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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:

  • All holders of a GP contract
  • Every GP and GP Registrar
  • Practice Managers and Practice Nurses

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:

  • Your personal details, including a valid email address
  • Place of work details for all your roles

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 servicesNHS practitioner health serviceSamaritans 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:

  • Visa related queries and issues should be raised directly with the dedicated NHS Visa Team at the Home Office via UKVINHSTeam@homeoffice.gov.uk
  • Queries relating to the 4-month visa extension for newly qualified GPs should be raised with NHS England’s Overseas Sponsorship Team via england.sponsorship@nhs.net

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 servicesNHS practitioner health serviceSamaritans 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:  

  • Creating respectful, fair and compassionate workplaces for colleagues and patient
  • Promoting patient-centred care
  • Tackling discrimination
  • Championing fair and inclusive leadership
  • Supporting continuity of care and safe delegation

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:

  • a GP engaged exclusively or predominantly in providing personally or performing NHS primary medical services for a minimum of 52 sessions distributed evenly over six months in the year immediately before election
  • a GP on the doctors’ retainer scheme
  • a medically qualified LMC secretary.

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

On behalf of GPC England, I want to thank every single GP and GP registrar across the country who took part in our referendum. Let us not forget, this referendum wasn’t even a ballot, it was merely a dress rehearsal for what’s around the corner. Either way, had it been a ballot, it would have comfortably passed the required thresholds. 

This referendum was a temperature check of the profession - and make no mistake - in the week where we have a third consecutive contract imposition, we are at boiling point. I’m overwhelmed to share the result that more than 99.2% of you have voted firmly against this contract. This is an unequivocal result that will demand NHS England, the Department of Health and Social Care, Government, and other parties now sit up and take notice. 

It is now clear that we are one profession, which has spoken with one voice and said enough - time’s up. This contract imposition does not give practices stability. It does not give us hope. This contract, which NHSE are choosing to impose upon us, is not safe. 

The contract changes, which will be imposed by the Government and NHS England from 1 April 2024, include a national practice contract baseline funding uplift of just £179m for England’s general practices, way below inflation in recent years, meaning many practices will struggle to stay financially viable over the next six to 12 months and risk closure. 

The day after the referendum closed, GPC England met to decide and determine the next steps we’ll be taking as a profession knowing you’re standing right behind us. We are now starting to receive the full dataset and results breakdown from Civica, and we’ll share that with you in due course too.  

When I qualified as a GP in 2008, we were called the ‘jewel in the crown of the NHS’. General practice has been demeaned, diminished, diluted, bullied and gaslit long enough. We now start the fight back, bringing our patients with us. Patients want access to their family doctor in a surgery that feels safe, with a well-resourced team ready to meet the needs of our communities, and that’s what we want too.  

We are the bedrock upon which the rest of the NHS stands, with 400 million patient contacts a year. Almost 1.4 million every single day. That’s a lot of voters.  

So congratulations, ‘team GP’. The battle to save general practice has begun. I’m proud to represent you, and I know that your BMA committee, GPC England, is proud to serve you.  

We will be in touch soon with more information, guidance on the 2024/25 contract and next steps for us all. 

Watch my video about the GP contract referendum results: GPCE contract referendum results 

Find out about the contract changes and read our FAQs to learn what this means for you. 

Link to press release: GPs vote overwhelmingly to reject contract changes in BMA referendum  

BMA guidance on physician associates 

The BMA published guidance on 7 March 2024 regarding medical associate professionals (MAPs). From a GP perspective, we are well aware that some practices will have substantive employment contracts with associate clinical staff employed both directly by a practice, and also within the ARRS under the PCN DES at a network level. 

We readily appreciate the shifting sands of opinion, not to mention the NHSE letter of 27 March 2024, and the Government’s planned and imminent regulation of MAP roles by the GMC which itself has aroused strong feelings across the profession. GPCE recognises it may be likely that many roles may have been working in a manner as described in the PCN DES contract, that is they “must” see as a “first point of contact”, “undifferentiated and undiagnosed” patients.  Substantive guidance for employing practices which will complement the wider BMA position is under development. In the interim, it is for GP employers to determine the terms of individual staff members’ abilities to undertake their job competently and safely in meeting the needs of the practice’s registered list.  

GPC England is in discussion with NHSE and DHSC in light of the recently published guidance which may present a demanding expectation in terms of both supervisory time and availability. However we would remind GP employers that PAs are not independent practitioners – they do require supervision and oversight. Their scope of practice means that GP employers retain responsibility and liability for clinical oversight. Hence in reality, the ‘undifferentiated’ element is unlikely to be practically implemented in its fullest sense. 

Each MAP needs to be assessed on an individual basis, with GP employers undertaking due diligence in assessing and monitoring the relevant scope of practice and clinical competence of their respective employees.  Furthermore, at present there is no general practice training pathway with supported induction, curriculum or competency coverage. It might be noted that nascent preceptorships are conspicuous by their absence due in part to a familiar story of a lack of ICB support to practices and PCNs. 

  

All staff require induction, and a programme of support. Who decides when staff are ready (or not) to see undifferentiated clinical presentations should be determined on an individual basis after an automatic period of close supervision. In the absence of regulation and quality training assurances, GPs as employers remain ultimately responsibility.  GPC England would always advise GPs ensure they are fulfilling their GMC obligations. 

In terms of a strategic perspective, we appreciate that medically qualified doctors who are not GPs must stay within their scope of practice, therefore one might perceive an inconsistency in approach to then support non-regulated professionals, (given the imposed contractual guidance from NHSE) in seeing undifferentiated, undiagnosed patients. 

Headlines from the latest NHS stats 

GP workforce – February 2024   

  • There are 32 fewer fully qualified, full-time equivalent GPs in February 2024 than January 2024, the first month showing a fall in FTE numbers after seven months of sustained increases.  
  • We have the equivalent of 1,862 fewer fully qualified full-time GPs than we did in September 2015. 
  • The number of GP practices in England has decreased by 105 over the past year – reflecting a long-term trend of closures as well as mergers. This fall in both staff numbers and GP practice coincides with a rise in patients: as of February 2024, there was another record-high of 63.20 million patients registered with practices in England – an average of 10,018 patients registered per practice.   
  • As a result, each full-time equivalent GP is now responsible for an average of 2,298 patients. This is an increase of 360 patients per GP, or nearly 19%, since 2015, demonstrating the ever-mounting workload in general practice.   

GP appointments – February 2024  

  • Around 30.5 million standard (non-COVID-19 vaccination) appointments were booked in February 2024, with an average of 1.45m appointments being delivered per working day. This is lower than the average of 1.48m appointments per working day the previous month.  
  • An average of 1.40m appointments per day were booked in the past year (March 2023–February 2024).  
  • The number of COVID-19 vaccination appointments decreased significantly from about 11,700 in January 2024 to approximately 140 in February 2024.  
  • In terms of access, the proportion of appointments booked to take place the same day has decreased slightly from the previous month: 43.5% of appointments in February 2024 were booked to take place on the same day, compared to almost 45% in January 2024.  

Appointments booked to take place face to face stayed the same – about 67% of appointments in both January 2024 and February 2024. 45.2% of appointments were delivered by a GP in February 2024: a slight decrease since the previous month (45.5%). 

GPC regional byelection for the E York / N Lincs / Lincs constituency 

The nominations for the GPC regional byelection for the E York / N Lincs / Lincs constituency will open on 12pm 11th April 2024.  

To nominate please visit https://elections.bma.org.uk/  (The deadline is 12pm 2nd May 2024). Please note that following changes to bye-law 90(1) agreed at the ARM in September 2021 all appointed and elected committee members, eligible for BMA membership, must be and continue to be a BMA member to remain on the committee.  

