Launch of BMA GP Safe Working Guidance Handbook
Following the overwhelming YES vote in our ballot over the summer, practices are starting to take action as part of our ‘Protect your Patients and Protect your Practice‘ campaign.
GPC England have published a ‘Safe working guidance’ handbook to help GPs and practices in the delivery of safe, high-quality care for their patients and communities. The profession wants to provide care without risking harm to others or ourselves.
At a time of unprecedented pressures, we must make changes to our workload to preserve patient care in the face of a shrinking workforce and rising demand. This will help to protect the sustainability and future of general practice.
We recommend you do this by focusing on the delivery of General Medical Services, in line with the needs of your patients and practice, and deprioritising work and activities that fall outside of your core contractual requirements. This guidance reflects the contractual changes imposed by NHS England in April 2024. We offer ways of doing this that still enable you to stay within the terms of your GMS/PMS.
The guidance outlines how to manage workload effectively, setting safe limits of 25 patient consultations per day in line with UEMO recommendations, and encouraging practices to adopt systems that protect both patients and staff.
The BMA handbook can be downloaded and saved from the website: www.bma.org.uk/GPsSafeWorking.
Further guidance and resources such webinars and FAQs can also be accessed, with patient information posters and social media graphics to download and share.
We cannot care for our patients if we do not care for ourselves and our colleagues.
Manage workload to protect your patients and protect your practice.
Practice Finance Survey – DEADLINE MIDDAY 17 SEPTEMBER
We are inviting practices in England to complete our Practice Finance survey, to build evidence for us to support the annual contract negotiations. This is your opportunity to feed into an evidence base demonstrating the impact of inflation and rising cost over the last couple of years, on GP practices.
Please share the survey link with your practice manager colleagues so that they can complete the survey. The survey will close at 9am, Tuesday 17 September.
We recommend that respondents have relevant information to hand before starting the survey: they will need GP practice accounts for 2022/23 and 2023/24, expenditure data for April 2023 and April 2024, and information on staff numbers and practice list size. Take the survey
ACTION TO SAVE GENERAL PRACTICE
Following the overwhelming YES vote in our ballot over the summer, practices are starting to take action. Each action is safe, effective, sustainable and clear, and it is up to each practice to choose which actions to take. We would encourage you to find out more about how to take part in the toolkit menu on the BMA website. Your LMC will also provide you with additional advice, tailored to local arrangements.
Visit our GP campaign page for more information about taking part in the campaign, the actions and how to order campaign materials and patient resources.
Please note that most campaign resources are back in stock, with more lanyards being available very soon. If you are ordering for a wider group of people or practices, please make sure you are not double ordering.
Read the guidance for salaried GPs and locum GPs during collective action and the collective action FAQs for GP Registrars
Action tracker survey
We are gathering data on any actions that practices across England are taking, and from 16 September, surveys will be sent monthly. We will share the survey with LMCs to distribute to practices and we will be contacting partner members directly to ask you to input data per practice.
We want to hear about the actions you are doing, or considering so please do reply when you receive the survey during the week commencing 16 September. Responses from practices helps us to monitor how collective action is progressing across the country, supporting our negotiations and work towards a GP contract that is fit for purpose. The data is just for us and will not be shared outside of the BMA.
GPCE view on request for Cloud Based Telephony data
As part of the 2024/25 contract imposed on the profession in April, NHS England (NHSE) have sought directions from the Secretary of State to extract data from our clinical systems on our Cloud Based Telephony (CBT) usage. An email has been sent by NHSE outlining the instructions to comply with this data extraction under section 259 (1) (a) of the Health and Social Care Act 2012, stating:
‘All general practices are therefore mandated to comply with this invitation and approve the collection.’
The legal basis for the collection is explained in the Data Provision Notice, which will enable your call data to be extracted on a monthly basis.
The BMA has taken its own legal advice:
Practices cannot decline the instructions, as doing so will risk breaching their contract.
We have made it clear to NHSE that the data must not be used to performance manage practices or single them out for criticism.
The PCN DES includes three components of the Capacity and Access Improvement Payment (CAIP). This data extraction is the component pertaining to the existing use of CBT and the relevant metrics. GPCE advice is that should a practice fail to sign up ahead of the October 1st deadline, there may be a risk of a breach notice being imposed as well as contravening the Health and Social Care Act 2012.
There is another component which relates to ask No 9 in our collective action campaign. We have significant concerns around online consultation software being available to patients from 08:00-18:30 given practices’ lack of capacity, and their responsibilities for ensuing patient safety.
GPCE advice continues to apply here: CDs and PCNs are advised not to sign this particular declaration presently, but to await further guidance closer to the financial year end.
Read the full update here and if you have any queries, please email us at info.gpc@bma.org.uk
Rollout of the medical examiner system in England
In England, the statutory implementation of the medical examiner system will take place on 9 September 2024. This will mean that independent scrutiny by a medical examiner will become a statutory requirement prior to the registration of all non-coronial deaths from this date. Information from the Department of Health and Social Care is here.
While many are using the medical examiner system, some are not. If you require further information on implementation in your area, please contact your LMC. For more wider information on the medical examiner system please contact the BMA.
Zero tolerance of racism: download our poster
Last month’s racist, Islamophobic and anti-migrant riots were hugely distressing with wide reaching impact felt across healthcare settings and communities. All healthcare workers have a right to work in an environment free from abuse. Patients need to be warned that there will be zero tolerance of racist behaviour with resultant consequences, should this not be respected. We have produced a poster you can print and display in your premises, making it clear that racist abuse will not be tolerated.
You can also contact the BMA for wellbeing and support, and we have guidance for managing discrimination from patients, with clear steps to take when incidents of racist abuse against healthcare staff occur.
GP pension campaign in England
At the end of July, the BMA’s pensions committee launched a campaign to assist GPs in England to get their pension records up to date. There is a step-by-step guide for members to follow, with pre-populated email templates to assist. It is important to ensure that your record is as accurate as possible so you can make appropriate decisions about your pension and the McCloud remedy.
If you have received your 05 and AA statement from NHS Pensions, and your record is not updated to 2022-23, you can check what years are missing from your record by logging into your PCSE Pensions Online account. As the Pensions Online system is updated in sequential order, you will be able to see which type 1 or type 2 form is holding up your record from being up to date. You can then submit the required forms via your online account or through the online form.
If you have submitted all required forms and your record is still not up to date, you should raise a complaint with PCSE. If it not fully resolved within 40 days - follow the escalation process.
Successful RCGP legal challenge in support of disabled doctors
The BMA has won a legal challenge supporting a trainee GP who believed they had been unfairly treated by the RCGP because of its policy on the number of attempts at taking an exam. The BMA supported the doctor to bring judicial review proceedings challenging the lawfulness of the RCGP’s attempts policy, which only allows four attempts at the AKT/RCA exam required to complete GP training. According to the policy, no additional attempts would be granted, even in circumstances where a candidate discovered, after sitting a test, that they had a disability which would have entitled them to “reasonable adjustments”, including additional time for the taking of the test.
BMA sessional GP conference 2024: diversity, opportunity, safety
The BMA sessional GPs conference takes place on 20 September 9:30am - 4:30pm. It's free for members, but non-members can also attend. This event will give you information on topical issues including future models of general practice and establishing professional relationships with new clinical roles such as ARRS staff and PAs. Breakout groups will provide practical advice and guidance on a choice of topics in smaller groups. Check out all the details of the day and register your place
Conference of England LMCs 2024
The Conference of England LMCs 2024 will be held on Friday 22 November at Friend’s House, 173-177 Euston Road, London SW1 2BJ. The deadline to submit motions is noon, Wednesday 11 September 2024. The motions should be submitteed via the BMA website using this link (further instructions were sent on 10 July). The deadline for registration is noon Friday 1 November. Register here
Reviewing LMC Listserver
We are reviewing the LMC listserver to ensure that only current and relevant officers of LMCs are registered on it. We would be grateful if you could let us know who should be on the listserver on behalf of your LMC, eg office email and/or medical secretary, name, role, email address, to kday@bma.org.uk by 30 September 2024. Those that are on the listserver but not on your lists will be removed.
Read more about the work of GPC Englend and practical guidance for GP practices.
See the latest update on X @BMA_GP and read about BMA in the media.
Contact us: info.GPC@bma.org.uk
Read the latest GPCE bulletin: Safe working guidance handbook launch | practice finance survey | taking action to save general practice
Practices taking action
Following the overwhelming YES vote in our ballot practices are beginning to take action – the range of actions are all detailed on the toolkit menu on the BMA website. Each action is safe, effective, sustainable and clear, and it is up to each practice to choose which actions to take, and when. Your LMC may also provide you with additional advice, tailored to local arrangements.
As LMCs are aware, we are gathering data on any actions that practices across England are taking, so we can measure the impact of collective action. This crucial information will help inform our discussions and negotiations with NHS England, encouraging them to do the right thing for patients in protecting general practice, as well as support the new Government in delivering on the commitments in their election manifesto.
Surveys will be sent weekly on Mondays, with a deadline of 5pm on Sunday for practices to complete. These surveys should be completed by only one member of staff per practice.
Please look out for the weekly messages from your LMCs about completing the action tracker return. These insights are vital to the overall campaign and securing the profession’s objectives.
If you haven’t received a copy of the survey to disseminate, or if you have any questions, please email info.lmcqueries@bma.org.uk. Thank you in advance for your support with this.
Read our GP campaign page for more information about the actions you can take and how to order campaign materials and patient leaflet. There is also a patient-facing animation, complete with additional subtitles that can be activated for screen reading.
Read also the guidance for salaried GPs and locum GPs during collective action
Data Request for Cloud Based Telephony Statistics
You will have received in your practice a request to share telephony data due to a Data Provision Notice. This email will have been sent to the main practice contact registered with the CQC. We have received additional documentation and messaging from NHSE on this issue. David Wrigley and Mark Coley met NHSE yesterday on the topic. We were given 24hrs notice of the data request and documentation associated with it.
We are now analysing the information we have been sent and will issue a further update with more information. At the present time we would ask that you defer making a decision this week and await further communication from us.
Practice Finance Survey – Summer 2024
We are inviting practices in England to complete our Practice Finance survey. The aim is to build evidence for the GPC England team to support the annual contract negotiations.
We appreciate how hard the past few months have been for GP contractors and their managers. This is your opportunity to feed into an evidence base demonstrating the impact of inflation and rising costs, over the last couple of years, on GP practices across England.
Please send the survey link to your practice manager, so that they can complete the survey. The survey will be close at 9am, Tuesday 17 September.
