Female GP with patient 24887 Female GP with patient 24887

Disputing the 2024/25 GP contract changes

GP contractors/partners in England have strongly rejected changes to our contracts and we are now in dispute with the NHS. Vote YES in the non-statutory ballot to support action to protect your patients and practice.

GPC England non-statutory ballot – VOTE YES

The ballot is now open and will close on 29 July. To ensure you have a say you must:

  • be a GP contractor/partner member of the BMA. Non-members can join now for 3-months free membership 
  • update your personal and place of work details for all your roles – login in to update your details

Read our full guidance on taking part in the ballot here.

 

We need all GP contractors/partners to vote YES to send a message to the Government that we are ready to stand up for a better service for our patients, and to protect our practices.

 

The ballot is taking place online and eligible members will receive an email from [email protected]. Your link to vote is unique and should not be forwarded as it can only be used once.

Protect your patients, protect your GP practice



What will action by GPs look like?

If our ballot is successful, we will be inviting GP contactors/partner BMA members to talk things through with their practice teams and, working in liaison with their LMC, determine the actions they will be willing to take. Each of these actions is outlined below in our GP practice survival toolkit.

GP practice survival toolkit

PCN DES 24/25 CAIP

1. Practices should defer signing declarations of completion for “better digital telephony” and “simpler online requests” until further GPC England guidance in by 2025

  •  Better digital telephony: Practices who have not declared or received monies need not agree to share call volume metrics before October 2024.   
  • ‘Simpler online requests: Practices who have not declared or agreed to share data as part of the “online consultation systems in general practice” publication, nor received monies, may continue to switch off their online triage tool during core hours, when they have reached their maximum capacity.

Read our guidance on this.

Data sharing

2. Switch off GPConnect functionality which permits the entry of coding into the GP clinical record by third-party providers. Read our guidance on GP data sharing and GP data controllership.

3. Withdraw permission for data sharing agreements which exclusively use data for secondary purposes (i.e. not direct care).

4. Freeze sign-up to any new data sharing agreements or local system data sharing platforms.

Safety first

5. Limit daily patient contacts per clinician to the UEMO recommended safe maximum of 25. Divert patients to local urgent care settings once daily maximum capacity has been reached.

6. Stop engaging with the e-Referral Advice & Guidance pathway.

7. Serve notice on any voluntary services currently undertaken which plug local commissioning gaps.

8. See patients face to face as a default, unless there is a compelling reason not to do so.

9. Switch off Medicines Optimisation Software embedded by the local ICB for the purposes of system financial savings and/or rationing, rather than the clinical benefit of your patients.

Stopping actions

10. Stop rationing referrals. Refer your patient for specialist care when it is clinically appropriate to do so, via eRS.

Outside of 2WW, write a professional referral letter where this is preferable to using a local referral form.

11. Stop rationing investigations. Refer your patient for specialist diagnostic investigations when it is clinically appropriate to do so.

12. Stop unsafe risk-holding to protect the system over the patient. Admit your patient to the local Emergency Department when it is clinically appropriate to do so via a written referral letter to the admitting team.

GPC England is not recommending which action(s) practices take. It is for each practice to pick and choose as they see fit. You may decide to add to your choices over the days, weeks, and months ahead. This is a marathon, not a sprint.

Some of these actions can be permanent changes – professional, collective and a single opportunity to embrace sustainable and safe change. Others may de de-escalated following negotiations with the new Government.

You can also download campaign materials to display to patients here.

Our asks of Government will be summarised in our 'Vision, Safety, Stability & Hope: How to Rebuild General Practice' document being launched at the BMA House Roadshow on Thursday 18 July.

What happens after the ballot?

The outcome of this ballot will inform our collective next steps. If the majority of members vote in favour of collective actions, the BMA will direct practices to choose one or more suggested actions from the menu listed on this page above from 1 August 2024. Please note, this menu of suggested actions is subject to revision prior to that.

In the meantime, members are strongly encouraged to review the BMA advice and guidance – available here, discuss within your practice teams and start implementing measures to improve the safety of patient care and staff working conditions.

What could phase two look like?

We hope we never get there, and the new Government listens to our reasonable proposals, but, if we do, this could involve escalation to contract breach actions, e.g. action short of strike and strike action. This may include salaried GPs, registrar GPs and or other practice staff. GPs who exclusively locum are unlikely to be directed to breach their subcontracts, so the only action they can lawfully take is to refuse to take on new work, which would leave them without any income.