Non-BMA members - You will need a BMA web account to access the election – you may already have one if you have registered for one to attend an LMC conference or if you have previously been a BMA member – if you think you have an account but are not sure please email elections@bma.org.uk with your GMC number and the team can check for you.  

If you do not have an account, please contact support@bma.org.uk to let them know you need a web account to be able to participate in the GPC election. A member of the team will help you create an account and you will be assigned an BMA ID number. Please email elections@bma.org.uk with this number and details of the region you wish to participate in. The team can then grant you access to the election.  

If you have any queries regarding the election process, please contact elections@bma.org.uk

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_GP and read about BMA in the media. Contact us: info.GPC@bma.org.uk 

Read the latest GPC England bulletin 

2024-25 GP contract referendum open – last chance to vote 

GPC England voted unanimously to reject the derisory 1.9% 2024/25 GP contractual uplift and changes from the Government and NHS England. This is your opportunity to send a strong signal as to how the profession feels about the final contract and how we collectively move forward to protect the future of General Practice 

The member referendum on the contract is now open and closes at midday on 27 March. You should by now have received an email from Civica with your unique voting link.  

Watch a video of GPs committee chair Katie Bramall-Stainer discussing the GP contract referendum and last chance to votehttps://youtu.be/S4oPp0gRq8Q 

Missing your ballot voting link? 

There were some membership coding issues for a minority of members when the referendum opened.  

However, if you are still missing your ballot, please follow the actions below: 

  • Check your junk folder in the email account that you have registered with the BMA. 
  • Search for an email from the British Medical Association: ‘bma@cesvotes.com’ 
  • Log-in to your BMA account and check your membership data with us is up to date. If you are having issues updating your details, email our Membership Team to get support. We normally respond on the same day. 
  • Civica receives new data from the BMA every two working days, which enables them to send out voting links to new and existing members who have updated their details 
  • If you still have not received a voting link after following the above steps, please complete our form and we will be in touch shortly. 
  • If you have been in touch with us already, we will get back to you directly to support you and ensure you get your voting link email in plenty of time. Normally on the same day. 
  • If you are not a BMA member, join the BMA by Monday 25 March to have your say in this and any future votes. Spread the word – get your colleagues to join and vote, we want and need to hear from the profession. 
  • They need to have joined by first thing Monday 25 March, to have their say in this and any future votes 

Find out about the current contract changes and read our FAQs to learn what this means for you 

If you have any questions about the referendum, please contact us on gpreferendum@bma.org.uk 

How you vote will determine our next steps as a profession. 

GPs see the equivalent of half the UK population every month.  

England general practice SOS    ???? Over 1000 practices gone  ???? 1,900 fewer full-time qualified GPs  ???? Over 6,000,000 more patients on the books  ???? Equivalent of 1:2 population seen EACH month ???? 400 million consults per annum  ???? 5-6% of overall NHS funding spent on practice contracts  ???? 5% of all NHS staff 
We urge practices to continue to use our safe working guidance to limit contacts to 25 per day in order to prioritise safe patient care, within the present bounds of the GMS contract.     

Emergency motion at GPC UK on The Phoenix Partnership  (TPP) 

At its meeting last week, GPC UK debated and passed the following motion: 

That this meeting is disgusted by the reported violent, openly racist and misogynistic comments made by Frank Hester, Director of The Phoenix Partnership (TPP), and directed at the Rt Hon Ms Diane Abbott MP, and: 

i) notes that his comments contravene NHS England’s fit and proper person test framework introduced in response to the 2019 Kark Review recommendations, taking into account CQC requirements in relation to directors 

ii) calls upon UK health boards to apply their own processes vigilantly when contracting external stakeholders whose views and values may not align with the wider professional national NHS workforce 

iii) advises GP practices to consider Hester’s comments prior to signing new contracts with TPP 

iv) believes Frank Hester should resign and handover his Directorship with immediate effect. 

You can read more here. 

GP Connect issue 

Following recent reports that NHSE has been exploring using GP Connect as a means of centrally pulling patient data from practices, the BMA is seeking immediate clarification from relevant stakeholders. Data transferred via GP Connect is shared on the clear understanding that it is used for direct care. The deployment of the platform for any other purposes – including to circumvent GPs statutory role as data controllers, and access patient data for uses other than direct care is a clear contravention of the agreement put in place to use GP Connect. 

Rebuild General Practice patient engagement toolkit  

Rebuild General Practice has launched a patient engagement toolkit action pack containing ideas, tools and support available for Local Medical Committees (LMCs) and individual GPs wishing to engage with patients about the Rebuild General Practice campaign. 

Watch the Rebuild General Practice patient engagement animation which can be downloaded to the screens of your surgery. 

 
GP Registrars survey highlights increased levels of burnout and worries about future 

A survey by the BMA’s GP Registrars Committee showed that qualified doctors who are training to become GPs in the UK are facing increased levels of burnout and are worried about their health prospects early in their careers.   

In addition, under 10% of those who took part in the survey said they intend to work as a full-time GP, with just less than 20% stating that they feel confident of their future as a GP working in the UK.  

Last chance for NHSE New to Practice GP and Nurse Fellowship sign up: deadline 31st March 

NHSE recently announced the cessation of the NHSE GP and Nurse fellowship schemes  

We would like to remind encourage those GPs eligible (within 12 months of CCT), to sign up for the programme in advance of the 31st March 2024 deadline. Please get in touch with your local Training Hubs for details regarding how to register. 

Please also send any feedback on the scheme to info.gpc@bma.org 

 
Annual flu letter 

The tripartite annual flu letter for 2024/25 has now been published: National flu immunisation programme 2024 to 2025 letter - GOV.UK (www.gov.uk) 

The letter sets out for providers the details of which cohorts are eligible for a flu vaccine in 2024/25 and which vaccines will be reimbursable. There are no changes to the cohorts for next year’s programme, but based on JCVI advice, there are changes to the timing of the adult programme.  

NHSE will aim to publish the flu service specifications shortly. 

Very high-risk breast screening 

NHS England is currently contacting a group of 1,487 women at very high risk of breast cancer following chest radiotherapy for Hodgkin lymphoma, after NHSE was alerted that some of these women treated when aged between 10 to 35 years during 1962 to 2003 may not have been invited for this annual testing.  NHSE has sent a letter apologising for what has happened and NHS breast screening services will follow up by offering appointments.  

Anyone who thinks they might be in this group can get further information and support from a dedicated helpline: 0345 8778962​ 

More information can be found on the NHS website  

Guidance on conditions for which over-the-counter items should not routinely be prescribed 

NHS England has published new guidance on conditions for which over the counter items should not be routinely prescribed in primary care: NHS England » Policy guidance: conditions for which over the counter items should not be routinely prescribed in primary care 

GPC UK Regional Elections 

The voting period is now open for seats to the General Practitioners Committee (GPC) in the following regions: 

  • Norfolk/Suffolk/Great Yarmouth & Waveney  
  • Enfield & Haringey/Camden & Islington/Barnet/Kensington & Chelsea/Westminster  
  • Sefton/Liverpool/Wirral 
  • Salford & Trafford/Manchester/Stockport  
  • Forth Valley/Fife/Lothian/Tayside  
  • E Sussex/W Sussex  
  • Derbys/Notts  
  • Herefordshire/Worcs/Warks/Coventry  
  • Birmingham/Solihull  

To submit your vote for any of the above seats please visit https://elections.bma.org.uk/  (The deadline for voting is 12pm Tuesday 26th March 2024).  

Non-BMA members - You will need a BMA web account to access the election – you may already have one if you have registered for one to attend an LMC conference or if you have previously been a BMA member – if you think you have an account but are not sure please email elections@bma.org.uk with your GMC number and the team can check for you.  

