Safe working and preparing for balloting on industrial action
Current working conditions are not safe, for patients or GPs, and the contractual changes imposed by NHS England in April do not recognise the immense pressures that GPs are under. Practices are strongly encouraged to continue to use our safe working guidance to help prioritise safe patient care, within the present bounds of the GMS contract.
We need to come together to save general practice, defend our profession, and make general practice safe for patients. The BMA’s GP committee has voted to prepare to ballot GPs on industrial action if the Government does not agree to improve the contract drastically in forthcoming negotiations. The BMA will be communicating directly with GPs and LMCs over the coming weeks and months.
At the LMC UK Conference last week, representatives passed a motion calling for the GMC, who has already confirmed they will not act against junior doctors taking industrial action, to extend this pledge to GPs, should they also invoke their legal right to take industrial action.
We are asking you to join us as we prepare for potential industrial action. By law, only BMA members can participate in a ballot on industrial action, and the more BMA members working collectively sends a powerful message to government that the present situation must urgently change. If you are a member, it is essential that you make sure the details we hold for you are up to date to ensure your vote counts. Update your member details on the BMA website www.bma.org.uk/my-bma or join us as a member today.
Workforce data
The latest workforce data, published yesterday, show that the number of fully qualified GPs has significantly declined since September 2015. In April 2023, the NHS in England had the equivalent of 27,231 fully qualified GPs, which is 2,133 fewer than in September 2015.
Over the past year the NHS has lost the equivalent of 512 fully qualified, full-time GPs, and on a headcount basis, we have lost428 GP partners and 149 salaried, locum and retainer GPs – creating a net loss of 577 individual GPs from the NHS since April 2022 – more than 1 GP per day.
This coincides with a rise in patients: as of April 2023, there was a record-high of over 62.43 million patients registered with practices in England. As a result, the average number of patients each full-time equivalent GP is responsible for continues to rise, and is now 2,292. This is an increase of 355 patients per GP, or 18.3%, since 2015, demonstrating the ever-mounting workload in general practice.
These figures both demonstrate the need for government to take urgent steps to make general practice sustainable again, and the government must focus its efforts on addressing the workforce crisis across the NHS, investing in the health and appropriately valuing staff. That is the only way to tackle the record-breaking backlog and help patients who are desperate to be treated swiftly and close to home.
Read more about the pressures in general practice here
BMA member briefing on the GP delivery plan
In May 2023, NHS England and DHSC jointly published their Delivery plan for recovering access to primary care, setting out how they intend to tackle the ‘8am rush’ and make it easier and quicker for patients to access primary care services.
Whilst some of our recommendations have been incorporated into the plan, in our view it falls short and fails to address the severe inflationary cost pressures all practices currently face. We are also very concerned that the continuing cuts to public health funding and the lack of adequate investment in practices and community pharmacies will negate the commitments set out in the plan.
Alongside our initial press statement responding to the plan’s publication, we have also produced this member briefing on the report.
We will share with practices and LMCs some resources to support local implementation of the primary secondary care interface elements of this plan.
Labour Party's NHS plan - Building an NHS fit for the future
Earlier this week Sir Keir Starmer announced the Labour Party's NHS plan Building an NHS fit for the futureand in his speech he declared that Labour will modernise appointment systems and get salaried GPs to serve all communities. We will be writing to Sir Kier to ask how they are planning to do this, highlight the huge benefits of the independent contractor model, and offer to help shape their finer detail. RRead the statement in response to the plan by Phil Banfield, Chair of BMA Council.
Annual flu letter
UKHSA and NHS England have published the annual flu letter for the 2023/24 flu vaccination programme. Practices should be aware that there are no changes to the reimbursable vaccines from the 2022/23 programme. Further details will be available once the specification has been agreed and published.
Oliver McGowan Mandatory Training on Learning Disability and Autism
All GP practices in England must ensure their staff receive training in learning disability and autism, including how to interact appropriately with people with a learning disability and autistic people. This requirement was introduced by the Health and Care Act 2022 in July last year. The government’s preferred training programme is the Oliver McGowan Mandatory Training on Learning Disability and Autism. However, the Act does not specify a training package or course for staff. The CQC cannot tell practices specifically how to meet their legal requirements in relation to training, and while NHS England and ICBs may share the government’s training programme preference and encourage uptake, it is ultimately for practices to determine how their staff are trained to meet their legal requirements. Further information is available here.
EMIS reverses panic button decision
BMA lobbying has helped GP practices to retain the EMIS panic button, which is used in emergency situations, as EMIS has decided that the EMIS panic button will continue to be available for practices who wish to keep it.
The number one priority for any doctor is ensuring patient safety, which is why changes to the EMIS system have an impact. We have a duty of care to voice our concerns when there is a risk, and are pleased to see they have been taken seriously.
Although we know that some practices face technical challenges with the system so do not use it, this is a sign that the NHS IT infrastructure is seriously inadequate. We need to see actual investment in practices to not only help them stay open, but ensure that they are as safe a space as possible.
OpenSAFELY
In recent months GPCE’s Digital Transformation Policy Group, along with the Joint GP IT Committee, have been providing scrutiny to the forthcoming Data Provision Notice (to be sent under the COVID-19 Directions from the Secretary of State for Health and Social Care) that will allow OpenSAFELY to continue to operate as a Trusted Research Environment (TRE) once its COPI permission expires on 1 July 2023. It has been a complex process with regard to information governance.
The proposal speech to Motion 12 at the conference of England LMC representatives last November referenced the OpenSAFELY TRE as one that has the support of the profession. This remains the case. Practices will not need to do anything and formal communication from NHS England explaining the evolving legal basis for operation will be coming soon.
LMC meetings
The GPC England officers are keen to continue to engage with LMCs throughout the country. This is a vital time for the profession and GPCE’s leadership wants to be on hand to answer any queries and provide information that LMCs require. If it would be beneficial for a GPCE officer to virtually attend your LMC meeting, then please get in contact with Karen Day (kday@bma.org.uk) with the time and date of the meeting, as well as which LMC you are contacting GPCE on behalf of.
ARM 2023 - agenda
The Agenda for the BMA’s ARM (Annual Representative Meting), which will be held 3-5 July, has now been published - access it here.
GPC England committee pages and guidance for practices
Read more about the work of the Committee
Read practical guidance for GP practices
See the latest update on Twitter: @BMA_GP / Twitter @TheBMA / Twitter
Read about BMA in the media: BMA media centre | British Medical Association
Contact us: info.GPC@bma.org.uk
Read the last bulletin: Safe working in general practice | industrial action ballot preparations | new workforce data
Read the latest Sessional GPs newsletter
Preparing for balloting on industrial action
Last month, the BMA’s GPs Committee for England voted in favour of preparing to ballot GPs in England on industrial action if the Government does not agree to improve the contract drastically in forthcoming negotiations with us.