We recommend that respondents have relevant information to hand before starting the survey: they will need GP practice accounts for 2022/23 and 2023/24, expenditure data for April 2023 and April 2024, and information on staff numbers and practice list size.
Take the survey: https://www.research.net/r/H9CYXCP
2024/25 practice funding increase for pay uplifts - Implications for General Practice
NHS England and the Department of Health and Social Care have finalised how the national practice contract baseline funding – ‘Global Sum’ – will be uplifted for 2024/25 following the DDRB’s recommendation for a 6% uplift to the pay element of contracts (GP contractors / partners) and the salaried GP pay range. For more details, read the letter from Dr Julius Parker, GPCE Deputy Chair.
DHSC announcement to expand the ARR Scheme to include GPs
GPC England, Sessional GPs Committee and GP Registrars Committee have written a letter to the Secretary of State for Health, Wes Streeting, about our concerns over the DHSC announcement to expand the Additional Roles Reimbursement Scheme (ARRS) to include GPs, and how the expansion can be best implemented and possible long-term alternatives.
We expressed concerns that providing this funding at PCN level does not provide GPs and patients with the desperately needed stability required, and instead suggested that it would be far more effective to provide this funding at a practice level, helping to address GP unemployment in the places most severely affected. In the long-term, GP contract funding must be increased so practices have full control over who they recruit to best serve their patients’ needs without the need for additional schemes like ARRS.
GP pressures: latest workforce data
The latest workforce data showed that the NHS had the equivalent of 27,662 fully qualified full-time GPs in July 2024 – a decrease of 8 FTE GPs since the previous month, and 1,702 fewer fully qualified full-time GPs than in September 2015. The number of GP practices in England has decreased by 98 over the past year – reflecting a long-term trend of closures and mergers.
Between September 2015 and June 2023, the NHS had been losing FTE fully qualified GPs at an alarming rate. While some recent gains are positive, they have not been sufficient to make up for historical losses. During this time, there has also been a rise in the number of patients, with July 2024 seeing yet another record-breaking number. GPs are now responsible for about 18% more patients than in 2015, demonstrating ever mounting workload pressures.
See more BMA infographics and data, showing the pressures in general practice >
BMA sessional GP conference 2024: diversity, opportunity, safety
Our conference for sessional GPs is happening at BMA House and online on 20 September. It's free for members, but non-members can also attend. This event will give you information and updates on topical issues including future models of general practice and establishing professional relationships with new clinical roles such as ARRS staff and PAs. Breakout groups will provide practical advice and guidance on a choice of topics in smaller groups. Check out the details of the day and register your place
Clinical academic trainees conference 2024
The BMA’s clinical academic trainees conference is an exciting half-day event on 12 September. It aims to help you make the most of your academic training and develop your career, and provide an opportunity to share experiences with colleagues. Find out more and register >
Conference of England LMCs 2024
The Conference of England LMCs 2024 will be held on Friday 22 November at Friend’s House, 173-177 Euston Road, London SW1 2BJ. The deadline to submit motions is noon, Wednesday 11 September 2024. The motions should be submitteed via the BMA website using this link (further instructions were sent on 10 July). The deadline for registration is noon Friday 1 November. Register here
Reviewing LMC Listserver
We are reviewing the LMC listserver to ensure that only current and relevant officers of LMCs are registered on it. We would be grateful if you could let us know who should be on the listserver on behalf of your LMC, eg office email and/or medical secretary etc – and names, role and email address, to kday@bma.org.uk by end of 30 September 2024. Those that are on the listserver but not on your lists will be removed.
Just a reminder that as the purpose of the listserver is to allow LMC officers to discuss issues of process and strategy, which are often confidential, related to LMCs, only LMC officers should be included on the membership. The GPDF have been made aware and support us carrying out this audit exercise.
Wellbeing resources
A range of wellbeing and support services are available to doctors, from the BMA’s 24/7 confidential counselling and peer support services, NHS practitioner health service and non-medical support services such as Samaritans. The organisation Doctors in Distress also provides mental health support for health workers in the UK, providing confidential peer support group sessions. Please visit the BMA’s wellbeing support services page for more information and resources.
Read more about the work of GPC Englend and practical guidance for GP practices.
See the latest update on X @BMA_GP and read about BMA in the media.
Contact us: info.GPC@bma.org.uk
Read the latest GPCE bulletin: Practices taking action | summer finance survey | DDRB uplift implications
An overwhelming 98.3% of members who voted in our ballot said YES to taking part in one or more suggested actions from the menu within our toolkit. This result clearly shows the united voice of a beleaguered GP profession willing to say – enough is enough. This is the opportunity you have asked for to demonstrate to local health systems and NHS England that we are ready to take a stand and fight for the future of our practices, our profession, and the GP service our patients deserve to receive.
Practices in England can now begin to take action from our menu. We know many practices have been planning and may already know the actions you wish to take. Others may still be considering their options. This must work for your individual practice – do what is right for your individual needs. Each of the actions are safe, effective, sustainable and clear. You can choose to do one or many, and they are each described and detailed on the BMA website. It's up to each practice to choose which actions to take, and when. Your LMC may provide you with additional advice, tailored to local arrangements.
Over the coming weeks, we'll also be gathering data on any actions that practices across England are taking, so we can measure the impact of your collective action. This crucial information will help inform our discussions and negotiations with NHS England, encouraging them to do the right thing for patients in protecting general practice, as well as support the new Government in delivering on the commitments in their election manifesto.
Read our GP campaign page for more information about the actions you can take and how to order campaign materials and patient leaflets, including a patient-facing animation, complete with additional subtitles that can be activated for screen reading.
GPs in England vote yes to take action (youtube.com)
GP Local Action Tracker Survey
We are asking for LMCs’ support in disseminating our weekly local action tracker surveys to the practices. The survey asks which ICB and LMC the respondent is part of, whether their practice is undertaking each type of action, and provides a space for further comment.
The surveys will enable us to identify areas of high and low participation, which can enable us to identify best practice in areas of high participation and obstacles to participation in areas of low participation, along with what support is needed to enable participation by those who wish to participate.
Surveys will be sent weekly on Monday, with a deadline of 5pm on Sunday for practices to complete. These surveys should be completed by only one member of staff per practice.
The data collected will be used to monitor the participation with the different types of action across the country, and as a lobbying tool to demonstrate the level of participation in collective action.
If you haven’t received a copy of the survey to disseminate, or if you have any questions, please email info.lmcqueries@bma.org.uk. Thank you in advance for your support with this.
DDRB announcement
This year’s investment into national GP practice contract funding to support DDRB recommended pay uplifts for 2024/25 is a welcome step forward.
However, the formula that’s used allocates funding per patient for each individual practice, and is based on criteria like the age and sex of patients and where the practice is located. Instead, staff costs should reflect the diverse skill-mix needed to deliver the full range of patient care within each individual practice. Partners will want to reward all their staff for their dedication and commitment, but while some practices may receive enough to pass on a full 6% salary uplift, others won’t, forcing them to make difficult choices about what they can and can’t afford to give hardworking staff.
We have raised these issues repeatedly with DHSC and NHS England. For years, GPs have been expected to do more with less, but practices can’t make insufficient funding stretch any further and staff morale, recruitment and retention is suffering as a result. This inevitably contributes to longer patient waiting times, poorer outcomes and widening health inequalities across England; the very opposite of GPC England’s vision for the future of General Practice.
When we negotiate the new GP contract – which we have publicly stated we expect to do with the new Government in this Parliament - we will seek to devise a better mechanism for allocating annual DDRB uplifts. Investment must be distributed fairly and equitably so that every hard-working staff member gets the annual pay uplift they deserve wherever they work in England. In the meantime, we will continue to work with DHSC and NHSE to develop short, medium and long-term solutions to give patients and practices safety, stability and hope.
ARRS funding scheme expansion
Following the recent announcement from the DHSC and the secretary of state on the temporary inclusion of newly or recently qualified GPs in the ARR Scheme, GPC England provided a joint statement with the Sessional GPs Committee highlighting the potential impact of expanding funding to include GPs, and raising our concerns about the practical implementation of this:
'There are experienced and talented GPs, ready and able to work, but practices can’t afford to hire them so expanding the funding scheme to include GPs shows the Government is keen to find solutions to stabilise general practice. However, we have concerns around how this policy will work in practice, and it’s fundamentally nowhere near enough to save general practice. Because the funding won’t be allocated at a practice level, but instead via Primary Care Networks, this means any GPs employed through this scheme could be forced to move across the country at short notice, uprooting their families in the process, and depriving their patients of continuity of care. This in itself could drive more GPs away from the NHS.
'We’ve shared ideas with the Government for how to best get more unemployed GPs back into the workforce, because there are more flexible and effective ways that this funding could be used to ensure the maximum benefit for patients – for example reimbursing the practices themselves. In the long-term, however, we need to see the core GP contract funding increased so that practices have full control over who they recruit, without the need to go via bolt-on schemes. We will continue to share suggestions with the new government to potentially take forward in 2025/26.'
We continue to call on the new government to listen to the concerns of GPs and to act swiftly to restore and enhance the cornerstone of effective healthcare – our general practitioners.
GPC England’s vision to rebuild general practice
We have published our Vision for General Practice which outlines key short, medium and longer term asks of the new Government framed around safety now, stability for next year’s contract and longer-term hope in negotiating a new substantive contract for general practice in England.
Our vision has been informed by our conversations with thousands of GPs across our roadshows in recent weeks and responding to the manifesto commitments from the new Government where we have an opportunity to repair trust and rebuild general practice.
Not been able to attend a roadshow? See the attached slides or watch a recording
NHSE Potential collective action by GPs: supporting guidance
Many colleagues will have seen this guidance by NHS England on potential collective action by GPs, which is been reviewed by GPC England and an update will be circulated shortly.
PCN Pilots - S96 guidance
Following requests from LMCs and practices GPCE has sought advice on the Section 96 Agreement that is being sent out to practices to sign up to participation in the PCN Test Pilots. This sets out a number of concerns with the proposed Agreement raised following legal consultation.
In line with our recommended list of collective actions, we would strongly urge practice to defer making any decisions to accept local or national NHSE Pilot programmes whilst we explore opportunities with the new Government. Read our guidance.
| Keeping our communities safe from racism and fascism |
| We are horrified by the recent racist and Islamophobic attacks on people, shops and community buildings. The BMA is anti-racist and anti-fascist, and BMA members may need to organise with others to keep our communities safe for colleagues and patients. Employers need to urgently support migrant and ethnic minority staff and students, including those facing racism from patients. Read our guidance on managing discrimination from patients > Read our message and guidance to GPs and GP practices > As always, you can contact the BMA for wellbeing and general support > |
Crowdstrike outage
Following the events of Friday 19 July that saw critical digital services, including in general practice, across the country impacted by the outage. GPC sought and received assurances from the ICO and NHS England that GPs would not be required to report the availability breach to the ICO created by the outage on an individual basis. Instead – NHSE is providing a bulk report to the ICO, allowing them to satisfy their obligations under Article 33 (1) UK GDPR. The ICO confirmed that for those practices that have already reported, they may consider the matter closed with no further action to follow. However, any breaches unrelated to the crowdstrike outage and its impact on EMIS will still need to be reported.