If you do not have an account, please contact support@bma.org.uk to let them know you need a web account to be able to participate in the GPC election. A member of the team will help you create an account and you will be assigned an BMA ID number, please email elections@bma.org.uk with this number and details of the region you wish to participate in. The team can then grant you access to the election.  

If you have any queries regarding the election process, please contact elections@bma.org.uk

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_GP and read about BMA in the media. Contact us: info.GPC@bma.org.uk 

Read the latest GPC England bulletin 

2024-25 GP contract referendum – England

Join one of our webinars to find out more. 

GPC England has rejected the 2024/25 GP contract changes. The contract has now been put to BMA GP members in a referendum. The referendum cannot prevent the Government from choosing to impose their changes to the contract, but it will send a strong signal as to how the profession feels about the contract, a potential third successive contractual imposition by Government and where we collectively go next.

Find out more about the current contract changes here

You can watch Dr Katie Bramall-Stainer discussing the GP referendum here: GPC England contract referendum - YouTube

To ensure you can feel fully informed before you vote, we are holding a series of webinars and as we receive your feedback we will add FAQs to our webpage www.bma.org.uk/gpcontract early next week, which you can read and reflect on with your practice colleagues. As we receive more feedback, we will update the FAQs.

What to expect:

  • A presentation from GPC England Officers outlining the context of the 2024/25 contract and what it means both for your practice, and you as a GP. A summary of next steps and the choice BMA GP members will need to make in the referendum
  • A roadmap of what the months ahead may look like 
  • The opportunity to have your questions answered – please send your questions in advance to gpreferendum@bma.org.uk

Webinar dates, times and Microsoft Teams joining links:

South East Coast: Wednesday 13th March - 19.30 - 21.00

Microsoft Teams link

North East: Wednesday 13th March - 19.30 - 21.00

Microsoft Teams link

North West: Thursday 14th March - 12.30 - 14.00

Microsoft Teams link

West Midlands: Tuesday 19th March - 19.30 - 21.00

Microsoft Teams link

South Central: Wednesday 20th March - 12.30 - 14.00 

Microsoft Teams link

South West: Wednesday 20th March - 12.30 - 14.00

Microsoft Teams link

Yorkshire & Humber: Wednesday 20th March - 19:30 – 21:00

Microsoft Teams link

East of England: Wednesday 20th March - 19:30 – 21:00

Microsoft Teams link

National Catch-Up: Thursday 21st March                      

12.30 - 14.00 Microsoft Teams link

19.30 - 21.00 Microsoft Teams link

These webinars will NOT be recorded, so please attend your regional slot, or a national catch-up session. The referendum opened on 7 March and closes midday Wednesday 27 March. You should have received an email with a unique voting link.

How you vote will determine our next steps as a profession.

GP Workforce – January 2024 

There are 48 more fully qualified, full-time equivalent GPs in January 2024 than in December 2023, marking seven months of sustained increases. However, we have the equivalent of 1,830 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 registered at practices, with January 2024 seeing another record-breaking rise. GPs are now responsible for 18% more patients than in 2015, creating ever mounting workload pressures.  

  • In January 2024, the NHS had the equivalent of 27,534 fully qualified full-time GPs. This is an increase (48 FTE) from the previous month. January 2024 marks seven months of, albeit small, increases in full-time equivalent fully qualified GPs, with an additional 382 fully qualified GPs joining the workforce during this time. 
  • However, the NHS been losing fully qualified GPs at an alarming rate since 2015, with GP partners making up a substantial part of this shortfall (when this data set began). We now have the equivalent of 1,830 fewer fully qualified full time GPs than we did in September 2015. 
  • The GP Partner workforce in particular has been shrinking since 2015. There were 16,579 FTE GP partners in January 2023 but 16,176 in January 2024: a total loss of 403 FTE GP partners in the past 12 months alone. 
  • The number of GP practices in England has decreased by 106 over the past year – reflecting a long-term trend of closures and mergers. 
  • This fall in both staff numbers and GP practice coincides with a rise in patients: as of January 2024, there was another record-high of 63.15 million patients registered with practices in England – an average of 10,005 patients registered per practice. 
  • As a result, each full-time equivalent GP is now responsible for an average of 2,294 patients. This is an increase of 356 patients per GP, or 18%, since 2015, creating an ever-mounting workload in general practice. 

Read more on our analysis - “Pressures in General Practice”

HRT guidance updates

An updated HRT PPC guidance document has been published by DHSC. This is to reflect changes to the definition of products in scope of the HRT PPC, following the launch of new products onto the market, and an agreed process for managing discontinuations. The latest version can be found here: HRT PPC guidance | NHSBSA.

Preparing for the Spring 2024 COVID-19 vaccination campaign

Preparations are underway for the Spring 2024 COVID-19 vaccination campaign, following the achievements of the 2023 Autumn campaigns. The NHS is focusing on delivering a seasonal COVID-19 vaccine dose, aligning with government recommendations. Eligible cohorts include adults aged 75 and over, care home residents, and immunosuppressed individuals. Efforts are being made to ensure equity in access and address variations in uptake. Funding and contract arrangements are extended to support vaccination activities, with plans for supply and delivery to be finalised soon. The commitment of healthcare professionals is crucial for the campaign's success. Read more here.

PRSB survey – GP activity data

The Professional Records & Standards Body (PRSB) are surveying GPs as part of a set of proposals to implement a standard set of SNOMED codes to capture consultation mode and GP activity data. The survey closes on 15th March and seeks to garner views from practices on how day-to-day activity that takes place can best be defined and recorded.


NIHR In-Practice Fellowship

The NIHR In-Practice Fellowship (IPF) initially offered academic training to fully qualified general practitioners, general dental practitioners, and community dentists, who are in NHS practice in England. The eligibility for this scheme has been broadened in 2024 to cover all other health and care professionals working in a primary care setting, including (but not restricted to) nurses, midwives, pharmacists and health visitors. This enhanced offer will enable a larger cohort of health and care professionals to access research training and development, to advance their academic research careers. In-Practice Fellowship (IPF) Round 18 | NIHR

Professional Record Standards Body 

The PRSB is aligning its standards to the new Pathology standard (DAPB4101) going through approval at the DAPBin March. The current components used in PRSB standards were developed before the recent pathology standards. The PRSB need to ensure that test results and reports that clinicians receive can be shared digitally with their colleagues and can be incorporated into shared care records. The PRSB are asking clinical informaticians with an interest in pathology to review PRSB standards in light of the new standards to ensure that they align. To support this work, the PRSB are holding a webinar on Thursday 21 March, 11am - 1pm, to register click here.

GPC UK Regional Elections

The voting period is now open for seats to the General Practitioners Committee (GPC) in the following regions:

  • Norfolk/Suffolk/Great Yarmouth & Waveney 
  • Enfield & Haringey/Camden & Islington/Barnet/Kensington & Chelsea/Westminster 
  • Sefton/Liverpool/Wirral
  • Salford & Trafford/Manchester/Stockport 
  • Forth Valley/Fife/Lothian/Tayside 
  • E Sussex/W Sussex 
  • Derbys/Notts 
  • Herefordshire/Worcs/Warks/Coventry 
  • Birmingham/Solihull 

To submit your vote for any of the above seats please visit https://elections.bma.org.uk/

Non-BMA members - You will need a BMA web account to access the election – you may already have one if you have registered for one to attend an LMC conference or if you have previously been a BMA member – if you think you have an account but are not sure please email elections@bma.org.uk with your GMC number and the team can check for you. 

If you do not have an account, please contact support@bma.org.uk to let them know you need a web account to be able to participate in the GPC election. A member of the team will help you create an account and you will be assigned an BMA ID number, please email elections@bma.org.uk with this number and details of the region you wish to participate in. The team can then grant you access to the election. 