The Government is pushing General Practice to breaking point, and we are taking a stand. Yet again, ministers have dealt GPs a massive blow by imposing disastrous contract changes on us that we rejected.
Current working conditions are already running GPs and practice staff into the ground, and these contract changes threaten the safety of our patients.
We are simply asking for a contract that preserves general practice in the long-term and keeps patients safe.
If Government are unwilling to change the situation, balloting will be our only remaining option to save general practice from collapse. We are therefore asking you to join us as we prepare for potential industrial action.
By law, only BMA members can participate in a ballot on industrial action. If you are a member, it is essential that you make sure the details we hold for you are up to date to ensure your vote counts. Update your member details on the BMA website or join us as a member today.
We need to come together to save general practice, defend our profession, and make general practice safe for patients.
Watch GPCE acting chair Kieran Sharrock explain where we are with preparing members to ballot for industrial action in England here
NHS England Primary Care recovery plan
NHSE published its primary care recovery plan earlier this week, and whilst we welcome the planned investment and innovative new ways that will support our profession in delivering care, there doesn’t seem to be much in the plan about how we stop GPs leaving the profession, or how we retain the staff that we already have.
General practice is almost on its knees, facing a crisis as patient demand continues to rise and the workforce continues to dwindle. Managing the strain on services to help primary care recover will happen only when and if there is a commitment from the government to increase the actual numbers of GPs.
Although more community services are needed to relieve pressures on GPs, these measures don’t consider the continuing cuts to public health funding and that more community pharmacies are closing across England.
The growing problems in general practice workforce numbers and infrastructure are acting as barriers that will prevent effective change from happening. Read the full BMA statement in response
Meetings with minister and NHS England
Last week we met with Neil O'Brien MP, Parliamentary Under Secretary of State for Primary Care and Public Health, and senior DHSC officials to discuss the result of the GPCE emergency meeting and the GP recovery plan ahead of its publication. During the meeting we explained what the results of the ballot meant in terms of industrial action, the depth of feeling amongst GPs regarding the imposition of the current contract, and what must happen to address those concerns and restore GPs’ faith in the Government. The Minister acknowledged our concerns and agreed to further meetings to discuss these issues, including funding, QOF, workforce and morale.
In addition, we have met Dr Amanda Doyle OBE, National Director for Primary Care and Community Services, NHSE, who outlined the content of the GP recovery plan. We highlighted our concerns about a lack of direct investment in practices to address patient outcomes and improve recruitment and retention, but did agree that some aspects, including improvements to the primary secondary care interface, to reduce pressures on general practice had the potential to be beneficial. The BMA response to the plan can be viewed here.
GP workload and safe working
The contractual changes imposed by NHS England do nothing to recognise the pressures that GPs are under and we encourage practices to continue to use our safe working guidance to enable them to prioritise safe patient care, within the present bounds of the GMS contract.
The BMA has also developed a tool to help with the increasing workload and to support practices with implementing a triage system if they wish to do so. The toolkit aims to provide a cost neutral aid to reduce the administrative burden on staff members, ensure patients are seen by the right clinician at the right time and allow GPs to spend their time where it is needed the most.
Wellbeing resources
As we continue to face overwhelming pressures in general practice, we encourage practices to focus on their own team’s wellbeing and take some time to meet to reflect on their wellbeing and what they can do to protect it. This will meet the requirements of the QOF targets in the GP contract to do your quality improvement project on staff wellbeing.
We have produced a document for practices which includes some tangible recommendations and tools for managing workload and reflecting on wellbeing.
A range of wellbeing and support services are available to doctors, from our 24/7 confidential counselling and peer support services to networking groups and wellbeing hubs with peers, as well as the NHS practitioner health service and non-medical support services such as Samaritans.
The organisation Doctors in Distress also provides mental health support for health workers in the UK, providing confidential peer support group sessions.
See our poster with 10 tips to help maintain and support the wellbeing of you and your colleagues.
Please visit the BMA’s wellbeing support services page for more information and resources.
LMC UK Conference 2023 agenda
The LMC UK Conference will be held next week on 18-19 May at the Light, Friends House, London. The Agenda ‘Hanging on a thread’ has now been published and further information is available here
LMC meetings
The GPC England officers are keen to continue to engage with LMCs throughout the country. This is a vital time for the profession and GPCE’s leadership wants to be on hand to answer any queries and provide information that LMCs require. If it would be beneficial for a GPCE officer to virtually attend your LMC meeting, then please get in contact with Karen Day (kday@bma.org.uk) with the time and date of the meeting, as well as which LMC you are contacting GPCE on behalf of.
GP seats at the BMA Annual Representatives Meeting
The GPC still have a few available seats for this year’s ARM. If you haven’t already been accepted for a seat via the UK LMC conference or ARM Division and are a GP and BMA member, please email Karen Day kday@bma.org.uk so that you can be sent the registration link. Please note that we do only have a few seats left, so this will be on a first come, first served basis.
GPC England committee pages and guidance for practices
Read more about the work of the Committee
Read practical guidance for GP practices
See the latest update on Twitter: @BMA_GP / Twitter @TheBMA / Twitter
Read about BMA in the media: BMA media centre | British Medical Association
Contact us: info.GPC@bma.org.uk
Read the last bulletin: Preparing for ballot on industrial action | NHS England primary care recovery plan | GP workload and safe working
GPs vote to take industrial action if ‘disastrous’ contract changes are not renegotiated
GPC England held an emergency meeting today 27 April 2023, where the committee voted to ballot GPs working in England for industrial action if disastrous changes to the GP contract, which could threaten patient safety, are not renegotiated in the coming months.
The meeting was called after the Government and NHS England decided to impose changes to the 2023/24 GP contract, despite repeated warnings from GPC England that they were not suitable proposals. Changes to the contract were also roundly rejected by GPCE in February, calling the proposals ‘unsafe and insulting’.
Since then, the committee has also tried to meet with the Health Secretary to negotiate a better contract, but this too has been cast aside.
In response to this I said:
“Today’s vote is an opportunity for the Government to put right this disastrous contract and to secure the future of patient safety.
“No GP wants to have to consider taking industrial action – and it’s something we still hope to avoid - but the committee has been flatly ignored each time we’ve explained why this contract isn’t workable and needs to be urgently renegotiated.
“General practice is under unprecedented pressure, and these contract changes will only make things worse by taking GPs away from their patients when they need us the most. This is a time to support the health service, not wave through policies that only pummel us further into the ground.”
Read the press release here
New GP access regulations
On 15 May, the new access regulations come into force for GMS and PMS contract-holders. These changes were imposed after GPC England roundly rejected NHSE’s proposals for the 2023/24 year.
