NHS England and NHS Improvement has set out plans for changes to the 2022–2023 GP contract, which the BMA says devalues their goodwill

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The BMA said it was ‘bitterly disappointed’ with proposed changes to the GP contract in England, which it said failed to address current pressures on the service.

In a letter to all GP practices and primary care network clinical directors, dated 1 March, NHS England and NHS Improvement set out plans for 2022–2023, which include changes to both the GP contract and the network contract.

Among them is a requirement for GPs in primary care networks (PCNs) to offer services from 9.00–17.00 on Saturdays, as well as an ‘enhanced access period’ of 18.30–20.00 on weekday evenings.

Services offered outside core hours must include the full multidisciplinary team, and a range of general practice services, such as screening, vaccinations, and health checks.

The letter said: ‘PCNs will be able to provide a proportion of Enhanced Access outside of these hours, for example early morning or on a Sunday, where this is in line with patient need locally and it is agreed with the commissioner.’

The arrangements ‘aim to remove variability across the country and improve patient understanding of the service’, NHS England said.

NHS England said it was committed to honouring the 5-year settlement, but that its ‘default position’ was to roll over the existing 5-year general medical services contract at the end of 2023–2024 unless changes were agreed.

It said nationally guaranteed entitlements in the settlement meant significant real terms growth in overall investment for general practice.

General practice ‘needs an emergency rescue package’

Dr Farah Jameel, BMA England GP Committee Chair, said what general practice needed was ‘an emergency rescue package’, and warned that ‘waiting lists currently seen across the NHS are now going to become more of a reality in general practice’.

She said that GPs and practice staff would regard the proposed changes as ‘devaluing their goodwill and demolishing their spirit’.

Negotiations between the two sides on future amendments to the framework began in January, with the BMA proposing a funded pandemic recovery plan. It also called for extra money to cover increased employer national insurance contributions that come into effect in April, and rising inflation.

Among other proposals, the doctors’ union said primary care networks should be given flexibility to hire professionals on a local basis, rather than be bound by prescriptive job roles.

Talks reached a stalemate last month, although BMA representatives had since held a meeting with England’s Health Secretary, Sajid Javid, to try to make progress.

Surprise announcement

However, the BMA was taken by surprise by NHS England’s letter setting out amendments which the union said it did not agree with or endorse.

Among other changes announced by NHS England are:

  • the existing contractual requirement that at least 25% of appointments are available for online booking is ‘too crude’ and will be replaced with a more targeted requirement that all appointments which do not require triage are able to be booked online, as well as in person, or via the telephone
  • limited expansion of the cardiovascular disease prevention and diagnosis service
  • the early cancer diagnosis service would be ‘streamlined and refocussed’
  • changes to vaccinations and immunisations in 2022–2023, reflecting forthcoming changes to the routine vaccination schedule, including for human papillomavirus infection, measles, mumps, and rubella, and MenACWY. 

NHS England said it was committed to discussing any proposals for future changes with the BMA’s England GP Committee.

Dr Jameel said: ‘Despite our best efforts to outline a number of positive and constructive solutions that would make a difference to practices’ ability to improve care for patients, NHS England has instead decided to follow a path laid out 3 years ago, long before the arrival of COVID-19, and roll over a contract that fails to address the current pressures faced by general practice.

‘Failing to offer practices something as simple as reimbursement to cover additional costs for national insurance contributions means they are losing funding that should be going towards looking after patients.

‘Therefore, a tax aimed at funding the NHS has become a tax on the NHS itself.’

This article originally appeared on Medscape, part of the Medscape Professional Network.

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