The deadline for voting is 12pm Tuesday 26th March 2024. 

If you have any queries regarding the election process, please contact elections@bma.org.uk.

UK LMC Conference 23 and 24 May 2024 – Newport Wales 

The deadline to register for the conference is Wednesday 1 May 2024. Please ensure that you have registered to attend as this is a registered only event. You can register here.

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

GP SOS - Save Our Surgeries 

Have your say on the 2024/25 GP contract changes – join the BMA and update your details now

Following the unanimous rejection by GPC England of the contract offer on the table from government, GPCE’s officer team have reopened talks about the GMS contract changes for April 2024 onwards, giving the Government until the end of the month to present significant improvements. A letter has also been sent to the Chancellor of the Exchequer, Jeremy Hunt, outlining the perilous state of general practice and reminding him of his supportive words when he was chair of the Health & Social Care Select Committee. We are now waiting to hear back from NHSE and DHSC.

Whatever is on the table at that point will be put to you, as BMA members, via a referendum in March. This won’t stop the Government from imposing the contract changes, but it will give us a vital insight into how the profession feels about the contract, and where we go next. We know you need hope, stability and safety in your day to day-to-day work and in your surgeries and this is the message we give to government frequently and will continue to do so.

You need to be a BMA member to have your say in the referendum. This means making sure your details are up to date, and spreading the word to friends and colleagues about joining the BMAWe plan to open the referendum in early March, so do keep an eye on your email for the voting link. The email will be from Civica, which is handling the referendum on the BMA’s behalf. 

To find out more about the current contract changes and why GPC England requested further changes, click here. I would urge you to watch and distribute the excellent video from Katie, our chair, explaining the perilous situation we face – you can find the video here.

General practice is in crisis. These figures are very revealing…

  • 1.9% (£178m) - national GP contract uplift for 2024/25 on offer from Government
  • £800m – value lost from the contract since 2019 due to cost inflation
  • 31% - average drop in GP contractor earnings before tax for 2022/23 compared with the previous year
  • 1,900 - fewer full time, qualified GPs since September 2015 when….
  • 6,000 - additional GPs were promised by this government in 2019
  • 1.39 million - average daily appointments delivered in general practice across England
  • 6.25 million - extra NHS general practice patients in Jan 2024 compared to 2015
  • £107 – practice payment per patient per year (excluding PCN and COVID payments)
  • 5-6% - of the overall NHS budget spent on general practice-level contracts in England in 2022/23 (latest data)
  • £0 – this is the deficit accrued by GP surgeries in 2023/24. We are a very efficient part of the NHS trying to cope with limited resources

LMC guidance on IA

The team have updated our advice around what LMCs can legally do in times of industrial action and also in preparation for potential action. The advice does not discuss types of industrial action or timings as this will be discussed as progress is made. (see attachment – February 2024 - Advice to LMCs regarding preparatory activity relating to industrial action)

Workforce data

See more infographics and data showing the pressures in general practice >

We urge practices to continue to use our safe working guidance to limit contacts to 25 per day in order to prioritise safe patient care, within the present bounds of the GMS contract.

Cloud based telephony

GPCE has written to NHSE to raise concerns over the rollout of CBT (cloud-based telephony) and the financial and workload impact this is having on practices along with pressure to sign complex contracts on very short deadlines. NHSE advised last year that there would be no increased costs to practices for their monthly contracts. We have relayed concerns raised about these issues and are seeking an urgent meeting with NHSE while calling for a pause of the roll-out of this contract mandated procurement exercise. 

We want to hear if you are seeing increased costs and please do email info.gpc@bma.org.uk with details of what you pay now and what you are being asked to pay going forward with the telephony provider.

GPs have been pressured at the last minute to sign up to new telephony systems at huge extra cost – despite reassurances from NHS England this would not be the case. Deputy chair Dr David Wrigley thinks this is a huge mistake and has called for an immediate pause, read more here.

Measles outbreak – practice staff and MMR vaccinations

This is an issue we are all facing in our practices, and we have been doing searches for patients who need vaccinating. We have written to NHSE asking for funding to do this additional work and pressed for negligence scheme cover. We can now advise that cover is in place and is outlined in the message below.

On behalf of Jane Freeguard, deputy Director of vaccination – medicines & pharmacy

In light of the national measles outbreak and urgency to support rapid uptake of the MMR vaccine, we are permitting practices to administer MMR vaccines to their eligible staff who are registered with another practice under INT (immediately necessary treatment). Please note this is a time limited arrangement until 31 March 2024 in light of the on-going national incident and only applies to MMR vaccinations.  

An item of service fee cannot be claimed for the administration of MMR vaccines to staff registered with another practice. However, indemnity cover will be provided through CNSGP and nationally supplied MMR stock can be used to vaccinate eligible staff. Staff must be strongly encouraged to inform their registered practice that they have received an MMR vaccine, requesting it be included in their medical record.

UK LMC Conference 2024 - deadlines

The deadline for submitting motions for the UK LMC Conference is noon, 1 March 2024 - submit your motions here. The deadline for registration is 1 May 2024.  Please note that even if you've booked your hotel you will still need to register for the conference here - although booking the hotel does not mean you are registered for conference.

For any questions, please email info.lmcconference@bma.org.uk.

GPC UK Regional Elections

Nominations are now open for seats to the General Practitioners Committee (GPC) UK in the following regions:

  • Norfolk/Suffolk/Great Yarmouth & Waveney
  • Enfield & Haringey/Camden & Islington/Barnet/Kensington & Chelsea/Westminster
  • Merton, Sutton & Wandsworth/Kingston & Richmond
  • Sefton/Liverpool/Wirral
  • Salford & Trafford/Manchester/Stockport
  • Durham/Cleveland
  • Somerset/N & E Devon
  • E Sussex/W Sussex
  • Derbys/Notts
  • Herefordshire/Worcs/Warks/Coventry
  • Birmingham/Solihull
  • Forth Valley/Fife/Lothian/Tayside
  • Gwent/Bro Taf/Morgannwg
  • Grampian/Highland/Orkney/Shetland/Western Isles
  • Northern Ireland

To be eligible to stand in a constituency, you must be a BMA member and one of the following:

  • a GP engaged in providing NHS primary medical services for a minimum of 52 sessions distributed evenly over six months in the year immediately before election
  • a GP on the doctors’ retainer scheme
  • a medically qualified LMC secretary

To submit your nomination for any of the above seats please visit https://elections.bma.org.uk/ by the deadline 12pm, 4 March 2024. For any questions relating to the role or GPC please contact info.gpc@bma.org.uk and for any queries regarding the election process elections@bma.org.uk

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

GP contract 2024/25 

GPC England has rejected the formal contract from the DHSC and NHS England (NHSE) for the General Medical Services (GMS) contract for 2024-25. 

After consideration at its meeting on 1 February 2024, the committee unanimously voted that the current proposal, including a 1.9% uplift, is unacceptable. The committee was clear that in order to prevent practices from reducing services or closing down altogether, a contractual uplift sufficient to keep practice finances stable for the ‘stepping-stone’ contract year ahead is imperative. The proposal as it presently stands ignores the compelling evidence presented by the BMA GPC England officer team, which quantifies the attrition in the item of service fees for vaccs and imms; the reimbursements eligible under the SFE and the contract value since 2019.  A contractual uplift of 1.9% to the global sum would also be disastrous for the employees of practices, including salaried and locum GPs and GP nurses.  

Details of the contract come at a time when a BMA survey of 10% of practices in England found almost two in three (64%) report being concerned about their short and long-term viability, and more than half (57%) have experienced cashflow issues within the last 12 months. We had estimated that up to one in four GP surgeries would need to reduce their services to ensure they can remain open for patients, yet this was before this year’s derisory contract position and proposed below inflation funding uplift. GPC England was unanimous in providing us with a mandate to return to the DHSC, NHSE and ministers in Government to continue urgent talks ahead of a final position, which the profession will be asked to vote upon, in a referendum next month. 