The access regulations are fundamentally misconceived. It is not possible to meaningfully increase patient access without dealing with the issue throttling the access in the first place – workload and capacity in general practice. During contract negotiations we made clear our concern with this superficial approach to dealing with systemic problems, and forcefully bargained for real solutions. Unfortunately, our proposals were rejected, and the Government has elected to push forward with these changes.
We have developed guidance for practices to help them navigate this. The key change practices need to be aware of is that patients cannot be asked to call back another day; instead, patients must be offered an appointment, offered “appropriate advice or care”, signposted to a service or resource, asked to provide further information, or informed as to when they will receive further information about the services that may be provided (having regard to urgency of clinical needs and other relevant circumstances).
We will continue to campaign tirelessly on your behalf for a general practice which is sustainable, and safe for patients and staff. In the meantime, the GPCE Safe Working in General Practice guidance is still contractually compliant, and we strongly recommend that practices reflect on how they might incorporate this to prioritise safe patient care and staff wellbeing.
Read more about the 2023/24 GP contract changes on the BMA website
Workforce data
The latest GP workforce data, published today, shows that GP practices across England continue to experience significant and growing strain with declining GP numbers, rising patient demand, and struggles to recruit and retain staff.
Although there was a slight increase in fully qualified GPs in March 2023 (0.1%), we still have the equivalent of 2,059 fewer fully qualified GPs than in September 2015, and we have lost the equivalent of 463 fully qualified full-time GPs over the past year. In addition to this, the number of GP practices England has reduced by 92 over the past year – reflecting a long-term trend of closures, as well as mergers.
This coincides with a rise in patients: as of March 2023, there was a record-high of over 62.4 million patients registered with practices in England, resulting in another record-high average of 9,740 patients per practice, or 2,285 patients for each full-time equivalent GP. This is an increase of 348 patients per GP, or 18%, since 2015.
The latest GP Appointments data show that 31.6 million GP appointments were booked in March 2023, which is 4.3 million more than in February 2023, and 1.9 million more GP appointments than in March 2022, which is a significant increase and which demonstrates the increasing workload pressure on GPs.
Read more about the pressures in general practice here
Workforce returns
Please continue to review your workforce returns to ensure they capture all hours worked in an average week, including CPD time, which may be done at home. For salaried doctors the value in the contracted hours box is used in the returns. For contractors and zero-hours salaried doctors it is the actual hours box that is used. If you are unsure which box to use, please put the actual hours worked per week in both boxes. The website to file returns can be found here https://datacollection.sdcs.digital.nhs.uk/
GP workload management and triage toolkit
The BMA has developed a tool to help with the increasing workload and to support practices with implementing a triage system if they wish to do so.
The toolkit aims to provide a cost neutral aid to reduce the administrative burden on staff members, ensure patients are seen by the right clinician at the right time and allow GPs to spend their time where it is needed the most. The toolkit includes a number of case studies, along with examples of how you can tailor the system to your practice.
Read the blog ‘Exploring safe working in general practice: how we triage’
Wellbeing and stress awareness month
The contractual changes imposed by NHS England do nothing to recognise the pressures that GPs are under and GPs are being forced into a position where they worry about the care their patients are getting, which adds to their stress.
April is Stress Awareness month, and we recommend all GP practices to take some time to meet to reflect on their wellbeing and what they can do to protect it. This will meet the requirements of the QOF targets in the GP contract to do your quality improvement project on staff wellbeing. We have produced a document which can help guide and inform your project, which includes some tangible recommendations and tools for improving workload and safe working.
We would encourage practices to continue to use our safe working guidance to enable them to prioritise safe patient care, within the present bounds of the GMS contract.
Wellbeing resources
Self-care is more important than ever for the demoralised and over worked GP profession. If you are feeling under strain the BMA can help, read an account on how the BMA supported an overworked doctor and find out how the BMA can support you during #StressAwarenessMonth.
A range of wellbeing and support services are available to doctors, from our 24/7 confidential counselling and peer support services to networking groups and wellbeing hubs with peers, as well as the NHS practitioner health service and non-medical support services such as Samaritans.
The organisation Doctors in Distress also provides mental health support for health workers in the UK, providing confidential peer support group sessions.
See our poster with 10 tips to help maintain and support the wellbeing of you and your colleagues.
Please visit the BMA’s dedicated wellbeing support services page for further information and resources.
Improving access to OH assessments for small businesses
The Department of Work and Pensions is looking to understand how individuals (employees or employers) currently seek GP support for health concerns or disabilities that are impacting them at work, and to explore views on how they could use these channels to raise awareness and signpost to a new service that provides occupational health assessments. The GP contract does not fund occupational health work, and most GPs do not hold formal OH qualifications. This is extra work which places increased burden on already over-worked practices. DWP are looking for one or two GPs who could spend 30-45 minutes having a discussion with their researchers.
If you are able to help, please contact clayton.bull@engineering.digital.dwp.gov.uk, who is the user researcher on the DWP team.
Nominations open for seats on the GPs committee via the LMC UK conference
Every year the LMC UK conference elects seven members to the UK GPs committee. Any BMA GP member is eligible to stand.
The deadline for nominations is 12pm, 11 May. Following the close of nominations, voting will take place during the conference from 5pm, 18 May to 3.30pm, 19 May.
Please note that voting is only open to conference delegates.
Successful candidates will take their seats at the start of the next session after ARM in July. Submit your nomination
For more information, please contact the BMA’s elections team at elections@bma.org.uk
GPC England committee pages and guidance for practices
Read more about the work of the Committee
Read practical guidance for GP practices
See the latest update on Twitter: @BMA_GP / Twitter @TheBMA / Twitter
Read about BMA in the media: BMA media centre | British Medical Association
Contact us: info.GPC@bma.org.uk
Read the last bulletin: GP contract changes guidance | looking after your wellbeing | new triage tool
Read the latest Sessional GPs newsletter
GP contract changes guidance
Following the announcement of the GP contract changes for 2023/24, which were imposed on 1 April, we have updated our guidance explaining what it means for practices. The changes are in the following areas:
Note that the changes on ‘access to general practice services’ have not been laid before Parliament yet and ICBs will therefore not have sent contract variations to practices. This means the changes have not yet come into effect. We will share further information on this imposed contractual change as soon as it is available.
We need practices’ feedback – evidence of the negative impact of imposed 23/24 contract changes
In our regular engagement sessions with LMCs, we are already hearing of issues relating to unresourced increased costs for practices, e.g. relating to cloud-based telephony. We need to hear about these issues so they can be collated and shared with the DHSC and NHS England as a body of evidence against their ill-advised imposed changes. Please email your evidence, as well as any other feedback you may have, to feedback.gpcontractimposition@bma.org.uk
Read more about the 2023/24 GP contract changes on the BMA website
Wellbeing and stress awareness month
The contractual changes imposed by NHS England on 1 April do nothing to recognise the pressures that GPs are under and was a failed opportunity by the Government to support GPs, their practices, staff and patients. April is stress awareness Month, and we have been working hard to highlight the stress GPs face to the public. You can read our chair's response to this heartfelt blog from an anonymous GP in The Guardian, and a similar letter was also published in The Times.