New GPCE guidance on Physician Associates (PAs) working in general practice
We have published guidance to help standardise practice and reduce variation in how physician associates work within a general practice setting. It aims to provide a framework to support physician associates to work safely in general practice, for patients, their employers, and GP supervisors. It has been designed to complement the scope of practice and supervision guidance already published by the BMA and should also be read in conjunction with GPCE’s Focus on MAPs in general practice.
GP pressures - workforce and appointment data
The latest workforce data showed that the NHS had the equivalent of 27,670 fully qualified full-time GPs in June 2024. We have the equivalent of 1,694 fewer fully qualified full time GPs than in September 2015, and the number of GP practices in England has decreased by 90 over the past year.
This fall in both staff numbers and GP practices coincides with a rise in patients: as of June 2024, there was another record-high of 63.40 million patients registered in England – an average of 10,101 patients registered per practice. As a result, each full-time equivalent GP is now responsible for an average of 2,291 patients, which is an increase of 354 patients per GP, or about 18%, since 2015.
The latest appointment data shows that that over 28.6 million standard appointments were booked in June 2024, with an average of 1.43 million appointments per working day. Over the past year, approximately 367.1 million appointments were booked in England.
In terms of access, 44% of appointments in June 2024 were booked to take place on the same day. 44.6% of appointments were delivered by a GP in June 2024, and almost 65% of appointments were booked face to face. See more infographics and data, showing the pressures in general practice >
GPCE LMC drop-in sessions
The GPCE LMC drop-in sessions will be cancelled, but the LMC support network will be in place still to field any questions.
Are your pension records up to date?
The BMA’s Pensions Committee have launched a campaign encouraging you to take action to make sure that your pension records are accurate and up to date, so you can make informed decisions about your pension savings, retirement plans and the McCloud remedy. We are aware that thousands of GPs in England have “missing years” of pensions data due to PCSE’s maladministration of pension records. We have been consistently highlighting the failures of PCSE (run by Capita), and the significant importance of them fixing this issue as soon as possible. Unfortunately, there has not been sufficient progress to resolve this issue, so we are now encouraging you to take action to get your pension records in order.
To support you the Pensions Committee have created detailed guidance including template letters to help you get your records up to date, raise a complaint and escalate further where appropriate.
Guidance on getting your pension record up to date, for GPs in England - YouTube
UK Visa Sponsorship Licences (formerly known as Tier 2)
Does your practice have a visa sponsorship licence? Do you what it is or why you might want one?
This podcast will persuade you to push this up your practice list of priorities as something to have in place! Listen now to find out why. Wessex LMCs joint CEO and GP Dr Laura Edwards talks with a panel around visa sponsorship and how it impacts international graduates particularly around the time of qualification and what actions practices may want to take to help with their recruitment.
Read also the BMA guidance on Visa sponsorship for GP practices
Read more about the work of GPC Englend and practical guidance for GP practices. See the latest update on X @BMA_GP and read about BMA in the media. Contact us: info.GPC@bma.org.uk
Read the latest GPCE bulletins:
Yes to collective action | DDRB announcement | ARRS funding scheme expansion (9 August)
DDRB pay award | our vision for general practice | GP Practice Survival Toolkit (29 July)
Read the Sessional GPs newsletter
STOP PRESS:
BMA House London Roadshow and livestream 18 July
Come along to our roadshow at BMA House next week for the launch of our vision for the future of general practice and to hear more about the ballot and campaign to save general practice.
Thursday 18 July, 19:00-21:00 in BMA House, London. Register here
If you cannot make the event in person then watch it online as this event will also be live streamed
Working with the new government to rebuild general practice in England
GPC England has written to the newly appointed Secretary of State for Health and Social Care, Wes Streeting MP, offering to work together to rebuild general practice in England. We highlighted ‘the enormous frustration at the loss of over 2,000 GP practices over the past 14 years and of over 5,000 “home-grown” GPs whose training has cost taxpayers in the region of £2–3bn. The number of registered patients in England has increased by 6.4 million in the past 5 years alone, the average number of patients per full-time equivalent fully qualified GP has risen by 18% to over 2,300.’
In the letter we suggested that the real issue over access to general practice is patients’ access to their GPs, and as such GPC England has proposed some solutions to hit the ground running when we meet with Mr Streeting:
Read the full letter here
The GP patient survey 2024, published yesterday, also shows that there is a need to focus on general practice, something that the Nuffield Trust agrees on in their response: “Today's results show that if the new government is truly aiming to fix a broken NHS, it must prioritise fixing general practice”.
Read also my response to news that the Government plans to divert significant amounts of funding from hospitals to general practice
If not now, when? GPC England ballot for GP contractors / partners
Our ballot will close on 29 July. The ballot is open to all GP contractors / partners in England, and to vote you must be a BMA member. Tell your GP partners, friends and colleagues to join the BMA today to take advantage of three months free membership. Join by 22 July to be able to take part in the ballot.
Protect Your Patients, Protect Your Practice
Vote YES and use the BMA GP Practice Survival Toolkit
You should have received an email from bma@cesvotes.com. If you haven’t received an email, see more informationhere and if you have any questions, please email: gpcontract@bma.org.uk
Read our GP campaign page for more information about the ballot, contract guidance, and how to order campaign materials such as BMA GP Practice Survival Toolkit cards which fit inside GPs Are On Your Side lanyards, badges, window stickers, and patient leaflets.
As the non-statutory ballot is only open to BMA GP contractors/partner BMA members, we have also created thisform for non-GP partners/contractors to sign and show support for our campaign.
GP contract roadshows
The GPC England officer team is travelling the country in a series of roadshows, hosted by regional LMCs. This is an opportunity to hear about the action practices will be able to take, details about the ballot, expert leading counsel advice, collection of your practice resources, and a chance to discuss and debate with your peers. Our next GP roadshows are:
For those who couldn’t make any of the events there are also two new webinar dates on 23 July 12:30 - 14:00 and 25 July 19:30 - 21:00
The roadshows are free and you don't have to be a BMA member to register. Please encourage all your colleagues to attend, including ALL GPs, GP registrars, practice managers and practice nurses.
See a full list of roadshows and webinars and register here
Safe Working Guidance webinars with the BMA and Practice Manager Association, 16 and 17 July
Protecting your patients, Protecting your practice
The BMA Safe Working Guidance is being refreshed. Join us to find out about the updates and how this can support GPs to manage their workload and protect their patients and practice. This is your opportunity to Protect Your Practice and Protect Your Patients.
Speakers
Dr Samira Anane, GP in Manchester, vice chair of Manchester LMC and deputy chair of GPC England
Denise Smith, practice manager at Merepark Medical Centre in Cheshire, fellow of the PMA
BMA GP Practice Survival Toolkit
We will be inviting GP partners to work with their practice teams and, in liaison with their LMC, to determine the actions they will be willing to take. Each of these actions is outlined in the BMA GP Practice Survival Toolkit.
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. You can read more in the guidance provided or in our FAQs.
Read our contract guidance to help you consider how best to approach the contract changes.
Help spread the word to patients
| We’ve produced a range of materials to help you engage patients in the campaign GPs Are On Your Side: |
| download our MP4 video and show your next PPG meetingdownload and display posters in your surgerysave and share our social graphics for patients. |
Access the patient materials on the GPsOnYourSide Campaign page
GP Connect update
Our position on GP Connect (Update Record function) remains that GPs must retain the ability to restrict access to third parties to update the GP record. It is important to say we do not wish to restrict the use of the GP record for direct patient care. GPs who wish to and have already switched off update record need not make any further changes. Any GPs wishing to turn off the functionality can do so via the steps listed here.
*Save the Date* - Practice Finance Health joint webinar 7 August 12:30-14:00
GPCE - AISMA (Association of Independent Specialist Medical Accountants)
Find out how good practice management makes a difference. Join us to hear about improving practice income and keeping on top of finances. Register here
GP pressures: workforce and appointment data
The latest workforce data showed that the NHS had the equivalent of 27,649 fully qualified full-time GPs. Although this is an increase of 43 FTE GPs since the previous month, we still have 1,715 fewer fully qualified full-time GPs than in September 2015. The number of GP practices in England has decreased by 89 over the past year – reflecting a long-term trend of closures and mergers.
This fall in both staff numbers and GP practices coincides with a rise in patients: as of May 2024, there was another record high of 63.37m patients registered with practices in England – an average of 10,079 patients registered per practice, and each full-time equivalent GP is now responsible for an average of 2,292 patients. This is an increase of 354 patients per GP, or about 18%, since 2015, demonstrating the ever-mounting workload in general practice.
The latest appointment data show that over 30.5m (non-COVID vaccination) appointments were booked in May 2024. The number of COVID-19 vaccination appointments increased from around 247,000 in April to over 285,000 in May. On average there were 1.47m appointments (estimated total count of appointments, including COVID vaccination appointments) per working day in May 2024.
See more BMA infographics and data, showing the pressures in general practice >
Template letter requesting access to a patient’s record
Following some concerns raised, GPCE wrote to the OPG (Office of the Public Guardian), suggesting that under Para 5 (a) of the Mental Capacity Act, the OPG has the right of access to patients’ health records if they are investigating the actions of a deputy or an attorney. However, the OPG letter referenced card 16 of the BMA MCA Toolkit; section 4 of this card confirms the right of access and ‘if GPs can release this information promptly it can help ensure these investigations are completed as quickly as possible’.
We suggested that practices may misunderstand this issue; the BMA MCA toolkit is not saying that the OPG’s list of questions should be answered as soon as possible, but that the relevant health records should be released. Responding to the list of questions posed by the OPG is a private, non-NHS, matter for which a fee can be charged by the GP involved.