We’ve said from the beginning, our door will always be open to ministers and their teams. We’re willing to do all in our power to find a solution. As such, GPCE officers will now seek further discussions with the Government and NHS England to improve the GP contract to bring back hope, safety and stability to all GP practices across England. 

Referendum and next steps 

We have produced a webpage with everything you need to know about the current GP contract changes and what we plan to do next. Remember, whatever is on the table come March 1st will be put to you in a referendum which will enable the profession to decide whether the offer sufficiently supports general practice in England for the forthcoming financial year, or not.  to decide whether the suggested changes sufficiently support general practice in England for the forthcoming financial year, or not.  

To be eligible to vote in the referendum, you need to be a member of the BMA to have your say.  This means making sure your details are up to date and spreading the word to colleagues about joining the BMA. The referendum won’t prevent the Government from imposing changes to the contract, but it will give us vital insight into how the profession feels, and where we go next. 

Update your member details on www.bma.org.uk/my-bma and share this email with your colleagues and encourage them to join the BMA today to have your say. Visit our GP contract page here 

Pharmacy First 

Last Wednesday (31 January), NHS England launched the Pharmacy First initiative, whereby patients in England will be able to get treatment for seven common conditions at their high street pharmacy without needing to see a GP. 

Community pharmacists can play an important role in delivering non-urgent basic care, which in theory can help reduce our incredibly busy workload as GPs. However, there are concerns that this scheme is being rolled out too quickly, and will rely on an inadequate IT infrastructure that will ultimately increase the administrative burden on practices, not lessen it. With almost 2,000 fewer fully qualified, full-time GPs than in 2015, this will put further pressure on a system already close to breaking point.  

What patients want, and have always wanted, is the ability to access what they need from their local practice in a timely manner, and this must remain a priority. This remains in the Government's gift; we urge them to allow existing ringfenced funds, currently used to employ non-medical practitioners, to be used more flexibly so that practices can hire more GPs and nurses who are ideally placed to manage simple conditions. 

GPCE letter to NHSE regarding the Measles outbreak  

GPC England wrote to NHS England last week highlighting our serious concerns around the current Measles outbreak and the need for urgent support and resources in general practice.  

The communications from NHSE and UKHSA show the lack of accompanying infrastructure, planning and resources to help address the outbreak within general practice. We have explained how the increase in workload generated by patient queries, requests for vaccination history cross-checking, and unresourced catch-up vaccination clinics, seriously risks impacting upon practice service delivery. We reiterated our request and belief that lowering the thresholds for vaccination QOF payments would enable greater coverage, rather than the current financially punitive approach that is in place. 

We have requested an NHSE-mandated urgent rollout of time-limited packages of support for ICBs, and a Measles Vaccination Enhanced Service. The enhanced service would also cover the inherent costs to set-up and staff necessary clinics to limit the impact on normal day-to-day care. 

The letter was also shared in a meeting with the parliamentary under-secretary for primary care, Andrea Leadsom. 

GPC England Response to The Times Health Commission report 

The Times Health Commission report was published this week, making some key recommendations for immediate future NHS commissioning, with a lot of attention focused on how IT and data isn’t able to link up across NHS organisations. A seductive vision of all shared health and care records and data in one place sounds good, but fundamental missing steps along the way risk making that distant dream an impossibility.  

To free up millions of appointments, we need hospitals to be able to produce electronic prescriptions, and to be able to explain to a patient where they are in a queue after disappearing down a referral ‘black hole.’ Hospitals should be following a patient; the same way online shopping follows a parcel. 

Those of us working on the ‘shop floor’ of the NHS, stand ready to suggest many practical ways to improve financial efficiency and operational productivity (that won’t cost us millions to implement) but which will need genuine integrated thinking outside of the acute hospital model. This is what we need, which we are glad to see recognised in this report. 

The elephant in the room is resource, and we note difficult requests for detailed capital investment requirements are not outlined, which is a missed opportunity. GPC England believes that the million patients which GPs see every day recognise that if we are to make any progress, we need additional funds for additional activity, serving additional patients. We also need to recognise the forgotten millions on mental health waiting lists who aren’t included in media headlines but who GP and community teams feel are being ignored, especially children and adolescent mental health need. 

Access to records – ICO response to DPIAs 

Following DPIAs being submitted by many practices relating to the accelerated access to records programme, the ICO (Information Commissioner’s Office) this is a reminder that the ICO published its advice last month. The ICO is content that ‘potential data protection risks have been identified, and that sufficient mitigations are in place.’ Practices that haven't completed a DPIA are encouraged to do so and make their commissioners aware.  If practices identify particular data protection risks associated with providing online access, which they do not consider to be mitigated, they should consult and engage with the ICO and their commissioner to find a way forward. 

The ICO is technically correct that in theory, a practice could expend whatever infinite resource it wished in order to comply with the contractual requirement to give access. Because a practice could theoretically mitigate (at enormous cost) the ICO is content that the Data Protection Act will not be broken.  

It's what the ICO has not said which is telling. Reading between these lines, one may infer that if mitigations were not in place (i.e. access was blanket switched-on, as may have happened in many cases) there may be questions over the legality. Hence the BMA's advice is that as a practice you must still construct a DPIA and keep your commissioners updated. If you are facing local issues, let us know and be sure to include your LMC in such discussions. 

Workforce data 

Our BMA teams collate monthly workforce and appointment data on the pressures in general practice data analysis webpage, which is a great resource for signposting PPGs, local press and MPs. 

The overall number of GPs has seen little growth since 2015, with the number of GP partners declining significantly over that time. As of December 2023, there were 37,068 fully qualified GPs working in the NHS in England, with around 7.8 GPs per 10,000 people, and would need an additional 16,700 GPs to be on equal footing with the OECD average of 10.8. 

Despite the Government’s promise to recruit an additional 6,000 GPs by 2024 to reverse the stasis in GP workforce numbers, there are now the equivalent of 1,877 fewer fully qualified full-time GPs compared to September 2015. 

See more infographics and data showing the pressures in general practice > 

We urge practices to continue to use our safe working guidance to limit contacts to 25 per day in order to prioritise safe patient care, within the present bounds of the GMS contract. 

COVID-19 vaccination programme update 

NHS England have published an extension to the COVID vaccination service specification ahead of the proposed spring/summer booster programme.  The specification remains mostly unchanged from the current Autumn/Winter programme, however, following discussions with GPC England, there will be an additional £2.50 payment per vaccination for vaccinations from April-August 2024, in addition to the £7.54 Item of Service fee.  Whilst this move is welcome, we retain strong concerns about the future financial viability of the programme, and we again recommend that practices and their partners make a full assessment of whether delivery of the vaccination programme remains viable for them. 

Cloud based telephony 

GPCE has written to NHSE to raise concerns over the rollout of CBT (cloud-based telephony) and the financial and workload impact this is having on practices along with pressure to sign complex contracts on very short deadlines. NHSE advised last year that there would be no increased costs to practices for their monthly contracts. We have relayed concerns raised about these issues and are seeking an urgent meeting with NHSE while calling for a pause of the roll-out of this contract mandated procurement exercise.  

Tweet your MP and local 2024 general election candidates about #WhyCantISeeMyGP  

A new book by Cumbria LMC member Dr Ellen Welch highlights the crisis facing general practice today.  is already listed as a best seller on Amazon and is being reprinted. Dr Welch said: “This book shines a light on how general practice holds the NHS together. We urge anyone with a stake in the NHS – staff, patients, leaders – to take a read. If general practice fails, the NHS fails so we need both understanding and investment from our government.” 