GPs are being forced into a position where they worry about the care their patients are getting, which adds to their stress. The recent study on the impact of COVID-19 on GP wellbeing showed that the pressures GPs faced during the pandemic have had a negative effect on their wellbeing. The study also highlighted that if GPs continue to face stress and burnout, more GPs could leave the profession, threatening patient care and the need to focus on supporting GPs to prevent this and to improve their working lives.
UEMO’s response to the recent WHO Bucharest declaration the health and care workforce on what is needed to help health services meet demand, also highlights the importance of properly resourced and supported primary care for continuity of care and improved health outcomes. The present crisis is severe that we recommend all GP practices to take some time to meet to reflect on their wellbeing and what they can do to protect it during Stress Awareness month.
To help manage your stress, we encourage you to use the new QOF targets in the GP contract to do your quality improvement project on staff wellbeing. We have put together a document which can help guide and inform your project, which includes some tangible recommendations and tools for improving workload and safe working.
We would encourage practices to continue to use our safe working guidance to enable them to prioritise safe patient care, within the present bounds of the GMS contract.
Wellbeing resources
Self-care is more important than ever for the demoralised and over worked GP profession. If you are feeling under strain the BMA can help, read an account on how the BMA supported an overworked doctor and find out how the BMA can support you during #StressAwarenessMonth.
A range of wellbeing and support services are available to doctors, from our 24/7 confidential counselling and peer support services to networking groups and wellbeing hubs with peers, as well as the NHS practitioner health service and non-medical support services such as Samaritans.
The organisation Doctors in Distress also provides mental health support for health workers in the UK, providing confidential peer support group sessions.
See our poster with 10 tips to help maintain and support the wellbeing of you and your colleagues.
Please visit the BMA’s wellbeing support services page for further information and resources.
GP workload management and triage toolkit
As there is currently no standardised triage system for GP practices, to help with the increasing workload, the BMA have developed a tool to support practices with implementing a triage system if they wish to do so.
The toolkit aims to provide a cost neutral aid to reduce the administrative burden on staff members, ensure patients are seen by the right clinician at the right time and allow GPs to spend their time where it is needed the most. This toolkit will not apply to all practices, but we have provided a number of case studies, along with examples of how you can tailor the system to your practice.
Exploring safe working in general practice: how we triage
With the news that the impending contract imposition is going to require us to assess the need for every contact made each day, triage systems are going to become increasingly important. It’s not yet clear if this requirement is even achievable for us, but we also know that GPs will be faced with patients armed with the news of this change, so the tide is coming. Read the blog by GPC member James Booth.
Junior doctors' and GP trainees strike action
Junior doctors (including GP trainees) are taking industrial action this week after the Secretary of State failed to make any credible offer and we’d like to thank practices for your solidarity with GP trainees and junior doctors. 98% of junior doctors voted in favour of strike action and which gave us a huge mandate, and puts the government under intense pressure. This is a step in the right direction for full pay restoration not just for junior doctors, but the whole profession.
GP trainees have the full support of general practice and the wider profession during the strike action.
Watch David Wrigley, GPC England Deputy Chair, and Dave Smith, Chair of the GP Trainees Committee, explain more in this video: https://twitter.com/BMA_GP/status/1634235363156738052
See more on the strike action on GP trainees twitter https://twitter.com/BMAGPtrainees
Ahead of the strikes we published guidance for practices how to manage the impact of strikes.
Nominations open for seats on the GPs committee via the LMC UK conference
Every year the LMC UK conference elects seven members to the UK GPs committee. Any BMA GP member is eligible to stand.
The deadline for nominations is 12pm, 11 May. Following the close of nominations, voting will take place during the conference from 5pm, 18 May to 3.30pm, 19 May.
Please note that voting is only open to conference delegates.
Successful candidates will take their seats at the start of the next session after ARM in July. Submit your nomination
For more information, please contact the BMA’s elections team at elections@bma.org.uk
GPC England committee pages and guidance for practices
Read more about the work of the Committee
Read practical guidance for GP practices
See the latest update on Twitter: @BMA_GP / Twitter @TheBMA / Twitter
Read about BMA in the media: BMA media centre | British Medical Association
Contact us: info.GPC@bma.org.uk
Read the last bulletin: GP contract changes guidance | looking after your wellbeing | new triage tool
GP contract imposition
GPC England (GPCE) are calling on Steve Barclay, the Secretary for Health and Social Care, to reconsider the imposition of this year’s changes to the GP contract from 1 April, which is currently not fit for purpose. In a letter sent to the Health Secretary last week, we urged Mr Barclay to sit back down with us to negotiate a contract that the profession could accept. In our letter we said:
“At this time of unprecedented pressure across general practice, the imposition of such a contract will serve only to undermine further the confidence of the profession in the government to adequately deliver what is needed to maintain a safe and accessible general practice, for both GPs and their patients.”
In our letter we also explained what would be needed to rectify the inadequacy of the contract, including offering support to cover minimum wage uplifts for staff, inflationary rises in energy and medical supplies, and other practice running costs.
The letter to Mr Barclay was published the same week as a report by the Health Foundation laid bare the dire situation facing many GPs in terms of wellbeing, quality of care and service delivery.
Findings include the fact that 71% of GPs described their job as ‘extremely’ or ‘very stressful’ in 2022, up from 60% in 2019, while the percentage of GPs saying they were extremely or very satisfied with the way they were practising medicine fell from 39 to 24% during the same period.
Read the press release about the letter to Steve Barclay
Read more in this online news story
Read about the 2023/24 GP contract changes on the BMA website
Junior doctors' and GP trainees strike action – new strike dates announced
Following discussions with the Health Secretary, where no offer was made to begin negotiations, the BMA has announced further industrial action to be undertaken by junior doctors (including GP Trainees) in England. A 96-hour walkout will take place for shifts starting between 06:59 on Tuesday 11 April and 06:59 on Saturday 15 April 2023.
GPC England supports all junior doctors, including GP trainees, in their pursuit for pay restoration to 2008 levels, and we would urge practices in standing with GP trainees in their fight for fair pay. Show your support for the future of healthcare in England.
Watch David Wrigley, GPC England Deputy Chair, and Dave Smith, Chair of the GP Trainees Committee, explain more in this video and read also the statement by Dave Smith
We have published comprehensive guidance for GP practices, trainers and LMCs which covers everything from managing the impact of strike action on practice work to GP trainee rotas and information on how GP practices can support GP trainees financially.
We have produced a poster which we encourage you to display in your practice, a patient information leaflet, and an infographic that can be used on your website, which can be ordered here and are also attached.
The BMA has also published guidance on strike action for GP trainees.