The OPG has reviewed the letter templates, which they agree could be viewed as unintentionally misrepresenting OPG’s statutory rights to medical information. As a result, the templates have been edited to clarify that the BMA’s MCA toolkit and the legislation on which this advice is based only apply to medical records and not to any of the accompanying questions. Access the templates here:
IIF and GPAD
We recently wrote to NHS England about practices adversely affected by a significant flaw in the appointments mapping data processing for GP surgeries using the TPP SystmOne clinical system. It appears that although practices accurately mapped appointment slots in line with the indicator, an issue with the data collection/processing software meant that many did not achieve the necessary targets, as during processing for General Practice Appointments Data, the legacy mapping often persisted, rather than utilising the updated mapping by the practice. Some practices have lost significant sums of money; in some cases, running into thousands of pounds.
NHSE has now acknowledged that due to the issues we highlighted, GPAD will not be able to serve as a robust source of achievement data for 2023/24 and the usual route to correcting data locally through the declaration process is likely to require a disproportionate amount of local effort this year, given the unique difficulties in being able to access alternative local appointment data. For this reason, in 2023/24, all PCNs have been considered to have earned 100% of the points available for this indicator.
BMA vs RCGP judicial review hearing: exam attempts policy
BMA lawyers have argued in a two-day hearing this week that the failure to provide additional resits to GP trainees diagnosed with a disability following an unsuccessful examination attempt is discriminatory. Read more about this in this article in The Doctor magazine>
Read more about the work of GPC Englend and practical guidance for GP practices. See the latest update on X @BMA_GP and read about BMA in the media. Contact us: info.GPC@bma.org.uk
Read the latest GPCE bulletin:GP roadshow next week | our message to the new government | vote YES in our ballot
NHSE attempts to remove the ability of GPs as data controllers to amend GP Connect
Originally one of the actions within our GP Practice Survival Toolkit, we are inviting GP partners to follow our guidance and take steps NOW to remove the GP Connect functionality which permits third parties to add codes to GP patient records. We have been alerted to recent communications from NHS England to TPP and EMIS to frustrate this step, and remove GPs’ rights as the data controller to control this, by the start of July. We will be writing urgently to TPP and EMIS to remind them of their legal responsibilities as data processors, but in the meantime advise practices to take action as soon as possible. You can read our guidance regarding the precise action to take here
Covid and Flu vaccination programme
Last week, GPC England wrote to practices to highlight our position on both the COVID vaccination programme, and the seasonal flu programme for 2024/25. Since then, NHS England has also announced a new RSV vaccination schedule from Autumn 2024, which is discussed below.
The COVID-19 programme is being offered by NHSE under a new procurement process which covers the delivery of the Covid-19 vaccination over a two year period between 1 September 2024 and 31 March 2026. You should note the funding arrangements relating to this programme:
These funding arrangements are being unilaterally imposed, despite the evidence and arguments that both GPC England and Community Pharmacy England have made to NHSE regarding the increased complexity, workload and related administrative burden of the Covid vaccination process in comparison to other vaccinations. GPC England has made it clear to NHS England it believes current funding for all vaccination programmes is economically not viable.
Should any practice wish to take part in the programme, it is recommended that as the current offer of £7.54 does not cover the costs incurred, practices should contact their LMC before writing to their ICB to highlight the lack of financial viability to support its delivery. Read more in our guidance
If not now, when? GPC England ballot for GP contractors / partners
Protect Your Patients, Protect Your Practice
Vote YES and use the BMA GP Practice Survival Toolkit
The ballot to Save General Practice is open. Following the third annual contract imposition and with general practice at crisis point, we are holding a non-statutory ballot of GP Partners. Funding for core general practice services has been severely eroded. We’ve lost over 10,000 GPs and over 1,300 practices in a decade while patient numbers increase, and patient dissatisfaction sadly rises.
In the referendum earlier this year almost all of you said a firm NO to the new contract - you were ignored by the Government who have refused to make any improvements or give general practice any more resources.
If not now, when? Tell your partners, friends and colleagues to join the BMA today to take advantage of 3-months free membership. For GP partners to vote in the ballot, they need to have joined by 22 July. www.bma.org.uk/join - spread the word.
| Vote YES to keep the pressure up. Vote YES to protect your practice and to protect your patients. Vote YES to save general practice. |
How to take part in the ballot
The ballot is open to all GP contractors and partners in England and will close on 29 July (to vote you must be a member of the BMA). You should have received an email from bma@cesvotes.com - your link to vote is unique and should not be forwarded as it can only be used once. Support for GP members in England who can’t find or didn’t receive a voting email
If you have any questions, please email: gpcontract@bma.org.uk
Read our GP campaign page for more information about the ballot, contract guidance, and how to order campaign materials such as BMA GP Practice Survival Toolkit cards which fit inside GPs Are On Your Side lanyards, badges, window stickers, and patient leaflets. All can be ordered directly from the BMA Reps Hub or via the GP campaign page.
GP contract Roadshows
Our next GP roadshow is on 10 July in Tunbridge Wells and the next GP roadshow webinar is on 11 July at 7.30pm. You'll hear from GPCE Officers, Dr Katie Bramall-Stainer and Dr Julius Parker, speaking about the GP campaign and the non-statutory ballot for GP contractors/partners. It's free and you don't have to be a BMA member to register - please encourage all your colleagues to attend:
Register for the in-person roadshows across the country and the online webinars here
BMA GP Practice Survival Toolkit
We will be inviting GP Partners to work with their practice teams and, in liaison with their LMC, to determine the actions they will be willing to take. Each of these actions is outlined in the BMA GP Practice Survival Toolkit
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. You can read more about these actions in the guidance provided or in our FAQs.
Read also our 2024/25 contract guidance documents, which now also includes an ‘Advice and Guidance update’, to help you consider how best to approach the contract changes.
Help spread the word to patients
| We’ve produced a range of materials to help you engage patients in the campaign GPs Are On Your Side: |
| download our MP4 video and show your next PPG meetingdownload and display posters in your surgerysave and share our social graphics for patients. Patient materials |
The GPsOnYourSide Campaign page can be shared with patients and the public.
BMA survey shows that over 80% of locum GPs struggle to find work
A recent BMA survey showed that four out of five locum GPs in England want to work more but cannot find suitable positions, despite patients wanting and needing to see GPs, and having to wait weeks for appointments. The survey found that the majority of locum GPs have either made or are expecting to make changes to their work or career plans in the next year, and a third of respondents who are planning for change say the lack of suitable shifts is forcing them to leave the NHS entirely.
In response to this, Dr Katie Bramall-Stainer, GPCE chair, said: “We are in a ridiculous situation where GP practices cannot use government funding to hire GPs. We have made it clear to the government that this needs to change so we can have more GPs working in local practices. In last year’s BMA GP Practice Finance survey more than half of practices reported cashflow challenges that were affecting the day to day running and meant that practices were going without locum cover and partners were trying to cover for each other, to care for their patients, because of the lack resource at practice level.”
Read more here: Over 80% of locum GPs struggle to find work, finds BMA survey
New NHS Vaccination programme against Respiratory Syncytial Virus (RSV)
Following recommendations by the JCVI, two new RSV vaccination programmes will begin from 1 September 2024:
NHSE intend to commission this from General Practice as an Essential Service. This represents a single vaccination. The routine programme means adults become eligible after the age of 75 commencing 1 September 2024, but a catch-up programme will be in place until 31 August 2025.
The programme for pregnant women, designed to create immunity in infants, will commence on 1 September with eligibility after 28 weeks. The antenatal service can be commissioned via a variation to the Trust NHS Standard Contract. Whilst GPCE supports the delivery of this programme via the usual antenatal pathway, opportunistic or on-request GP delivery of antenatal vaccinations will be part of Essential Services, however, as commissioners want General Practice to routinely deliver this service it will need to be commissioned locally.
We have made it clear to NHSE that the current £10.06 IoS fee is not economically viable for practices and should be substantially uplifted. Whilst GPCE advise practices to deliver immunisation programmes included within Essential Services, it strongly recommends carefully reviewing the appropriateness of participating in any other non-core contract programme, if this were to be offered, where a £10.06 IoS fee [or less, such as Covid-19 concurrent with seasonal flu, when the fee is £7.54] is offered.
A new RGV PGD template will be developed by UKHSA, available from the PGD collection here. Detailed clinical guidance on RSV and RSV vaccination is expected imminently within Chapter 27a of the Green Book. Both professional and public facing information materials are available here.
SAVE THE DATE 16 and 17 July: Safe Working Guidance webinars
Following the roadshow feedback, the BMA Safe Working Guidance is being refreshed - join us at these BMA / Practice Manager Association webinars to hear practical examples in how this can support practices in managing their workload. This is your opportunity to Protect Your Patients and Protect Your Practice. Please join with your practice management teams.
Speakers
Dr Samira Anane, GP in Manchester, Vice Chair of Manchester LMC and Deputy Chair of GPC England
Denise Smith, Practice Manager at Merepark Medical Centre in Cheshire, Fellow of the Practice Managers’ Association
Cervical Screening Management System (CSMS)
The CSMS has gone live, replacing the previous Open Exeter call/recall IT system. The CSMS is accessed via an NHS smartcard. All providers are asked to update any internal operating procedures and documentation that supports delivery of cervical screening services, to reflect access to and how CSMS should be used. GP Practices should log on and review the notification section to check:
For any technical support with using or accessing CSMS please visit: CSAS
BMA sessional GPs conference 2024: diversity, opportunity, safety
The next sessional GPs conference will be held on Friday 20 September. The conference will give you updates on topical issues and is a one-day conference specifically for sessional GPs, free for BMA members. Register here
GPC England committee pages and guidance for practices
Read more about the work of GPCE and practical guidance for GP practices. See the latest update on X @BMA_GPand read about BMA in the media. Contact us: info.GPC@bma.org.uk
Read the latest GP bulletin: GP Connect | COVID and flu vaccination programme | vote YES in our ballot
Read the latest Sessional GPs newsletter
GPC England ballot for GP contractors / partners –
Protect Your Practice, Protect Your Patients
Vote YES and use the BMA GP Practice Survival Toolkit
It is now only three days to go until 17 June when the ballot to Save General Practice opens. We are holding this non-statutory ballot because general practice has been deliberately broken. Over 1,300 practices have been lost, and thousands more GPs with them. Funding for essential practice services has eroded to the tune of £660 million and successive sub-inflationary uplifts have threatened practices’ viability. With almost 2,000 fewer FTE GPs compared with a decade ago, and an additional 6.4million patients it is no surprise that patient dissatisfaction has doubled in the past five years.
In the referendum earlier this year almost every single one of you said a firm NO to the new contract and you were ignored by the Government, who have refused to make any improvements or give general practice any more resources.
This ballot is open to all GP contractors and partners in England. If you’re not yet a member you can join the BMA now to ensure you have your vote. And what’s more, any new member joining from 17 June, will get their first 3 months of membership for free: www.bma.org.uk/join
The Ballot Question:
‘Are you prepared to undertake one or more examples of collective action as outlined in the BMA campaign to Protect Your Patients, Protect Your Practice?’