The book is full of personal accounts from GP leaders including GPC England deputy chair Dr David Wrigley. Katie Bramall-Stainer, chair of GPC England, said: “As the saying goes, ‘you don’t know what you’ve got ’til it’s gone’. Thankfully this book presents us with solutions, and I gifted an advance copy to Minister Leadsom for Christmas!” 

Please use the resources on this page to write to your MP and spread the word on social media. 

BMA divisional elections 

Elections are taking place within BMA divisions to choose local representatives to attend the BMA 2024 ARM (annual representative meeting). The ARM debates important policy issues that affect the whole profession and conducts elections to many BMA committees, so a strong GP voice and influence is important. All GP colleagues are encouraged to review the local nominated candidates in their divisions and vote accordingly. Voting closes noon, 13 February. Access the election portal > 

GPC UK Regional Elections 

Nominations are now open for seats to the General Practitioners Committee (GPC) UK in the following regions: 

  • Norfolk/Suffolk/Great Yarmouth & Waveney 
  • Enfield & Haringey/Camden & Islington/Barnet/Kensington & Chelsea/Westminster 
  • Merton, Sutton & Wandsworth/Kingston & Richmond 
  • Sefton/Liverpool/Wirral 
  • Salford & Trafford/Manchester/Stockport 
  • Durham/Cleveland 
  • Somerset/N & E Devon 
  • E Sussex/W Sussex 
  • Derbys/Notts 
  • Herefordshire/Worcs/Warks/Coventry 
  • Birmingham/Solihull 
  • Forth Valley/Fife/Lothian/Tayside 
  • Gwent/Bro Taf/Morgannwg 
  • Grampian/Highland/Orkney/Shetland/Western Isles 
  • Northern Ireland 

To be eligible to stand in a constituency, you must be a BMA member and one of the following: 

  • a GP engaged in providing NHS primary medical services for a minimum of 52 sessions distributed evenly over six months in the year immediately before election 
  • a GP on the doctors’ retainer scheme 
  • a medically qualified LMC secretary 

To submit your nomination for any of the above seats please visit https://elections.bma.org.uk/ by the deadline 12pm, 4 March 2024. For any questions relating to the role or GPC please contact info.gpc@bma.org.uk and for any queries regarding the election process elections@bma.org.uk 

LMC Secretaries Conference 2024 

The LMC secretaries conference is taking place on Friday 15 March 2024 at BMA House in London. To register to attend please use the online application form available here, each person attending the conference must register by completing a registration form regardless of how they are planning to attend i.e. first, second or observer, the closing date for registration is 23 February 2024.  

Please contact the GPC office at info.lmcconference@bma.org.uk with any queries. 

UK LMC Conference 2024 - deadlines 

The deadline for submitting motions for the UK LMC Conference is noon, 1 March 2024 - submit your motions here. The deadline for registration is 1 May 2024.  Please note that even if you've booked your hotel you will still need to register for the conference here - although booking the hotel does not mean you are registered for conference. 

For any questions, please email info.lmcconference@bma.org.uk

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_GP and read about BMA in the media. Contact us: info.GPC@bma.org.uk 

Read the latest GPC England bulletin 

Read the latest sessional GPs newsletter 

Referendum of the GP 2024/25 Contract – Join the BMA today and have your say

Your national team are anticipating a final contract proposal for 2024/25 from the DHSC (Department of Health and Social Care), together with NHSE (NHS England) to arrive later today – Friday 26 January. Your national committee, GPC England, will be meeting to fully consider this offer next week, on Thursday 1 February.  In line with LMC conference policy, we are preparing to hold a referendum which will enable colleagues to decide whether the offer sufficiently supports general practice in England for the forthcoming financial year, or not.

To be eligible to vote in the referendum, you need to be an NHS GP, practising in England, and a BMA member. You can join the BMA hereWe will be writing to you again the week after GPCE meets with more details.

We recognise that the Government can still choose to impose a contract, regardless of a referendum outcome. It will, however, provide a vital temperature check of the profession which we can then share with ministers, the Department of Health and Social Care and NHS England.

Whether GPC England feels able to recommend the contract offer for 2024/25 will depend on whether it fulfils its promise to be a sufficiently stabilising ‘stepping stone’ contract following the end of the 2019-24 multi-year contract framework and PCN DES. We have been clear with the Department and NHS England that the 2024/25 contract must bring hope for the future and return confidence to our profession; allow practices to feel safe in delivering a sustainable service; deliver safe care for patients; and permit a safe working environment within which they can recruit and retain GPs and the wider essential practice team.

There are no surprises here, for context in Spring 2023, GPC England voted to prepare to ballot GPs on taking collective action if the Government did not ‘drastically improve the contract’ in these negotiations. With those discussions now reaching their conclusion, GPC England and the profession have important decisions to make. If there is no positive outcome to current talks with ministers, DHSC and NHSE, the spectre of GP collective action in 2024 remains. 

If you are a GP member practising in England within the NHS, make sure the details we hold for you are up to date to ensure your vote counts. Tell your partners, colleagues, peers and friends. Update your member details on www.bma.org.uk/my-bma share this email or join us as a member today.

Ensure everyone has a voice – please encourage your colleagues to join the BMA

Medical Examiners’ arrangements and changes in the Medical Certificate of Cause of Death

Colleagues will recall the ultimately postponed March 2023 introduction of the Medical Examiner (ME) scrutiny of non-coronial deaths in the community; this is now planned to be implemented in April 2024.

Regrettably there is no consistency within the England wide rollout; instead, ME units have been asked to form geographically appropriate links with local GP practices; this then means each practice should know where the deceased’s details, including medical records and the proposed MCCD (Medical Certificate of Cause of Death), should be sent. If a GP wishes to report a death to the coroner instead, they can still do so but increasingly it is likely the coroner’s office may ask if this referral has been discussed with the medical examiner first. 

The purpose of the ME scrutiny is to:

  • review the proposed cause of death on the MCCD
  • review the care offered to the deceased prior to their death
  • to offer an opportunity for the bereaved to ask any questions about, or put forward any concerns in relation to, the deceased’s care. 

The ME can contact the GP who has written the proposed MCCD to discuss this, or any information in the medical records. If all goes smoothly, the ME will confirm the proposed MCCD with the Registrar, GP practice, and a person who can act as the informant in terms of registering the death – normally a family member of the deceased.

The ‘attending practitioner’ will remain responsible for completing the MCCD, although there is now provision for a GP not being available, as in exceptional circumstances the ME can write a MCCD. If the ME and attending GP cannot agree on the cause of death, the matter will be referred to the Coroner.

To complement the ME arrangements, a new paper MCCD will be available from April 2024, with an online version promised later this year. This will include: 

  • details of the ME who scrutinized the cause of death
  • ethnicity, if this is recorded in the deceased medical records
  • medical devices and implants to be recorded on the MCCD by the attending practitioner.

The current Crematorium Form 4, and the private fee payable, is being abolished. Based on feedback so far, GPC England has the following concerns:

  • the provision of information to ME Units from practices may be administratively burdensome in some cases
  • ME units may not have sufficient capacity to undertake the scrutiny of community deaths within reasonable timescales and be unable to adapt these timescales to faith groups with particular expectations
  • ME units may not appreciate the level of patient concerns and distress about delays in this process, as these concerns are currently being directed to practices.

GPC England recommends LMCs ask all practices to confirm their links with local ME units and to test the system for reliability and administrative burden. GPC England has written to the National Medical Examiner to highlight these continuing concerns.