GP pressures
The latest GP workforce data, published last week, shows that GP practices across England are continuing to experience significant and growing strain with declining GP numbers, rising patient demand, and struggles to recruit and retain staff.
We lost 95 GP practices in the past year – reflecting a long-term trend of closures, primarily due to lack of workforce. This coincides with a rise in patients with a record-high of 62.4 million patients registered in February 2023. The average number of patients each full-time equivalent GP is responsible for has also reached a record high of 2,286.
Over the past year the NHS has lost the equivalent of 522 fully qualified full-time GPs, which includes losing the equivalent of 399 partners. We now also have the equivalent of 2,087 fewer fully qualified, full time GPs than we did in September 2015.
Despite all this, the Government is refusing to listen to us and make the meaningful changes general practice urgently needs. This is why the forthcoming workforce plan must include a fully-funded plan, based on published modelling, for expanding the workforce.
The latest GP appointment data, published today, shows that practices in England delivered 27.3 million appointments in February, almost 2 million more than they did in February last year. Eighty-five per cent of appointments were delivered within two weeks of booking, and around two-thirds were face to face. This is all despite practices in England having lost the equivalent of more than 500 full-time, fully-qualified GPs over that time, showing the intense pressures that practices are under.
To support practices during this crisis, we have produced safe working guidance to enable them to prioritise safe patient care, within the present bounds of the GMS contract.
Read more about the pressures in general practice here
General practice pay declaration: guidance
NHS England has now published guidance setting out which individuals are required to make a pay self-declaration and outlines the definition of NHS earnings for the purpose of the general practice pay declaration. It also explains the process of making the self-declaration and how the data collected will be used. It could affect contractors, salaried GPs, self-employed locums and those employed through third party providers.
GPC England is opposed to this policy, believing that it will increase the risk of abuse on of GPs and practice staff. This may also lead to further GPs leaving the profession which will harm patient care. We have repeatedly lobbied for this policy to be reversed. We recommend that all GPs read our read our guidance which is in the process of being updated.
Guidance on HRT Pre-Payment Certificate (PPC)
The government has a new policy from 1 April 2023 to support patients having menopausal symptoms with the cost of treatment. Patients who are not already exempt from NHS prescription charges will be able to purchase an annual HRT Pre-Payment Certificate for the cost of two single prescription charges - £19.60. This will only be valid for HRT preparations published in the Drug tariff Part XVI. These drugs can be prescribed for any clinical reason and still qualify for the HRT PPC.
The amended regulations require the script for HRT be issued separately from non-HRT items (whether paper or EPS). GPCE supports the Government’s decision to make HRT medicines more accessible to patients at reduced cost, but we consider the introduction of this new prepayment certificate, specifically for HRT medicines, too complex. We are disappointed that despite our advice, the DHSC has decided to proceed before the IT for automatic separation of prescriptions is ready, in contravention of the bureaucracy concordat, which they agreed to only a year ago. From 1 April, new FP10s will be introduced with a box ‘w’ for HRT PPC, but old stock can continue to be used with the patient selecting box ‘f’ general PPC and the dispenser checking for valid HRT PPC.
When applying for the HRT PPC patients will be advised that they must inform the practice/prescriber that they hold an HRT PPC and ask that the script be issued separately.
Pharmacy Contractors and dispensaries may either:
GPCE recommends that GP practices and LMCs should discuss with their local pharmacies and LPCs about local approaches to this guidance. We will continue to work with DHSC and system suppliers to ensure a digital separation solution is in place as soon as possible.
The patient can choose to apply for an HRT PPC backdated for up to 1 month. If they have not yet applied the pharmacy can issue a FP57 refund form. Patients who already have a valid 3 or 12-month pre-payment certificate for all their prescriptions will not need an HRT PPC. For patients that are stable on HRT we would recommend issuing via repeat dispensing at review, with one authorisation to cover a 12-month period, thus ensuring HRT is issued on a separate prescription.
The items included all contain oestrogen/progestogen or both as listed in DHSC guidance. Other medications sometimes used in menopause are not included and would need to be paid for as normal. For further information and guidance for dispensaries see the full DHSC guidance.
Medical Examiners
The new medical examiner system continues to be rolled out across England and Wales. While initially supportive of the increase in scrutiny of deaths, the BMA continues to have concerns around the system and its implementation. In England, the roll-out is expected to take place at a local level, with the risk of inconsistent decision making and unequal support for practices. Some members have found that the new system is working as intended, however others have found it to be difficult to implement without additional resourcing or capacity. While learning from death is an important aspect of medicine, it must not come at a cost to the living and must be adequately resourced. If you or your practice is finding it difficult to comply with the requests of the medical examiner, you may invite the medical examiner to the practice to review the deceased patient’s file (ensuring they have all appropriate permissions from the family/next of kin).
There is currently nothing within the GP contract requiring doctors to interact with this system. The role of the medical examiner has been created through the Health Care Act, however the way the medical examiner system is expected to operate is not currently subject to legislation (we expect this to change in the next 6-12 months). If the medical examiner system is placing an excessive burden on GP work, we suggest you comply with your duties and obligations as a GP to certify the death.
DWP Special Rules update
From 3 April 2023, individuals who are likely to have less than 12 months to live can now claim PIP, DLA, AA, UC and ESA via the Special Rules. For more information: www.gov.uk/dwp/special-rules
Annual Conference of Representatives of LMCs (UK) 2023 – registration reminder
A reminder that the deadline for registering to attend the Annual Conference of Representatives of LMCs (UK) 2023 is Thursday 6 April 2023, by filling in this form. Representatives shall be registered medical practitioners appointed at the absolute discretion of the appropriate LMC, and LMCs may appoint a deputy for any representatives who are unable to attend.
The conference will take place on 18 and 19 May and will be held face to face in London at Friends’ House. Please email info.lmcconference@bma.org.uk if you have any questions.
Wellbeing
As we continue to face overwhelming pressures in general practice, we encourage practices to focus on their own team’s wellbeing.
A range of wellbeing and support services are available to doctors, from our 24/7 confidential counselling and peer support services to networking groups and wellbeing hubs with peers, as well as the NHS practitioner health service and non-medical support services such as Samaritans. The organisation Doctors in Distress also provides mental health support for health workers in the UK, providing confidential peer support group sessions. See our poster with 10 tips to help maintain and support the wellbeing of you and your colleagues.
We will also be producing some further resources on practice workload and wellbeing in time for Stress Awareness month in April.
Please visit the BMA’s dedicated wellbeing support services page for further information.
GPC England committee pages and guidance for practices
Read more about the work of the Committee
Read practical guidance for GP practices
See the latest update on Twitter: @BMA_GP / Twitter @TheBMA / Twitter
Read about BMA in the media: BMA media centre | British Medical Association
Contact us: info.GPC@bma.org.uk
Read the last GP bulletin
Read the latest Sessional GPs newsletter
The contract imposition has led to a situation where practices are doing more than ever, with fewer GPs, and more expectation being piled upon practices. Access targets, no relaxation of QOF, and no inflationary support. This is unacceptable. If Government do not provide support for practices soon we will see more GPs leaving and patient care will suffer.