The Ballot Answer
Vote YES to Take Action to Save General Practice.
Vote YES to protect your practice and to protect your patients.
We are not asking you to breach your contact, but we are asking you to take a stand.
The ballot opens 17 June and closes on 29 July ahead of action commencing from Thursday 1 August.
Read our GP campaign page for more information about the ballot, contract guidance, and how to order campaign materials: www.bma.org.uk/gpcontract
What will the menu of actions look like?
We will be inviting GP Partners to work with their practice management team and, working in liaison with their LMC, determine the actions they will be willing to take. Each of these actions is outlined in the BMA GP Practice Survival Toolkit
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.
PCN DES 2024/25 GPC England Guidance on the Capacity and Access Improvement Payment (CAIP)
There are three separate and discrete elements to the CAIP within the 24/25 PCN DES:
GPC England guidance is that practices should defer signing declarations of completion for “better digital telephony” and “simpler online requests” until further GPC England guidance in early 2025.
Read our Focus on guidance
GPC England recommends PCNs do not confirm compliance with the on-line platform CAIP element at this time, because unless the workload associated with a practice’s on-line platform can be controlled, it will not be possible for practices to effectively implement the BMA Safe Working Guidance.
GPC England recommends PCNs do not confirm compliance with better digital telephony CAIP element at this timeas NHS England has signalled its intention to issue a contract variation notice from October 2024 to make the sharing of the eight call data metrics they have identified contractual.
GP Contract guidance and campaign materials
We have now published our 2024/25 contract guidance documents, to help you consider how best to approach the contract changes. These documents cover the following areas:
We have also produced campaign infographics for you to attach to your emails, practice website and socials, as well as PPG and patient-facing resources – all of which are available to download from the BMA website or to be ordered directly BMA Reps Hub.
See the GP campaign page for more information about the ballot and how to order materials.
The GPsOnYourSide Campaign page is for practices to share, should you wish, with patients.
BMA.org.uk/GPsOnYourSide Public-facing campaign
We have produced campaign posters, presentation slides and infographics for you to attach to your emails, practice website and socials, as well as PPG and other patient-facing resources – all of which are available to download from the BMA website
The GPsOnYourSide Campaign page is ready for practices to share with patients and the public.
Campaign materials for GPs and practice teams
GP Survival Toolkit cards to fit inside GPs Are On Your Side lanyards, window stickers, posters, badges and leaflets are now able to be ordered directly from the BMA Reps Hub.
See the GP campaign page for more information about the ballot and how to order materials.
GPC England Officer Team face-to-face contract roadshows
The GPC England officer team are currently travelling the country in a series of over 20 roadshows, hosted by regional LMCs. This is an opportunity to hear face-to-face about the action practices will be able to take, details about the ballot, expert leading counsel advice, collection of your practice resources, and a chance to discuss and debate with your peers.
The roadshow events are taking place across England from now until 24 July and are open to all GP contractors/partners and practice managers, salaried GPs, GP registrars and practice nurses. You do not need to be a BMA member to attend, so please invite your colleagues and ensure there is representation from every practice in your locality.
There are also a number of virtual webinars, which will be open to all.
See the list of events across the country and register here
BMA membership details
It is vital that you keep your BMA membership details up to date so you can vote in our ballot. To vote, we need you to login to www.bma.org.uk and check your details are current and correct. We must have the right information for your vote to count, so please check.
Please look out for an email from bma@cesvotes.com which will allow you to vote.
We need:
Your details MUST be up to date for your vote to count.
In this first ballot, GP contractors / partners need to vote YES to send a message to Government that we are ready to stand up for a better service for our patients, and to protect our practices.
Please check and update your details here BMA - Sign In
Non-members still have time to join in the ballot. Any new member joining from 17 June, will get their first 3 months of membership for free. The latest date to join for the vote to be counted is 22 July. Please encourage your colleagues to join: bma.org.uk/join
Parliamentary Constituency Dashboard
Bedfordshire & Hertfordshire LMC has created a Parliamentary Constituency Dashboard, designed to help GPs and LMCs to present General Practice data to their local Members of Parliament (or Parliamentary Candidates in the upcoming election). Select the region of the country and the constituency from the dropdown menus and you should get all the data from that constituency. Launch the tool here (best viewed on a PC or tablet).
Contraceptive services, formerly an Additional Service funded by an identified 2.4% of Global Sum, have been included as an Essential Service under the Primary Medical Services (GMS/PMS) Contract, since 2020. This includes the treatment of and prescribing for patients for contraceptive services, with the specific exclusion of the “fitting and implanting of intrauterine devices and implants”.
In addition, Para 14(2)1 of the GMS/PMS contract includes a reference to “drugs” including contraceptive as substances and “appliances” as including contraceptive appliances.
GPC England’s advice is therefore that the prescription and administration of contraceptive infections (such as Depo Provera, Sayana Press, and Noristerat) does form part of Essential Services. Reimbursement is available through the Personally Admitted drugs provisions in the Statement of Financial Entitlements and indemnity is available via CNSGP.
Seasonal Flu Immunisation Programme QIVr vaccine
Sanofi has advised that the Recombinant Quadrivalent Influenza vaccine [QIVr] will, due to a supply issue, not be available for the flu vaccination programme for the 2024/25 season.
The original JCVI recommendation was to use QIVr for adults aged 65 years and over, and also adults aged 16 to 64 who are in eligible groups.
In the light of this change, NHS England has advised the following:
| Aged 65 years and over | Aged 18 to 64 years in risk groups |
| adjuvanted quadrivalent influenza vaccine (aQIV) high-dose quadrivalent influenza vaccine (QIV-HD) The cell-based quadrivalent influenza vaccine (QIVc) can also be considered only when every attempt to use aQIV or QIV-HD has been exhausted – evidence of this may be requested by the commissioner before reimbursement is agreed. | Aged 18 to 59 years cell-based quadrivalent influenza vaccine (QIVc) Aged 60 to 64 years cell-based quadrivalent influenza vaccine (QIVc) high-dose quadrivalent influenza vaccine (QIV-HD) The egg-grown quadrivalent influenza vaccine (QIVe) can also be considered only when every attempt to use QIVc, or in the case of those aged 60 -64 years also QIV-HD, has been exhausted – evidence of this may be requested by the commissioner before reimbursement is agreed. |
As QIVr is only licensed for those aged 18 and over, this does not affect the immunisation programme for younger patients. For practices who have ordered QIVr, and who are participating in the 2024/25 immunisation programme, the primary alternative is QIV-HD [high dose quadrivalent influenza vaccine] which is licensed in the UK for those 60 and over. Otherwise, practices may seek to order additional supplies of aQIV [Adjuvanted Quadrivalent Influenza Vaccine] for those aged 65 and over, and QIVc [Cell-based Quadrivalent Influenza Vaccine] for those under 65 years.
NHSE has updated the list of influenza vaccines marketed in the UK
GP Appointment data – April 2024
The latest appointment data shows that that around 30.5 million standard appointments were booked in April 2024, with an average of 1.45 million appointments per working day. Over the past year, approximately 359.6 million standard (non-Covid-19 vaccination) appointments were booked. When comparing to pre-pandemic levels, this is around 57.3 million more appointments than between May 2019 to April 2020.
In terms of access, the proportion of appointments booked to take place the same day has increased slightly from the previous month: 44.6% of appointments in April 2024 were booked to take place on the same day, compared to 43.9% in March 2024. Face-to-face appointments remained the same as the previous month, around 65%. See more data showing the pressures in general practice >
Empowering sessional GPs week
‘Empowering sessional GPs’ week was held this week, dedicated to celebrating and empowering sessional GPs. GP partners also benefitted from content promoting the advantages of offering the model contract to their employees, alongside guidance on ensuring good working practices. The goals were to promote professionalism, fairness and wellbeing within the sessional GP workforce. During the week, the new GP Diary app, which helps GPs understand their working patterns, and the annual leave calculator that simplifies leave entitlement calculations, were highlighted. Read more
NHS Education Funding Agreement 2024/27
NHSE has published a new NHS Funding Agreement. Unlike the previous education contract, this new version includes GP-specific elements in schedule 1. The contract creates a formal mechanism for training practices to receive payment from NHSE.
GPC England has had the opportunity to review and comment on the funding agreement during its development and is content with the final version.
All of the funding agreement documentation can be accessed on the NHS England website. If they haven’t already done so, NHS England commissioners will be contacting training practices shortly about bringing you onto the new agreement.
Wellbeing resources
We continue to encourage practices to focus on their own team’s wellbeing and take time to reflect on what can be done to protect it (this will also meet the requirements of QOF quality improvement project on staff wellbeing. A range of wellbeing and support services are also available to doctors, from the BMA’s counselling and peer support services, NHS practitioner health service, Samaritans and Doctors in Distress. See also our poster with 10 tips to help maintain and support wellbeing.
GPC England committee pages and guidance for practices
Read more about the work of GPCE and practical guidance for GP practices. See the latest update on X @BMA_GPand read about BMA in the media. Contact us: info.GPC@bma.org.uk
Read the latest GPC England bulletin
GPC England ballot for GP contractors / partners - If Not Now, When?
Everybody loves an election swingometer. This one has been designed by our team to explain why we must proceed with taking action to save general practice. Take a close look: it shows how high the backdated uplift would need to be just to restore real-terms funding to 2028/19 levels. So, the election timing is ideal. The new Government will receive a recommendation from DDRB and will make a decision on a backdated uplift right in the middle of our ballot. Spoiler alert: it will not be anywhere near enough. A new government on 5 July will change nothing.
What will each possible % DDRB uplift really mean, in real terms, for core contract funding compared to 2018/19?
* Assuming the recommended DDRB uplift is applied to both Staffing Expenses and Contractor Pay elements of the contract. Existing contract uplifts for respective elements have been subtracted.
For context, NHSE and DHSC have recommended 2%. But 10.7% is the uplift required to restore real-terms funding to 2018/19 levels.
When the next Government takes the reins on 5 July, it is very unlikely they will go significantly beyond the recommendations of DDRB. What effect would (for example) a 4% uplift have on your practice? Look at the swingometer: you’ll see this represents much less in real terms than your practice was receiving 5 years ago. A 4% uplift is still a 7% real-terms cut.
What does that mean? It means the closures of GP surgeries will continue. Those that struggle on will find it even more difficult to offer enough appointments and manage their workload. This is a vicious spiral, and it’s why we have no choice but to Take Action to Save General Practice – Protect Your Practice, Protect Your Patients.
