The BMA says that its recommendations are intended to ‘enable practices to prioritise safe patient care’, stating that ‘our first duty is to our patients’

Doctors meeting

The British Medical Association (BMA) has advised GPs to consider opting out of the Primary Care Network (PCN) Directed Enhanced Service (DES) over concerns that forthcoming changes to the GP contract for 2022/2023 will prevent them from being able to provide safe care to their patients.

The updates to the 2022/2023 GP contract include changes to the core contract and the Network Contract DES. Published on 1 March 2022, the NHS England 2022/2023 PCN requirements state that practices must open from 9.00–17.00 on Saturdays from October, offering a range of general practice services ‘in line with patient need.’  

In response, the BMA has said that the new PCN requirements were published without agreement from the BMA England GP Committee, and do not provide sufficient opportunity to address the challenges faced by the GP workforce via contractual means.

Unprecendented pressure

The BMA states that general practice is currently under ‘unprecedented pressure’, facing increasing patient demand and a backlog of care created by the COVID-19 pandemic with a workforce that is ‘shrinking and exhausted.’ 

According to the update guidance, ‘Despite there being 1608 fewer fully qualified full-time equivalent GPs today than there were in 2015, each practice has on average 2222 more patients than they did then … Fewer GPs providing care for more patients increases the risk of harm and suboptimal care through decision fatigue, as well as risking harm to the GP through burnout, and psychological injury.’ 

The new PCN requirements add to the burden on general practice, the BMA says, by ‘asking PCNs to deliver greater requirements than previously.’

The BMA updated Safe working in general practice in response to these challenges, ‘to preserve safe care for patients, and to protect the health and wellbeing of the existing general practice workforce.’

System changes

The updated guidance states: ‘At a time of unprecedented pressure and workload, with a shrinking workforce, we must undertake system changes within our practices (within the constraints of the present GMS contract), to preserve patient care.’

The BMA recommends that practices should take action to protect their staff and patients. Therefore, practices that consider that they are only able to provide safe care to their existing patients with their current workforce are advised to consider closing their list to new patients. The guidance states: ‘There is a clear protocol for undertaking this action. Practices should initially consult with their patient participation group … and subsequently with their clinical commissioning group (CCG). Once closure is granted, assignments to the patient list will cease for a period of time not to exceed 12 months.’

Practices are advised to consider prioritising areas of non-core work that provide safest and most effective patient care, and deprioritising those that either do not provide direct patient care or are underfunded to provide care efficiently. The guidance also advocates ensuring that appointment times are long enough to provide good-quality care, that staff are able to take adequate breaks, and that the full extent of GP’s workloads is documented—at present, NHS England measures GP workload based on appointment data, which ‘gives an incomplete picture of GP activity, and fails to reflect the huge number of non-appointment patient contacts.’

Finally, practices are asked to consider whether ‘the requirements of the DES [outweigh] the benefit brought by the investment into practices and ARRS staff.’  The guidance states: ‘Practices will need to consider if the PCN DES enables them to offer safe and effective patient care within the context of their wider practice, and their present workforce.’ 

There is a process by which, between 1 April and 30 April 2022, practices can express to their CCG that they no longer choose to continue within the DES.

Impact on patients

The BMA acknowledges that some decisions made by practices may impact patients: ‘It may be the case that some patients regrettably have to wait longer to access GP care for their non-urgent problems, or are directed to another more appropriate provider.’

However, the BMA says that its recommendations are intended to ‘enable practices to prioritise safe patient care’, stating that ‘our first duty is to our patients.’


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