EMIS and coding problems for QOF

The Joint GP IT committee (with representatives from GPC England and RCGP) met last week. EMIS had been invited to speak following concerns raised by members about QOF/coding problems and medications missing from data sets following EMIS updates MKB 203, MKB 204 and MKB 205. EMIS is aware of these issues and apologised for them. They assured the committee they have been working to resolve them.

EMIS plan to release MKB 206 by the end of January to remedy the issues caused by previous updates. Once MKB 206 has been released, if you continue to run into problems, please do get in touch so we can collate concerns and share these with EMIS and resolve any further issues email: info.gpc@bma.org.uk. We recognise this has had an impact on your QOF work in this critical time running up to April and we have made EMIS aware of the seriousness of the situation for hard-pressed colleagues. 

Access to Records – ICO response to DPIAs

Following submission by many practices of their DPIAs (Data Protection Impact Assessments) relating to the accelerated access to records programme, the ICO (Information Commissioner’s Office) has decided to publish its advice ‘so GPs affected are aware of the ICO’s views on the matter.’ Read the advice >

The ICO is content that ‘potential data protection risks have been identified, and that sufficient mitigations are in place.’ Practices that haven't completed a DPIA are encouraged to do so and make their commissioners aware.  If practices identify particular data protection risks associated with providing online access, which they do not consider to be mitigated, they should consult and engage with the ICO and their commissioner to find a way forward.

GP end of year forms: submission deadline extended to 31 March

All Type 1 and Type 2 practitioners must complete the relevant certificate or form and submit to Primary Care Support England (PCSE) for work in England, or their local Health Board for work in Wales.

The release of both they Type 1 and Type 2 forms was delayed this year, and as a result the deadline for submitting these has been extended to 31 March 2024.

BMA divisional elections

Elections are now taking place within BMA divisions to choose local representatives to attend the BMA 2024 ARM (annual representative meeting). The BMA ARM debates and develops important policy issues that affect the whole profession, it also conducts elections to many of the BMA’s committees, so a strong GP voice and influence is important. All GP colleagues are encouraged to review the local nominated candidates in their divisions and vote accordingly.

You can access the BMA election portal here (BMA members only) and click on “Online elections”:

NHSE GP Fellowship Scheme cessation

NHSE has announced that the NHSE GP Fellowships and Mentor schemes will end on 31 March 2024.

We would like to remind and encourage those GPs who are within 24 months of having CCT’d on 31 March, and who have not yet taken advantage of the NHS GP Fellowship Scheme, to sign up for the programme in advance of the 31 March deadline. Those successful in securing a place ahead of the deadline will have funding secured for two years. Please get in touch with your local Training Hubs for details regarding how to register. Please share this information across your trainers and First 5 groups. Please also send any feedback on the programmes to info.gpc@bma.org.uk

Rebuild General Practice – template letter to MPs

Rebuild General Practice is asking GPs to use its template letter to write to your local MP asking them to prioritise rebuilding general practice in their election roadmaps. Party manifestos are being written this spring, and we can make a difference by speaking as one unified voice and profession, to engage MPs, and local press. We must ensure that all major parties are motivated to prioritise the crisis in general practice and are committed to developing plans to do so following the election.

Find all the materials you need to take part in this action here

1. Write to your MP 

2. Share the social media thread: https://twitter.com/RebuildGP/status/1750131367575204082 

3. Write to your local newspaper editor to inform them of this action. 

4. Encourage your colleagues to do the same by sharing your post and the materials with them.

UK LMC Conference – deadlines

The deadline for UK LMC conference registration is 1 May 2024.  Please note that even if you've booked your hotel you will still need to register for the conference via https://events.bma.org.uk/uk-conference-of-lmcs-2024/registration - although note that booking the hotel does not mean you are registered for conference.

The deadline for submitting conference motions is noon, 1 March 2024.  You can submit your motions here.

Any questions regarding registration and submission of motions please email info.lmcconference@bma.org.uk.

Extension of services for GP partners

For GP partners who are BMA members, we provide HR and employment law advice for you or your delegate. The BMA Employer Advisory Service is now offering a valuable extension of its services under the EAS: GP Enhanced Services Pilot. In addition to providing HR and employment law advice to GP practices through the BMA’s GP partner membership, we are delighted to offer:

  • support at formal meetings*: disciplinary, grievance or appeal hearing (remote or in person)
  • interpersonal mediation between practice staff  
  • support in conducting investigations in preparation for disciplinary or grievance meetings.

Please contact the BMA on 0300 123 1233, or email support@bma.org.uk.

*excluding those involving employed/locum doctors.

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). We have produced a document which includes some tools for improving workload and safe working. A range of wellbeing and support services are also available to doctors, from the BMA’s counselling and peer support servicesNHS practitioner health serviceSamaritans 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_GP and read about BMA in the media. Contact us: info.GPC@bma.org.uk

Read the latest GPC England bulletin

Have your say now on the future of general practice COMPLETE OUR SURVEY

We know how busy you all are - but we need your help, and we need to hear your voice.

2024 marks both the 20th anniversary of the introduction of the 2004 GMS contract, and the end of the current 2019-24 five-year investment framework. A general election is also likely later this year, and potentially, a new Government.

With change comes opportunity, and a window to influence how we deliver patient care now, and for the years ahead. 

As your representatives, we are keen to feed your views into our strategy to help influence the future direction of General Practice.  We will be articulating our vision outlining the direction we need to see for our patients, profession and practices determined by those who know it best: GPs themselves. 

This is where you come in. We want to give you a voice.

The next 6-12 months are key, and we need to make the most of this window of opportunity to influence, shape and inform the future.

If you only respond to one survey, make it this one.

We want to hear from all fully qualified GPs an ST3/4 GP Registrars in England, including non-BMA members.

The survey will close on Sunday 21 January 2024 but please complete it as soon as you're able.

Share the survey via WhatsApp with all your GP colleagues now 

Preparation for any future ballot

We need our GP contract to feel safe to sustain services and deliver for our patients. We need our workload to feel safe to retain and recruit GPs and the wider practice workforce. We have been clear with DHSC and NHSE that 2024/25 must bring hope for the future of our profession. This is also the will of GPC England, who in April 2023 voted to prepare to ballot GPs on taking collective action if the Government does not “drastically improve the contract” in 2024/25 negotiations.

At the England Conference of LMCs 2023, Conference also voted to take the outcome of future contract negotiations to the profession. Tell your colleagues and partners to join the BMA today.  

Death certfication reforms

The government has confirmed that the death certification reforms will be enacted from April 2024, including the role of the medical examiner (ME) becoming statutory. Once the new death certification process comes into force, all deaths in England and Wales will be independently reviewed by a medical examiner or a coroner. The main changes:

·       NHS trusts hosting a medical examiner office should provide adequate support and ensure the independence of medical examiners is respected.

·       All other healthcare providers including GP practices should set up processes to start referring deaths to medical examiner offices if they have not already done so. There is a podcast on how medical examiners can support GPs and their work with bereaved people.

·       Integrated Care Boards (ICBs) in England should ask all healthcare providers in their area to establish processes to refer relevant deaths to medical examiner offices for independent scrutiny as soon as possible.

Other changes including a new Medical Certificate of Cause of Death, which can be completed by a doctor who attended the deceased at any time (at present MCCDs can only be completed if the doctor saw the patient within 28 days before death or after death). Read more here

GP pressures and workforce data

Our BMA teams collate monthly appointment and workforce data onto our website, which is a great resource for signposting PPGs, local press and MPs. November 2023’s data shows that the NHS in England has 1,881 fewer fully qualified FTE GPs than we did in September 2015. The number of GP practices in England has also decreased by 112 over the past year – reflecting a continued trend of closures as well as mergers primarily due to a lack of workforce that coincides with a rise in patients.