This week sees the release of our 2024/25 contract guidance documents which we are sharing directly with LMCs, and which will be on the www.bma.org.uk/gpcontract site next week. We have also produced campaign infographics for you to attach to your emails, practice website and socials, as well as PPG and patient-facing resources – all of which will be available to download from the GP campaigning pages on the BMA website next week.
At the Roadshows we will guide you through the list of potential actions practices can take – which can be chosen from among the menu within our BMA GP Practice Survival Toolkit. The national roadshows will cover the period our online ballot will be open for GP contractors / partners across England, from Monday 17 June, closing 29 July ahead of action commencing from Thursday 1 August. There will also be an opportunity to join the BMA and get three months’ membership free from 17 June.
GP contractors/partners will be asked to vote YES and send a powerful message to the new Government to agree to a new contract for GP practices across England.
We need to fix the contract, not the model. Show the next Government that you are committed to fight for your future, and to reassure your patients that ‘GPs Are On Your Side’.
Watch our video about voting YES for collective action. Read more here
GPC England Officer Team face-to-face contract roadshows
Following the announcement of the ballot of BMA GP partner members for action on the 2024/25 GP contract, the GPCE officer team is travelling the country in a series of roadshows, hosted by regional LMCs. The roadshows will take place in over 20 locations across England from 5 June to 24 July.
This is an opportunity to hear face-to-face about the action practices will be able to take, details about the ballot, expert leading counsel advice, collection of your practice resources, and a chance to discuss and debate with your peers. We will also be sharing the BMA GP Practice Survival Toolkit to Protect your Practice, Protect your Patients.
The roadshows are open to all GP contractors/partners and practice managers, salaried GPs, GP registrars and practice nurses. You do not need to be a BMA member to attend, so please invite your colleagues and ensure there is representation from every practice in your locality.
See the list of events across the country and register here
Please note - if you are accessing on a phone you will need to scroll right across the screen to view the registration links.
BMA membership details
It is vital that you keep your BMA membership details up to date so you can vote in the non-statutory ballot for all GP contractors / partners in England that has just been announced.
To vote in the non-statutory ballot, we need you to login to www.bma.org.uk and check your details are current and correct. We must have the right information for your vote to count, so please double check. If you have any issues updating your details, please email gpcontract@bma.org.uk for further assistance. Please look out for an email from bma@cesvotes.com which will allow you to vote. We need:
Your details MUST be up to date for your vote to count.
In this first ballot, GP contractors / partners need to vote YES to send a message to Government that we are ready to stand up for a better service for our patients, and to protect our practices.
Please check and update your details here BMA - Sign In
Non-members still have time to join in the ballot. Any new member joining from 17 June, will get their first 3 months of membership for free. The latest date to join for the vote to be counted is 22 July. Please encourage your colleagues to join: bma.org.uk/join
LMC UK Conference update 2024
The LMC UK Conference was held last week at Celtic Manor, Newport, Wales. A number of motions were discussed, including the following about Physician Associates in general practice:
That conference has increasing concerns about the development and promotion of physician associates in general practice and:
(i) agrees that GPs, as expert medical generalists, cannot and should not be replaced by physician associates
(ii) believes that the GMC is complicit in the government’s agenda to create a cheaper and inferior delivery model of primary care by using PAs in place of GPs
(iii) insists that patients are made fully aware of the role of any health care professional before any consultation
(iv) necessitates that all GPC UK members openly declare any interest, financial or otherwise, in PAs from this point onwards.
This follows the recent BMA guidance for the supervision of Medical Physician Associates which will require Physician Associates to have named doctor supervisors immediately available at all times.
The Conference resolutions are available, and will be available on the BMA website shortly. The Agenda ‘Yma o hyd’ (‘still here’) and further information is available here
GP Workforce data
The latest workforce data showed that the NHS had the equivalent of 27,606 fully qualified full-time GPs in April 2024. We have the equivalent of 1,759 fewer fully qualified full time GPs than we did in September 2015. During this time, there has been a rise in the number of patients, with April 2024 seeing yet another record-breaking number. GPs are now responsible for almost 20% more patients than in 2015, demonstrating ever mounting workload pressures.
See more infographics and data, collated by our BMA teams, showing the pressures in general practice
GP unemployment crisis survey
Whilst practices are closing due to lack of funds, it’s clear that available resources to engage locum GPs has also collapsed and locum GP employment is in crisis. The underfunding of general practice combined with the exclusion of GPs from ARRS funding has led to a ridiculous situation where we have patients desperately wanting to see a GP, practices in need of GPs, and GPs in need of work. For many, the only viable decision has been to leave general practice or the NHS altogether and find more stable work. The sessional GPC are working hard to combat this issue, but we need data to support us in influencing, lobbying and campaigning right now, during the election campaign.
This is where you come in. We want to share your experiences.
It’s very important that any GPs undertaking locum sessions respond to this survey.
We want to hear from any GP across England who has undertaken locum sessions in the past 12 months. The survey is also open to non-BMA members. All responses will be anonymised.
The survey will close at midnight on Sunday 9th June 2024. Please complete the survey as soon as possible, to ensure our negotiating position is as strong as possible.
Share the Survey with ALL your GP colleagues now: Locum employment survey
Dr Mark Steggles
Sessional GPC chair
Infected blood inquiry – Hepatitis C testing
Although it is likely that the majority of people directly affected by infected blood have now been identified and started appropriate treatment, there may be people who have not yet been identified, particularly where they are living with asymptomatic Hepatitis C. People who had blood transfusions may not have considered these risks before or sought testing. Patients may decide to contact practices as they are worried following the publicity about this issue.
The Inquiry report recommends that people who received blood transfusions up until 1996 should be offered a blood test for Hepatitis C if they have not been tested before (GP practices may have noticed that previous guidance set the date as before September 1991).
Patients can be directed to the online service for at-home Hepatitis C self-testing kits, which are available via hepctest.nhs.uk for anyone over the age of 18 and living in England. Any positive results from at-home testing are dealt with by local Operational Delivery Networks and passed to specialist hepatology teams, who arrange to contact the patient, notify them of their results, manage their care and treatment, and communicate this to the patient’s registered GP.
Further resources for Hepatitis C care, including a Primary Care Toolkit are available here
Wellbeing resources
We continue to encourage practices to focus on their own team’s wellbeing and take time to reflect on what can be done to protect it (this will also meet the requirements of QOF quality improvement project on staff wellbeing. A range of wellbeing and support services are also available to doctors, from the BMA’s counselling and peer support services, NHS practitioner health service, Samaritans and Doctors in Distress. See also our poster with 10 tips to help maintain and support wellbeing.
GPC England committee pages and guidance for practices
Read more about the work of GPCE and practical guidance for GP practices. See the latest update on X @BMA_GPand read about BMA in the media. Contact us: info.GPC@bma.org.uk
Read the latest GPC England bulletin
GPC England vote for GP contractors / partners ballot ahead of collective action
If Not Now, When?
GPC England (GPCE) met yesterday and unanimously voted to move to Phase ONE of Saving General Practice, with the announcement of a ballot for GP contractors / partners across England next month, ahead of prospective action commencing on 1 August.
In March, 99.2% of nearly 20,000 GP BMA members voted ‘No’ to reject the 2024/25 GP Contract. Almost 75% of the votes cast were from GP contractors / partners, who have told us they are ready to take action and take it soon. The online ballot will outline a menu of actions which will not breach GP contracts. GP contractors / partners are the key decision makers: able to take small steps leading to a big impact to “Protect Practices and Protect Our Patients.”
Following the vote at GPCE to proceed to a ballot ahead of action, we will be explaining what action we are asking GPs to take, why, and when, early next month to coincide with our roadshows (see below). We will also be sharing profession-facing resources and a public-facing campaign very soon.
GP contractors/partners will be asked to vote YES to send a message to Government.
We are committed to fight for the future of General Practice.
We will reassure our patients that ‘GPs Are On Your Side’.
Read the press statement here
The GP contractor / partner ballot
The ballot will open on Monday 17 June and close on Monday 29 July ahead of action commencing from Thursday 1 August.
Please login to bma.org.uk to make sure your personal details, job roles, place of work and best contact email are correct. If you experience any issues, please email gpcontract@bma.org.uk for support. Please look out for an email from Civica which will allow you to vote.
Your details MUST be up to date for your vote to count.
Colleagues, it’s time.
GPC England Officer Team face-to-face contract roadshows – June and July 2024
Across June and July, the GPC England Officer team - Samira, David, Julius and I will be undertaking over 20 events nationwide, hosted by regional LMC leaders near you. We will be presenting GPC England manifesto and sharing the BMA GP Practice Survival Toolkit to Protect your Practice, Protect your Patients. These face-to-face events provide the perfect opportunity to hear about the menu of actions, understand the ballot, and give you an opportunity to ask us any questions. You can also take campaign resources and goodies back to your practice. These events are free and open to:
You do NOT need to be a BMA member to attend.
Please encourage your colleagues who are not members to register too.
See the list of events across the country and register here: https://bma.org.uk/gproadshow
BMA GP Membership Refresh
It is vital that you keep your BMA membership details up to date so you can vote in the non-statutory ballot for all GP contractors / partners in England that has just been announced.
Following the referendum BMA member services have refreshed the GP membership system.
To vote in the ballot, we need you to login to www.bma.org.uk to check your details are correct. We must have the right information for your vote to count, so please double check. If you have any issues updating your details, email gpcontract@bma.org.uk for further assistance. We need:
We must have the right information for your vote to count. Please double check!
In this first ballot, GP contractors / partner need to vote YES to send a message to Government that we are ready to stand up for a better service for our patients, and to protect our practices.
Please check and update your details at: BMA - Sign In
If you are not a BMA GP member, you can join here: www.bma.org.uk/join
LMC UK Conference Agenda 2024
The LMC UK Conference will be held next week, 23-24 May, at Celtic Manor, Newport, Wales.
The Agenda ‘Yma o hyd’ (‘still here’) has now been published and further information is available here
#ConfLMC24
GP contract guidance
GPC England is currently preparing contractual guidance following the imposition on 1 April and this should be available on the BMA website shortly. There is also a planned update of the safe working guidance, which it is hoped will be completed by early June.
Premises Costs Directions
After almost a decade of pressure from the BMA, the Department of Health and Social Care (DHSC) have published the long-anticipated update to the Premises Costs Directions (PCDs), which will bring changes to assist premises costs, including permission for commissioners to award improvement grants of up to 100% of the project value, (up from 66%), and new powers for commissioners to better support contractors.
These changes were initially agreed five years ago, as part of the multi-year GP contract in 2019. The full guidance will be published at a later date.