We have to protect GPs and patients form this unsafe situation, and thus have been exploring options for Alternative Action to push Government back to the negotiating table for meaningful talks. LMCs will have a vital role if this is to succeed.
We were asked to list the actions which we would like all England LMCs to take over the next few weeks until we have a definitive timeline for action following the planned extra GPCE meeting. If all LMCs could undertake the following actions we would be grateful
None of these is inciting action.
Read more about the 2023/24 GP contract changes on the BMA website
Read more about the options being considered in the Doctor magazine
To support practices during this crisis, we have produced safe working guidance to enable them to prioritise safe patient care, within the present bounds of the GMS contract.
Reminder: 2023/24 GP contract update webinars
We are organising webinars to ensure that every GP has an opportunity to hear about thisyear’s imposed contract changes, ask questions, share their feedback and understand what next steps are being considered, at no cost. We encourage as many GPs to attend these events as possible, as we will also use them as an opportunity to explain our options around next steps. You can register here
Tuesday 21st March 19.00-20.30
Wednesday 22nd March 12.30-14.00
Wednesday 29th March 19.00-20.30
Thursday 30th March 12.30-14.00
Thursday 30th March 19.00-20.30
Life time allowance scrapped
At the budget announcement earlier this week, the Government has finally taken meaningful steps to address the impact of punitive pensions taxes by scrapping the lifetime allowance that means doctors will no longer be forced to retire early because of pension tax.
The additional rise in the annual allowance to £60,000 will mean that far fewer doctors will face large, unexpected tax bills and will significantly reduce the perverse incentive to reduce hours.
This is a significant win for the BMA and the BMA’s pension committee has campaigned extensively for the Government to provide a fix to the pension crisis that has left a significant number of doctors with no option but to retire early or reduce their hours. This will help us to retain our most senior doctors who have a pivotal role to play not only in providing care for patients but in teaching and mentoring our junior colleagues.
However, it doesn’t address all the issues and the BMA will be continuing to support those doctors who continue to be impacted by big pension tax bills, including those affected by the tapered annual allowance, and will aim to work with the Government to find appropriate solutions to address this.
Read the press statement here
Junior doctors' and GP trainees strike action
Junior doctors (including GP trainees) took industrial action this week and we’d like to thank practices for your solidarity with GP trainees and junior doctors. 98% of junior doctors voted in favour of strike action and which gave us a huge mandate, and puts the government under intense pressure. This is a step in the right direction for full pay restoration not just for junior doctors, but the whole profession. GP trainees have the full support of general practice and the wider profession during the strike action.
Watch David Wrigley, GPC England Deputy Chair, and Dave Smith, Chair of the GP Trainees Committee, explain more in this video. See more on the strike action on GP trainees twitter
Ahead of the strikes we published guidance for practices how to manage the impact of strikes.
Strikes (Minimum Service Levels) Bill – Protect the right to strike
The Government is pushing through anti-strike legislation that could undermine workers’ ability to take strike action. The proposals would mean government could set “minimum service” levels for health workers during strike periods. Employers would then be able to issue work notices naming workers required to work to make up these minimum service level on strike days. The BMA is calling on Lords to block Government’s attempts to curtail legitimate strike action and to ensure there is safe staffing across the NHS every day of the year. Take action and write to a peer today
Workforce returns – please report all hours that GPs work
Following some exploratory work within GPC England it has become evident that the workforce returns that each practice submits may no longer be accurate given the increased work GPs have been doing since the pandemic. We would like to remind practices to ensure their submitted workforce returns accurately match the work being done by partners and salaried doctors. It helps GPCE in negotiations to be able to evidence that GPs are working longer hours to provide the care their patients need.
Returns for each GP are filed in hours per week and should reflect the work being done each week, during a normal week when not on leave. It is important that returns reflect the actual hours worked, not an estimate based on nominal sessions planned.
Returns will usually be completed by practice managers and can be filed here. There are two boxes where hours worked per week can be entered. One shows contracted hours and one shows actual hours. For salaried GPs, only the contracted hours box is used in the returns. For contractors and zero-hours GPs, only the actual hours box is used in the returns. If the same numbers are put in both boxes it will ensure the hours are correctly captured.
You should factor in all work done over the course of a week in providing NHS services, including time spent doing CPD (including any done at home).
It is worth remembering that the salaried model contract references four hours per week of CPD on an annualised basis and that this therefore is to be considered working time. If a salaried GP has an annualised CPD allowance included in their contract, the equivalent hours per week should be added to the reported hours for the return.
If salaried GP’s contracted hours happen to be fewer than the hours actually worked, then aside from a conversation about how the contract might be updated to reflect this work, recording the actual hours worked will be beneficial to the profession in showing to government exactly how much work we are doing.
Once processed, the returns are published monthly on NHS Digital website. One full time equivalent doctor is associated with 37.5 hours of work per week. The next collection is at the end of the March and it would be helpful if returns could be checked prior to next month's publication.
New to partnership scheme (N2PP)
The N2PP scheme was introduced in July 2020 for an anticipated two years. In December 2021, NHS England extended the scheme into 2023. GPs and other clinical staff intending to apply for the scheme need to have entered into an equity partnership by 31 March 2023 to be able to submit an application by 30 June 2023. Find out more about the application process online or email england.newtopartnershipenquiries@nhs.net
GPC elections
We would like to flag essential steps for members or non-members who are unable to see the GPC election or the correct region to vote in (area of residence vs area of practice) – please share this with your constituencies to ensure eligible individuals are granted access to voting in their regions.
BMA member but unable to access the election
The most common reason for members not being able to access an election is due to their member details being out of date, it is worth checking your details here https://www.bma.org.uk/my-bma and updating anything that is not accurate, please include a place of work if there is not already one listed for you. In addition to this please email elections@bma.org.uk with your BMA number and the region you wish to participate in. The team can then grant you access to the election.
Non-members unable to access voting
You will need a BMA web account – you may already have one if you have registered for one for 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. If you have an account the team will be able to grant you access, if you do not have an account you will be advised to create an account by following this link (‘request a temporary non-member account’). You will then be assigned an 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.
To reiterate, the regions open for voting are:
To submit your vote for any of the above seats please visit https://elections.bma.org.uk/.
The deadline for voting 12pm Thursday 30 March 2023
To be eligible to vote in a constituency, you must be one of the following:
Wellbeing
As we continue to face overwhelming pressures in general practice, we encourage practices to focus on their own team’s wellbeing.