Will this potentially result in a breach notice to my practice?

GPC England is not currently calling on GP contractors / partners to take any action that will place GP contractors in breach of their contract. Therefore, GPCE does not expect participating practices to be issued with breach notices.

This is instead an opportunity for a collective professional reset, to draw a line in the sand and say 'no more'. It's not a strike, it's not a crash diet - this is more a lifestyle modification. It's going to continue this way; it's not just for the summer. It is until the next Government comes to the table and agrees a new contract that is safe for GP partners, their practices, and their patients.

What is collective action in this context?

When GPC England refers to collective action it means concerted action taken together by GP contractors / partners, which does not breach their contracts, to apply pressure to the Government to negotiate positive change to the GP contract.

Guidance on the imposed contract changes

The BMA GPCE has published advice and guidance to help you consider how best to approach the contract changes.

Why action by GPs is necessary

This is our one and only opportunity to come together as a profession to protect sustainable NHS GP services for our patients.

The Wilson Government heralded the 1965 Family Doctor Charter. We need a 2025 Family Doctor Charter fit for the following decades with a commitment to build up to a floor of 15% of NHS expenditure focused on the provision of excellent primary medical services to restore general practice as the jewel in the NHS crown and protect services, patient confidence, and NHS productivity.

Our aim is to get the Government back around the table to negotiate in good faith with GPC England. We want to deliver a new contract for the profession across England that provides the investment needed to transform, rebuild, and reinvigorate general practice. We need to fix our contract, not the model.

GP ballot roadshows

Over the course of the six-week ballot the GPC England team is appearing at over 20 face-to-face roadshows hosted by regional LMC leaders, as well as webinars, across England. The purpose of this series of roadshows is to ensure that all members of the practice team:

  • understand the ballot, the action and discuss and debate which actions your practice will choose to take with your peers from 1 August
  • have an opportunity to hear about both the profession-facing and public-facing GP campaigns
  • can pick-up free BMA GP member resources and campaign materials to support practice industrial action from 1 August and support PPG and patient conversations
  • hear more about the BMA’s 3-month free membership offer.

 

Background to the GP contract dispute

The ballot and the referendum

Following March’s unequivocal referendum result where 99.2% of BMA members returned a resounding vote AGAINST the 2024/25 GMS contract, we are now in dispute with NHS England. The responsibility to deliver the GMS contract is held by the partner(s) of the GP Practices, who are not NHS employees, but independent contractors to the NHS. Unlike other NHS employees in other branches of practice such as junior doctors and consultants, GP Partners are not subject to TULRCA. Therefore, the decision to hold a ballot is not statutory, but indicative. It is a means of gathering momentum ahead of organised collective action which will commence from 1 August where the BMA GPC England is asking members to vote YES to Protect Your Practice, Protect Your Patients.

Action by GPs

This will not be strike action. Services will not be withdrawn in this initial phase of the campaign, and contracts will not be breached – but the impact on NHS England and ICB budgets will be felt keenly. England general practice currently receives 7p in every NHS pound, and an average GMS sum of £107.57 per registered patient per annum. CPI erosion to the GMS contract since 2018/19 is worth £659 million – 6.6%. It is hardly surprising that over 1,300 practices have either closed or merged in the past decade.

GPC England wrote to ICBs in April to request that systems add GP action to their risk registers to prepare to mitigate any such potential impact. Government, NHS England and the DHSC have known this would be the consequence of a third consecutive contract imposition for over a year. Each have had repeated opportunities to come to the table in good faith to negotiate a reasonable agreement which would see a stop to practice closures, and GP unemployment – but our pleas have fallen on deaf ears.

Practices facing shortfalls

The outgoing Government committed to honouring the 2024/25 DDRB uplift in July 2024, but NHS England and the Department of Health and Social Care only provided a 1.9% uplift in the interim in April 2024 – a real-terms cut in funding. The BMA DDRB Swingometer shows that even if the newly elected Government were to more than quadruple such an offer, which the BMA thinks highly unlikely, practices will still be facing a shortfall compared with 2018/19.

Pressures in general practice data analysis

The BMA monitors data on GP workforce, working patterns, and appointment numbers, which illustrates the growing pressures on general practice.

View our recent data analysis
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