Responding to the announcement, Dr Gaurav Gupta, GPC England premises lead, said:
“We’re pleased to see positive steps to help GP premises owners, and any partners aspiring to buy into property-owning partnership in advancing their services to provide the best possible care for patients.
But we still have a very long way to go, with no additional funds going into ICB budget lines. The past decade has seen us caring for an additional eight million patients, with over a thousand practices lost, and record numbers of appointments. It’s clear to patients and GPs alike that we must push Government and NHS England for significantly greater investment into General Practice premises.”
Read the full statement here
Accelerated Access to GP-held patient records – update
Following engagement with the ICO and NHSE, BMA maintains the position outlined by the Information Commissioner. While the direction to provide prospective record access to patients is legal, mitigations outlined by practices in DPIAs submitted to the ICO should also be implemented to ensure that processing is compliant with the requirement of the Data Protection Act.
Where practices are facing pressure from ICBs to move ahead with prospective automatic access and have produced a DPIA, they should cite the ICOs response and continue in line with their DPIA.
Read more here
Cloud based telephony
Following changes that have mandated adoption of Cloud Based Telephony on NHSE’s approved procurement framework GPC England has received extensive complaints from GPs being charged excessive costs for adopting new systems.
While we remain in discussion with NHSE to seek a resolution, we have been advised that GPs can raise concerns directly with NHSE about additional costs they are experiencing using the following email commercial.procurementhub@nhs.net. Please continue to get in touch via info.lmcqueries@bma.org.uk with any concerns.
Changes to the benefits payment process
The DWP and DHSC has published a call for evidence that will inform a programme of work announced at the autumn statement in 2023, to explore reforming the fit note process to support those with long term health conditions in accessing work and health support. The evidence will help to assess the impact of the current fit note process in aiding work and health conversations, and the exploration of enhancements that GPs and other health care professionals would require for the fit note to better support people to start and stay in work. GPCE will submit its evidence in due course.
Medical Examiner System in England
The BMA continues to engage with stakeholders on the implementation of the Medical Examiner system in England which is currently scheduled for 9 September 2024. The Statutory Instruments and timeline of the ME implementation can be found here with the relevant legislation found here.
WorkWell Pilot
During the recent BMA Occupational Medicine Committee (OMC) meeting, the Government announced increased services being rolled out in occupational health. At ARM 2023, Motion 69 was passed which called on universal access to occupational health and medicine. Since the announcement, the Government has published the areas to pilot the WorkWell health and support service (all in England). Going forward, OMC will be lobbying the Government on a truly universal occupational health and occupational medicine system for all workers in the UK.
OMC also discussed recruitment and other challenges for those undertaking work in occupational medicine. For further information please contact info.omc@bma.org.uk
Wellbeing resources
We continue to encourage practices to focus on their own team’s wellbeing and take time to reflect on what can be done to protect it (this will also meet the requirements of QOF quality improvement project on staff wellbeing. A range of wellbeing and support services are also available to doctors, from the BMA’s counselling and peer support services, NHS practitioner health service, Samaritans and Doctors in Distress. See also our poster with 10 tips to help maintain and support wellbeing.
GPC England committee pages and guidance for practices
Read more about the work of GPCE and practical guidance for GP practices. See the latest update on X @BMA_GPand read about BMA in the media. Contact us: info.GPC@bma.org.ukRead the latest GPC England bulletin
Contract dispute update
We are now in dispute with NHS England in relation to the imposed changes to the 2024/25 GMS Contract for General Practice. We have warned them that industrial action could follow unless urgent improvements are made to the contract. It is now vital that we reassure patients that we’re on their side by raising awareness of the issues that have brought us to this crisis point. Thank you once again to the huge number of BMA members who responded to the referendum giving a 99.2% rejection of the 24/25 contract. We are preparing for the next steps over action we can take.
We also wrote to each of the 42 ICBs asking them to add ‘general practice’ to their risk register given the ongoing crisis we face with unmanageable workloads, practices handing back contracts and many being in financial distress. This was an important step and quite rightly has raised concerns from ICB leaders and NHS England.
We will soon be sending some digital resources to use in your surgeries to explain to patients some of the problems we face. Keep an eye out for these in your inbox and via our social media channels.
Within the next two weeks we will be sharing details of roadshows taking place across the country, both face-to-face and virtually. This will be an opportunity to be part of the wider discussion around what the next steps for the profession will be.
Thank you for your support. Together we will fight for the future of our profession.
Read more about the dispute here: GPs in England go into dispute with NHS England over contract
GP pressures
The latest GP workforce figures for England show the number of patients per practice is rising. GPs are now responsible for about 18% more patients than in 2015, demonstrating ever-mounting workload pressures.
The NHS in England has lost the equivalent of 1,790 full-time fully qualified GPs since 2015. There are also fewer GP practices, with a decrease by 106 over the past year. This fall in both staff numbers and GP practice coincides with a rise in patients: as of March 2024, there was another record-high of 63.27 million patients registered with practices in England – a full time equivalent GP is now responsible for an average of 2,295 patients.
The latest appointment data shows that that around 29.9 million standard appointments were booked in March 2024, and over the past year, approximately 353.3 million standard (non-Covid-19 vaccination) appointments were booked. When comparing to pre-pandemic levels, this is 43.1 million more appointments than between April 2019 to March 2020.
See more infographics and data, showing the pressures in general practice, on the BMA website.
BMA medical attrition report
Last week, the BMA released a new report exploring medical attrition in the UK’s health services.
In 2022/23, between 15,000 and 23,000 doctors left the NHS in England before reaching retirement age. Depending on the exact number of doctors leaving, we estimate that this loss has resulted in between £1.6 to 2.4 billion in additional costs for NHS employers and the public purse, at a minimum. With increasing numbers of doctors reporting taking hard steps to leave the profession, this cost will increase without action.
The actual cost of replacing an individual doctor will vary, however, and can easily cost over £250,000. For a full-time salaried GP who decides to move abroad, leaving their post at a small rural practice after six years work, the combatively cost would be around £295,000. The practice may struggle to recruit and have to rely on locum cover for 3 months – resulting in an addition £86,000 cost. Eventually, a newly qualified GP is hired, and they take around 25 days to find their feet – resulting in £1000 of productivity losses over that period. One less doctor in the workforce results in the need to train a new doctor to keep workforce numbers up - training a GP to the same level would cost at least £260,000.
The good news is that there is plenty that governments, UK health services and employers can do to hold on to staff and curb preventable costs in the process, many of which would result in immediate benefits. We pinpoint four key areas where urgent action is needed to retain doctors in the UK’s health services, and save public money: pay and debt; working conditions; diversity and inclusion; and development and support. Read the report
Covid therapeutics guidance
Further to the guidance sent out last week about COVID therapeutics, we have had multiple reports of ICBs trying to push this prescribing to General Practice, with minimal funding and support. It is very important to be clear that prescribing of the first and second line agents Paxlovid (Nirmatrelvir plus ritonavir) and Sotrovimab (an IV medication) are not suitable for prescribing routinely through General Practice.
Clinicians running Covid Medicines Delivery Units (CMDUs) are clear the assessment of these patients is time consuming due to the large number of interactions and contraindications, and often requires input from specialist colleagues before prescribing. The first line drug (Paxlovid) is very difficult to prescribe, as it has interactions with many common and specialist medications that many in these patient groups will be taking (e.g. Amlodipine). Even with increased eligibility, GPs would not see sufficient numbers to prescribe this drug safely, and doing so would be contrary to the GMC’s good medical practice guidance.
We therefore recommend that GPs do not agree to prescribe Paxlovid unless as part of an appropriately commissioned specialised service. We would recommend you contact your LMC if you feel pressured to prescribe or feel unhappy at how this is being dealt with by your local system.
Where traffic light systems are in place maintaining as a ‘red’ classification supports the need for a separately commissioned service. We are clear that governance of ICB Medicines committees must allow GPs to refuse such prescribing in line with GMC guidance. Read our guidance.
Medical Examiner arrangements
The National Medical Examiner (ME), Dr Alan Fletcher, has confirmed the deferment of the statutory introduction of the Medical Examiner (ME) until 9 September 2024; this delay offers a further opportunity for local ME Units to “on-board” GP practices. Practices should start to trial their links with ME Units in terms of IT connections, and when providing a draft MCCD for ME comment. This will help local ME Units plan their capacity and responsiveness both in terms of the numbers involved when all community deaths are reviewed, once this a statutory process, and the need to provide “fast-track” arrangements, for example, for certain faith groups. Finally, the digital MCCD is planned to be available by September.
GPC England will continue to liaise with the National Medical Examiner and provide updates as they become available, and practices are encouraged to contact their LMCs with any queries. Many LMCs already have good links with their local ME Units which is very helpful.
RCGP consultation on Physician Associates
The RCGP is undertaking a consultation on the role of PAs (Physician Associates) in general practice. A survey of all current RCGP members is running from 22 April to 10 May 2024. We would encourage all RCGP members to respond. To help inform your response the BMA position on PAs in general practice, including on scope of practice and seeing undifferentiated patients, is available here.
If you are an RCGP member and you have not received an email with the survey link and believe that you should have, please contact policy@rcgp.org.uk
National Visa support service for GPs
As part of the closure of NHSE’s Primary Care Workforce Team, the national Visa Support Service for GPs and GP practices currently provided by the team will also be closing. National support for practices, ICBs, regional teams and GPs with visa queries will end on 31 May 2024 and other responsibilities such as funding visas and providing practice matching are moving to ICBs under the new NHS England operating model. Individual GPs with immigration concerns can get free advice from our Immigration Advice Service, and the following contacts will apply after the 31 May 2024:
Please note that existing NHS England visa support for sponsored GP trainees, and GP and practices participating in the International Induction Programme will continue to be provided.
BMA members with concerns about this can contact the BMA’s International Team info.international@bma.org.uk
Participants needed for new autism research
Autistic Doctors International, in partnership with Brighton and Sussex Medical Schools, are conducting a new survey which aims to assess the prevalence of autism and autistic traits in doctors within the UK. The research is intended to help to improve understanding of autism within the medical profession on a national scale, which will help impact future support and policy. The survey is anonymous and takes around 7 minutes to complete. If you are interested in taking part and/or sharing with your networks, the link is here
Wellbeing resources
We continue to encourage practices to focus on their own team’s wellbeing and take time to reflect on what can be done to protect it (this will also meet the requirements of QOF quality improvement project on staff wellbeing. A range of wellbeing and support services are also available to doctors, from the BMA’s counselling and peer support services, NHS practitioner health service, Samaritans and Doctors in Distress. See also our poster with 10 tips to help maintain and support wellbeing.