A range of wellbeing and support services are available to doctors, from our 24/7 confidential counselling and peer support services to networking groups and wellbeing hubs with peers, as well as the NHS practitioner health service and non-medical support services such as Samaritans. The organisation Doctors in Distress also provides mental health support for health workers in the UK, providing confidential peer support group sessions. See our poster with 10 tips to help maintain and support the wellbeing of you and your colleagues.
Please visit the BMA’s dedicated wellbeing support services page for further information.
GPC England committee pages and guidance for practices
Read more about the work of the Committee
Read practical guidance for GP practices
See the latest update on Twitter: @BMA_GP / Twitter @TheBMA / Twitter
Read about BMA in the media: BMA media centre | British Medical Association
Contact us: info.GPC@bma.org.uk
Read the last bulletin: GP contract imposition | lifetime allowance scrapped
As you may be aware, GPC England recently voted to reject the initial contract offer from NHS England. We met with Steven Barclay, Secretary of State for Health, yesterday in a final bid to negotiate meaningful changes that would provide security and sustainability for practices and patients in England. However, Mr Barclay refused to come forth with any improved offer.
We approached the meeting in a spirit of collaboration hopeful that the Secretary of State would listen to our evidence and logic and be willing to take meaningful action to support practices and their patients when they need it most. We were therefore dismayed at his refusal to offer anything more than NHS England’s insulting offer last month.
It is particularly frustrating that the Government has insisted on sticking to the financial uplifts set out in the ‘5 year framework’ agreed in 2019 (allowing for a 2.1% pay uplift for all GPs, practice staff and practice expenses) despite the extreme change in economic circumstances that has seen a massive inflationary spike over the last 12 months, and significant increases in workload since the pandemic.
Whilst we have secured some welcome changes in the contract, including a reduction in IIF indicators we are disappointed in the inability of NHS England or the Government to adequately compromise on a number of ongoing issues that were raised during negotiations, including declaration of earnings, online access to records, or to allow a relaxation of QOF and IIF in order to allow practices to focus upon core patient care.
The Committee is now assessing its options in terms of the impending imposition of a contract for 23/24, including potential future balloting and industrial action.
Read my statement about the meeting with the Secretary of State for Health here
Details and guidance will also be published on the BMA website shortly.
2023/24 GP contract update webinars
Those wishing to attend one of the GP contract update webinars in March can now register via the BMA website. The GPCE officers will deliver the same presentation at each webinar, meaning that attendees need only attend the event most convenient to them. The planned dates and times are:
Tuesday 21st March 19.00-20.30
Wednesday 22nd March 12.30-14.00
Wednesday 29th March 19.00-20.30
Thursday 30th March 12.30-14.00
Thursday 30th March 19.00-20.30
Register here
GP workload pressures and safe working guidance
GP practices continue to experience significant and growing strain with declining GP numbers and rising demand, as shown yet again by the latest GP workforce figures.
In January 2023, 88 GPs left the NHS and there is 2078 fewer fully qualified GPs than in 2015. At the same time, each GP now has 2283 patients to care for, which is 18% more than in 2015. It is no wonder patients are finding it difficult get appointments and years of neglect by this government has led to an NHS on its knees.
As Emma Runswick, Deputy Chair of BMA, commented:
“In General Practice, the issue isn't access. It's capacity. We have over 2000 fewer GPs than in 2015, and rising demand from people with multiple conditions and complex needs. Government needs to resource for retention as well as recruitment.”
If Government doesn’t urgently get a grip on the crisis, we will see numbers fall even further. It is so important to retain the workforce and for practices to focus on their own wellbeing, whilst continuing to face these overwhelming pressures in general practice.
We encourage practices to continue to review their working practices in reference to our safe working guidance to prioritise care to manage the finite workforce and resources available.
With GPs working under such great pressures the BMA is also here to support your wellbeing. You can also read about our work to improve the mental health of the profession, including new research and our wellbeing charter.
A range of wellbeing and support services are available to doctors, from our 24/7 confidential counselling and peer support services to networking groups and wellbeing hubs with peers, as well as the NHS practitioner health service and non-medical support services such as Samaritans.
The organisation Doctors in Distress also provides mental health support for health workers in the UK, providing confidential peer support group sessions.
See our poster with 10 tips to help maintain and support the wellbeing of you and your colleagues.
Please visit the BMA’s dedicated wellbeing support services page for further information and resources.
NHS England is running a series of facilitated peer wellbeing sessions for the primary care workforce. Each peer wellbeing group will be made up of six-eight people that will meet fortnightly for four weeks. Register your interest here by Friday 10 March.
We will also be producing some further resources on practice workload and wellbeing in time for Stress Awareness month in April.
Junior doctors' strike action - guidance for GP trainees and GP practices
Junior doctors (including GP trainees) will be taking industrial action from 13-16 March. With this in mind, we have published comprehensive guidance for GP practices across England which you can now read here. The guidance covers everything from managing the impact of strike action on practice work to GP trainee rotas and information on how GP practices can support GP trainees financially. We’d encourage you to familiarise yourself with all guidance before the strike days.
Thank you once again for your solidarity with GP trainees and junior doctors. 98% of junior doctors voted in favour of strike action and more junior doctors voted than ever before. This gives us a huge mandate, and puts the government under intense pressure. This is a step in the right direction for full pay restoration not just for junior doctors, but the whole profession.
The LMC England Conference also passed a motion in November 2022, offering public support to all junior doctors, including GP trainees, in their pursuit for pay restoration to 2008 levels. This support was further demonstrated by GPC England, where a motion was passed with no votes against, offering support to all junior doctors, particularly GP trainees, in their pursuit for full pay restoration.
Join the GP profession in standing with GP trainees in their fight for fair pay. Show your support for the future of healthcare in England.
We have also produced a poster you may want to display in your practice, a patient information leaflet, and an infographic that can be used on your website, which can be ordered online.
You can download further guidance for practices and LMCs, such as impact on GP trainees rotas, running of GP practices and how to support GP trainees during the strike on the BMA website.
GP trainee visas
We have written to the immigration minister regarding the BMA’s ongoing concerns over barriers facing GP trainees to staying and working in the UK on completing their training. The letter followed the Minister’s commitment to ensuring officials in the Home Office are working with the DHSC and the BMA to consider umbrella sponsorship as a solution to the problem – something the BMA has repeatedly called for to help create a welcoming environment that ensures the UK attracts and retains talented doctors to help address the shrinking medical workforce in general practice. Stressing the importance of measures being in place to facilitate smooth transition into full time employment ahead of the next cohort of GP trainees completing their training, the letter calls on the Minister to consider a six month grace period as a temporary measure whilst conversations on an umbrella route continue. A grace period would help alleviate some of the stress and anxiety felt by GP trainees coming to the end of their training by providing them with a six-month window to find a GP practice to employ them.
GPC elections
Voting is now open for seats to the General Practitioners Committee (GPC) in the following regions:
To submit your vote for any of the above seats please visit https://elections.bma.org.uk/.