Around 31.5 million appointments were booked in November 2023, with an average of 1.43 million appointments being delivered per working day, which is above the average of 1.39 million per day for the past year. In addition, as of November 2023, there was another record-high of 63.03 million patients registered in England, with an average of 9,977 patients registered per practice. A single full-time GP is now responsible for around 2,300 patients – an increase of 18% since September 2015, demonstrating the ever-mounting workload in general practice.  

Click here for more infographics and data on showing the pressures in General Practice.

We urge practices to continue to use our safe working guidance to limit contacts to 25 per day in order to prioritise safe patient care, within the present bounds of the GMS contract.

Sessional GPs locum work challenges

The Sessional GPs Committee continue to hear increasing reports from our constituents that they are struggling to find locum work in practices. Practice finance pressures as highlighted in our recent practice finance survey and the need to use.

ARRS funded (which exclude GPs) has resulted in a huge reduction in available locum shifts, leaving many GPs unable to work.

We have raised these concerns face to face with NHSE and DHSC and, via the GP wide survey, are gathering increasing evidence of this issue. We will continue to lobby for the inclusion of GPs (and practice nurses) in the ARRS. Patients want and deserve to see a GP and at a time when we have a supposed shortage of GPs it is unconscionable that anyone should be struggling to find employment or that patients are denied the benefits of the skills and expertise those GPs have spent their entire careers developing. 

It is GPC England’s view that it would be appropriate to include General Practitioners (and Practice Nurses) as reimbursable roles within the ARRS programme. Had the considerable financial support associated with the ARRS programme over the past five years been directly available to General Practitioners for use within their practices, without the constraints on recruitment associated with the PCN DES specification, this would have created a far more flexible, responsive and sustainable solution to the workforce crisis facing General Practice. We also believe this would have resulted in better value for money from ARRS funding in terms of patient care.

Without the necessary support that General Practice so desperately needs from NHSE/DHS, in order to provide safe, effective and efficient care to its patients, we can expect to see further losses of GPs from the NHS, and from England to elsewhere with a consequent continued erosion in the standards and quality of care provided.

Online access to records - data breaches from misfiling of records

There is ongoing work continuing behind the scenes   focusing on making the online access to records project safer. Our outstanding concerns regarding how this was imposed on the profession can be found here.

If you have any examples of potential or actual harm that has arisen, for example: the accidental misfiling of data/letters in the wrong patient's record, or when information should have been withheld from online view in order to prevent harm, but wasn't, and which has only come to light now more patients have access to their records, please pass on details to info.gpc@bma.org.uk.

Direct access to diagnostic tests

NHSE has published ‘Enhancing GP direct access to diagnostic tests for patients with suspected chronic obstructive pulmonary disease, asthma, or heart failure’. This is non-clinical guidance for systems which should be helpful for LMCs in local discussions about availability of Spirometry, FENO and NT-proBNP. It is clear that commissioners should continue with local services where they exist but that additional services should also be in place, which must be made available for GP referral via eRS.

NHSE has been explicit that they are not the commissioner of these services and decisions on exactly what is commissioned rests with local ICBs.  This guidance confirms that these services should be made available for all GPs to refer to, therefore clarifying that practices should not be expected to provide, unless appropriate funding is in place.

Lipid modification resource implications

GPCE, along with RCGP, met several times with NICE about ‘Cardiovascular disease: risk assessment and reduction, including lipid modification’.  LMCs have raised concerns about QOF targets and the resource implications of providing alternative lipid lowering agents such as ezetimibe, Inclisiran and PCSK9 inhibitors.

As a result of these meetings, NICE reviewed its Resource assessment, which recognises the additional costs and demand on GP appointments associated with prescribing and administration of Inclisiran; and that PCSK9 inhibitor prescribing is mainly hospital based and likely to remain low. As these services will be commissioned locally and NICE has produced a template for ICBs to assess local resource implications, which includes the additional GP appointments likely to be required.  The NICE guidance committee stated that ‘increased uptake of lipid-lowering treatments is necessary for an overall improvement in population health, but that the extra cost of lipid-lowering treatment would be partly offset by savings due to a reduction in CVD events (including hospital admissions for stroke, heart disease and cardiovascular procedures).’  Therefore we would encourage LMCs to utilise this is local negotiations when ICB medicines committees are considering General practice provision of Inclisiran and PSCK9 inhibitors, and for the negotiation of Locally Commissioned Services to provide Inclisiran.

King’s New Year Honours

We are delighted that the following GPs have been recognised in the King’s New Year Honours list:

  • Dr Chandra Kanneganti, Goldenhill Medical Centre, North Staffordshire; North Staffordshire LMC Chair, and GPC England member, has been awarded a CBE for services to general practice.
  • Dr Terry John, Firs Medical Centre, Waltham Forest, previous chair of the BMA’s International Committee, receiver of the BMA’s President’s award in 2020-21, and previous GPC England member, has been awarded a BEM for services to medicine.
  • Dr Meena Nagpaul, Honeypot Medical Centre and Clinical Director, Harrow East Primary Care Network, has been awarded an MBE for services to the NHS.

Congratulations to all on receiving these much-deserved awards.

NHS Vaccination Strategy

In December NHS England announced their long delayed ‘vaccination strategy’, following an initial consultation in 2022. The strategy aims to support and boost vaccination rates in England.  GPC England will be discussing its approach to this and what it means for General Practice over the coming months. when it meets on February 1st. We shall respond in the coming weeks once 2024-25 contract negotiations have concluded.

DDRB Evidence submission for GPs across England

BMA Council took a decision in November to undertake a referendum of divisions on ARM policy following a motion from GPC England chair and BMA Council member for Eastern Region, Katie Bramall-Stainer. This led to BMA Divisions being invited to hold division meetings and vote afresh on the policy in line with Articles 69 and 70 of the articles and bye-laws of the Association.

22 Divisions participated in the referendum and a total of 135 votes were received. There was an overwhelming vote to overturn the existing policy, which has now been removed from the policy book, and all committees, including GPC England are now able to submit evidence to the DDRB. Our thanks to all the honorary secretaries of those divisions who went out of their way to arrange meetings.

MAPs to be regulated by the GMC - write to your MP

The Government has announced that physician associates and anaesthesia associates are to be regulated by the GMC. The BMA thinks that this will add further, dangerous confusion and we need every MP to be aware of this issue, oppose the legislation and force the Government to abandon its plans. Please help by using our tool to email your MP.

LMC Secretaries Conference

The LMC secretaries conference is taking place on Friday 15 March 2024 at BMA House London. To register to attend please use the online application form available here, each person attending the conference must register by completing a registration form regardless of how they are planning to attend i.e. first, second or observer, the closing date for registration is 23 February 2024. 

Please contact the GPC office at info.lmcconference@bma.org.uk with any queries.

LMC England Conference 2023

Watch a recording of the Annual Conference of England LMCs 2023, held on 23-24 November 2023:

Day 1: Bma Live Stream (streameventlive.com)

Day 2: https://bma.streameventlive.com/archive/323

Read more about the event, including the resolutions, here: Local medical committees (bma.org.uk)

BMA Annual Representatives Meeting 24 –25 June 2024

Calling all GPs to self-nominate for the ARM (annual representatives meeting) which considers important policy that affects the whole profession.

The RB (representative body) is made up of constituent bodies that sends elected representatives to the ARM each year to debate on and pass new BMA policies. It also conducts various elections, considers reports from council, the board, and committees.

We’d like a strong GP presence, so please put yourself forward!

Deadline to nominate is 19 January 2024 via this link

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). We have produced a document which includes some tools for improving workload and safe working. A range of wellbeing and support services are also available to doctors, from the BMA’s counselling and peer support servicesNHS practitioner health serviceSamaritans 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_GP and read about BMA in the media. Contact us: info.GPC@bma.org.uk

Read the latest GPC England bulletin

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