GPC England committee pages and guidance for practices
Read more about the work of GPCE and practical guidance for GP practices. See the latest update on X @BMA_GPand read about BMA in the media. Contact us: info.GPC@bma.org.uk
Read the latest GPC England bulletin
GPC England writes to NHS England and ICB leads
We have now written to NHS England, confirming that we are in dispute regarding the 2024/25 general medical services contract for general practice, and warning that steps that may ultimately lead to GP action will follow, unless urgent improvements are made to the contract.
The decision by NHSE and the Government to impose the 2024/25 contract on the profession on 1 April, comes despite a unanimous rejection by the BMA GPs committee England, and by 99.2% of over 19,000 GPs and GP Registrars across England who took part in our referendum. Of note, the turnout for BMA members who identify as GP principals, partners or contractors was almost 75%.
We have also written to integrated care board chairs and CEOs, advising that the potential threat of GP action be placed on system risk registers if not already there, and inviting them to meet with their Local Medical Committee representatives to discuss the potential implications of such action, as well as better understanding local general practice pressures specific to individual systems.
The Chair of GPC England, Dr Katie Bramall-Stainer said: “GPs and their patients want the same thing. We want patients to be able to see their family doctor, quickly and easily, in a practice that is local to them, well-staffed and resourced, and safe.
“This contract imposition will do untold damage to our profession, making it harder for surgeries to stay open and give the care our patients need.
“We don’t want to take any kind of industrial action and hope it can be avoided, but the further NHS England and the Government get from working with us on solutions, the closer GPs get to taking action.”
Read more here: GPs in England go into dispute with NHS England over contract
PCSE Seniority Payment Reconciliation process
Colleagues will recall that last Autumn many practices were contacted by PCSE, which was undertaking a reconciliation exercise for seniority payments made in financial years 2017/18, 2018/19 and 2019/20. Not all practices will be affected by this exercise.
This process was then delayed because of the need for further validation exercise. This has now been undertaken for all but a very small number of practices. As a result of the validation, the figure your practice (if affected) will now receive (which may be either positive or negative) may be different to the figure sent in October 2023.
The intention is to balance practice payments in the June contract payment run. Across England approximately 1,500 practices are due a deduction, and just under 1000 practices will receive a positive adjustment. PCSE are making special arrangements for practices who believe a one-off financial deduction in June would place their practice at risk of financial hardship. If this is the case, you should complete the request for a payment plan via the email you have received from PCSE.
There is a short window to complete this, as it should be sent to PCSE by 23 April 2024. PCSE will set up a payment plan for the remaining ten months of the financial year (June 2024 to March 2025) in which the total deduction will be subdivided into ten equal monthly deductions. GPC England (GPCE) understand from PCSE that this payment plan will be forwarded to the practice’s ICB and practices contacted if the ICB considers such a repayment plan is unnecessary. However, it is difficult to understand any ICB drawing this conclusion. LMCs are recommended to advise ICBs that if they have any queries about an individual practice’s repayment plan, they should urgently contact the practice and their LMC.
PCSE have also confirmed they will not make a June deduction if a dispute has been raised.
There is further information regarding seniority payments in my previous update letter of 23 October 2023 and also via the PCSE website at Seniority payments | PCSE (england.nhs.uk)
PCSE and NHSE both recognise that, having initiated this exercise and then withdrawn it for further validation, there may be some scepticism about the revised figures. This is a complicated exercise as the total figure sent to practices is an aggregate one, covering all partners at the practice entitled to receive seniority payments during the three years involved, and this may include both positive and negative adjustments. Practices can request further information from PCSE via the link above.
Due to the time that has elapsed, these adjustments may relate to GP partners who have now retired, resigned from the practice, or who are even deceased. They may also relate to practices which have now merged or closed. GPCE does not believe current practices should be contacted about practices that have closed, and patients dispensed to re-register elsewhere, as opposed to mergers, which have brought together previous existing practices. Practices may find that, because seniority payment reconciliations were always made some years in arrears, there is reference to such arrangements on retirement or resignation within a Partnership Agreement. There may also be similar arrangements detailed in Merger Agreement when this has occurred.
However, this exercise is undoubtedly going to create some work for practices: GPCE recommends that in the first instance, practice accountants are informed of the information received from PCSE. Obviously, past partners can be contacted, but this needs to be a value-for-money exercise as some adjustments (whether positive or negative) are small, in absolute terms, and may not justify a complicated accountancy exercise. Current partners can certainly inform previous partners (including partners of a then different practice if a merger has occurred) of the information they have received from PCSE. If a partner has died, then this may be a more sensitive exercise in terms of contracting the beneficiaries of their estate. If this isn’t possible, PCSE should be informed.
GPCE also understands that PCSE will eventually be in touch with practices affected by the 2013/14, 2014/15 and 2015/16 and 2016/17 financial years, although any adjustments related to these years are likely to be smaller in absolute terms, but we do not have a date for this exercise.
Updated version of GMC Good Medical Practice
All colleagues should note the recent update to the GMC’s Good Medical Practice (GMP), which sets out expected standards for all doctors in the UK; this came into effect on 30 January 2024 and replaces the 2013 version.
The GMP update is designed to rephrase some of the guidance to achieve the following five aims:
These aims are described in more details at: Key changes to Good medical practice 2024
There is also a very helpful side by side comparison of the GMP 2013 guidance and the updated 2024 version, with a commentary about these changes, available here
It is clear that the NHS has a long way to go to create a working environment in which all colleagues feel supported and valued, despite the aspirations of the NHS England Long Term Workforce Plan.
This means that part of the contribution all colleagues can make within their working environment is to encourage respectful, positive, and supportive relationships amongst all those working within practices, regardless of their role and job title.
Update: Medical Examiner Arrangements
Colleagues may feel that writing a further update regarding the Medical Examiner [ME] system represents something of a hostage to fortune.
As colleagues will recall, the original date for implementing these arrangements was April 2023, after many concerns were raised, this was ultimately postponed until April 2024, but as this date approached it became clear that reliable arrangements to ensure all community deaths were covered by local Medical Examiner Units were not in place.
The Health Minister has now announced that the statutory introduction of these changes will be delayed until 9 September, to allow “time to prepare for implementation”. This presumably represents a euphemism for “still not ready”. This means the use of the Medical Examiner system by GP practices will not be universal, and the current unsatisfactory hybrid process will continue. If your practice has been “on-boarded” by local ME Units, you can continue to refer draft MCCDs and accompanying information about the deceased to the Unit.
If your practice continues to refer all, or a proportion, of deaths to local Medical Referees, then colleagues can continue to do so over the coming months. ME units should be contacting practices not linked to their service to set up arrangements for GP referral of deaths within the community.
GPC England has contacted the National Medical Examiner, and is hoping to be able to pass on a further update shortly.
COVID therapeutics
We have updated the GPC England COVID Therapeutics guidance. NICE and NHS England are increasing the eligible cohorts this June 2024 and some ICBs are considering decommissioning services with an expectation that GPs prescribe. This is not core general practice work and there are significant interactions between the first line treatment and many common medications. We therefore recommend that GPs do not agree to prescribe this unless as part of an appropriately commissioned service. Read the guidance here.
NHSE Delivery plan for recovering access to primary care
NHS England has published an update on the Delivery Plan for Recovering Access to Primary Care and outlined next steps for the year ahead in 2024/25.
Continuing to “improve timely access to primary care” and “reducing pressure on staff” remains a continuing aspiration for NHSE for the second year, and their letter sets out some key areas, such as taking further steps to improve the primary / secondary care interface, increase the number of people self-referring, implementing core elements of modern general practice, and increasing the number of people viewing their health information and ordering repeat prescriptions via the NHS App. Clearly GPCE has proposed alternative approaches which have not yet been adopted by NHSE.
Agenda For Change DHSC Payment - practice nurses
There have been articles published in the past month in some Nursing journals regarding a ‘pay boost’ for practice nurses being funded by the Department of Health and Social Care. This relates to an initiative last year, where the Government offered staff on Agenda for Change pay scales a cash boost - information can be found here.
We appreciate that the vast majority of practice nurses working in general practices are not working on Agenda for Change contracts which align with AfC pay scales, terms and conditions - those practices will not be eligible to receive the payment.
GP referral pathway to Pharmacy First
Community Pharmacy England has developed an animation and infographic to help describe the GP referral pathway into the CPCS (Community Pharmacist Consultation Service), primarily aimed at GP practice teams. The animation outlines how referrals work and what pharmacies do with those referrals, as well as the success of NHS 111 referrals into the CPCS.
Read more about Pharmacy First on this information page for GPs
GPC England regional elections
GPC England is seeking nomination from GPs in the East Yorkshire/N Lincolnshire/Lincolnshire region to join the committee.
To stand or vote in this by-election you must be one of the following:
The 52 sessions electoral requirement shall be waived where a GP would normally have complied with this requirement but was prevented from so doing by sickness or absence on maternity leave, has a reasonable expectation of returning to clinical practice.
Nominations will close at 12pm, 2 May. Nominate yourself for election
If you have any questions or require assistance, please contact elections@bma.org,uk
LMC UK Conference - Registration deadline - noon 1 May 2024
Please be reminded that the registration for UK LMC conference deadline is noon 1 May 2024.
If you wish to attend, please can you register before the deadline as we will not be accepting any late requests. All attendees who have already registered would have received confirmation at their registered email address.
Please note that even if hotel / travel have been booked, if not registered to attend conference via the registration site, entrance to the conference will not be permitted.
If you haven't registered, please can you do so, via https://events.bma.org.uk/uk-conference-of-lmcs-2024/registration
If you need us to check if you are registered, then please contact Karen Day on kday@bma.org.uk
Update on CQC registration and portal
Due to issues with CQC’s new provider portal, some providers are still unable to use it to undertake notification and registration activity. CQC is working to resolve these issues and will provide an update as soon as they are in place.
Until fixes to the portal are in place, CQC is implementing a temporary process for providers who urgently need to undertake registration activity and cannot use the portal.
Providers can continue to submit notifications via email if you are unable to use the portal.
See more information here: https://content.govdelivery.com/accounts/UKCQC/bulletins/396c1fa
Updating LMC contact details
A reminder for LMCs when updating any contact details, or any changes to personnel, to please email Karen Day kday@bma.org.uk.
GPC England committee pages and guidance for practices
Read more about the work of GPCE and practical guidance for GP practices. See the latest update on X @BMA_GPand read about BMA in the media. Contact us: info.GPC@bma.org.uk
Read the latest GPC England bulletin
