand and capacity in general practice. Two new cholesterol indicators will also be added along with a new overarching mental health indicator.
Additional Roles Reimbursement scheme
To support PCNs to recruit the teams that they need, NHS England has made a number of changes to the ARRS, including adding Advanced Clinical Practitioner Nurses to the reimbursable roles, increasing the cap on Advanced Practitioners to three per PCN and removing the caps on Mental Health Practitioners.
Infrastructure must be improved
Professor Aruna Garcea, chair of the Primary Care Network’s advisory group at the NHS Confederation said: “There is a lot to welcome in the new GP Contract, including the significant reduction in national targets via the stripped back QOF and IIF indicators, the greater flexibilities around recruitment, and the pause in DES requirements.”
However, Prof Garcea highlights that more will need to be done to deliver real and long-lasting benefit to patients and staff, including managing patients’ expectations and analysing the barriers to why some primary care networks and practices may have been slower than others to adopt these systems.
She says that one in five premises in primary care are not fit for purpose, and these practices will struggle to work as efficiently as those which are well-equipped.
Addressing GP staffing shortfall must be a priority
Professor Hawthorne of the RCGP has echoed this sentiment, saying that the funding flexibilities outlined in the new contract “do not go far enough”.
With thousands of GPs considering leaving the profession, the RCGP warns that imposing this contract before staffing levels are restored could “worsen the situation”.
“We need support – not further demand without it. This is why we need to see a bold new plan to increase the GP workforce beyond the 6,000 more GPs the Government promised in its election manifesto, alongside more investment in our services, including our IT systems and premises, and further efforts to cut bureaucracy to allow us more time with patients,” she said.
Dr Sharrok says “ramping up” GP workload without additional support will lead to more GPs leaving the profession, and the BMA will now look to enter “serious discussions” with their members and the wider profession about what action we take next.
“This is not the contract our profession or patients need or deserve. Staff will be incredibly worried about how their practices can now possibly survive. The Government must surely understand the link between ignoring the profession and the fact that we’ve now lost the equivalent of more than 2,000 full-time, fully qualified GPs in England,” he said.