(The deadline for voting 12pm Thursday 30 March 2023).
To be eligible to stand or vote in a constituency, you must be one of the following:
To vote in this election you must have a BMA web account, if you do not have one please click here to create one, follow the link to ‘request a temporary non-member account’ and email the number to elections@bma.org.uk to get access to vote. It is essential to email your temporary number to the elections inbox as you have to be granted voting access manually.
If you have any queries regarding the election process, please contact elections@bma.org.uk.
Wellbeing
As we continue to face overwhelming pressures in general practice, we encourage practices to focus on their own team’s wellbeing.
A range of wellbeing and support services are available to doctors, from our 24/7 confidential counselling and peer support services to networking groups and wellbeing hubs with peers, as well as the NHS practitioner health service and non-medical support services such as Samaritans.
The organisation Doctors in Distress also provides mental health support for health workers in the UK, providing confidential peer support group sessions.
See our poster with 10 tips to help maintain and support the wellbeing of you and your colleagues.
Please visit the BMA’s dedicated wellbeing support services page for further information.
GPC England committee pages and guidance for practices
Read more about the work of the Committee
Read practical guidance for GP practices
See the latest update on Twitter: @BMA_GP / Twitter @TheBMA / Twitter
Read about BMA in the media: BMA media centre | British Medical Association
Contact us: info.GPC@bma.org.uk
Read the last GP bulletin: GP contract update | general practice pressures | guidance for working during industrial action
GP contract meeting with Minister O’Brien
Further to GPC England’s rejection of the 2023/24 contract change proposals at its meeting on 2 February, we have met with Neil O’Brien MP, Parliamentary Under Secretary of State, to discuss the GP contract deadlock.
Mr O’Brien thanked us for the constructive approach to contract discussions and commented on how hard GPs are working, and sought to focus on unnecessary bureaucracy and what changes could be made to QOF (Quality and Outcomes Framework). We raised the issue of the unsustainable pressures practices are under and the lack of investment, with the system working beyond capacity and the fact that every GP lost results in, on average, over 2,200 patients needing to be distributed to other already overburdened GPs. We stressed that stability is urgently needed for the next 12 months but the profession does not feel supported by Government at the present time, and that there is the perception that secondary care gets all the additional resource and focus and the huge negative impact this is having on GP practice workload.
Minister O’Brien confirmed that, within the forthcoming General Practice/Primary Care Recovery Plan, the primary secondary care interface is receiving particular attention, and acknowledged that there is more to do on GP appointments in terms of getting accurate data as the belief is GPs are actually doing more than national statistics currently show. Government/DHSC is also keen to tell a positive story regarding primary care. The Minister also reported willingness to change QOF, ARRS (additional roles reimbursement scheme), IIF (Investment and Impact Fund) where possible, bringing in changes faster and that DHSC welcomes ideas on this.
We also raised the issue of QOF and the impact of the end of year focus on unnecessary “box ticking” and stressed that less prescriptive quality improvement style approaches would be better, as this would ensure an improved experience for patients with GPs able to focus on the right aspects of their care.
We also stressed that the current intended core practice contract funding uplift is insufficient to help cover the cost of practice expenses and we strongly urged the Government to identify additional financial support for 2023/24 to ensure practices are not forced to reduce their workforce and thus patient access, to cut costs or, even more worryingly, cease operating altogether.
As we stated in the last newsletter, if the Government and NHS England refuses to negotiate an improved offer, and a contract is imposed on practices, we would be forced to consider all options, including the potential for industrial or collective action.
We encourage practices to continue to review their working practices in reference to our Safe working guidance to prioritise care in order to manage the finite workforce and resources available.
Read more about the pressures in general practice here
2023/24 GP contract update webinars
We are organising five webinars to ensure that every GP has an opportunity to hear about this year’s contract changes, ask questions, and share their feedback, at no cost. The GPCE officers will deliver the same presentation at each webinar, meaning that attendees need only attend the event most convenient to them.
These webinars will replace the roadshow events familiar to many from pre-pandemic times. The unusual lead up and consequent delay to this year’s negotiations has rendered that approach impractical. It will also free up more time for in-person engagement with the officers regarding the future shape of the contract.
We encourage as many members to attend these events as possible, as we will use these as an opportunity to explain our next step options and hear member feedback.
Further details and registration will be available via the BMA’s Events page in due course, and we will include the registration links in the next bulletin/update. The planned dates and times are:
Tuesday 21st March 19.00-20.30
Wednesday 22nd March 12.30-14.00
Wednesday 29th March 19.00-20.30
Thursday 30th March 12.30-14.00
Thursday 30th March 19.00-20.30
The presentation will be delivered first, with questions answered afterwards, so that those who cannot stay for the full 90 minutes will still have the key information.
Junior doctors' ballot on strike action and guidance for GP trainees
A reminder that the last day to send back the ballot on strike action for junior doctors in England is Friday 17 February in order for itto be counted. The ballot closes 20 February,
You can also download the latest GP trainee materials to share with colleagues on the BMA website.
Further guidance for practices and LMCs to support GP trainees will be shared in the coming weeks.
Working with Torture Survivors - an e-learning course for healthcare professionals
Freedom from Torture, a charity providing therapeutic care to survivors of torture across the UK, have designed a course for doctors and healthcare professionals providing care for refugees and asylum seekers. The course was established in response to requests for training from GPs who are treating increased numbers of asylum seekers. A significant proportion of these patients will have experienced traumatic events, including torture, and have resulting complex health needs. Doctors may feel that they lack the specialist knowledge required to support this group.
Backed with funding from BMA Giving, the BMA’s charitable arm, the 10-module course educates on the physical and psychological impact of torture, the unique treatment needs of survivors of sexual torture and how to document evidence of torture in medical records. GPs and other healthcare professionals can access the course online and free of via the Freedom from Torture website
Claiming for Personal Independence Payment (PIP)
If you have a conversation with an individual about PIP, please signpost them to the PIP information pages at GOV.UK/PIP so they can consider if they may be eligible prior to claiming. The PIP pages include easy-read guides and links to YouTube videos about eligibility, evidence requirements and the claims process. These will help individuals to understand what information they need to provide to support their claim and consider whether PIP is the right benefit for them.
LMC Secretaries Conference
Please remember to register here, to attend the LMC Secretaries Conference, being held on Thursday 9 March 2023 in London at BMA House, by 22 February. This is a registered only event and everyone attending must be registered.
Annual Conference of Representatives of LMCs (UK) 2023
The Annual Conference of Representatives of LMCs (UK) 2023 is due to take place on 18 and 19 May and will be held face to face in London at Friends’ House. LMCs have been emailed information about submitting motions (including motions amending standing orders) to conference, which should be submitted by LMCs via this link by 12 noon, on 28 February 2023. If you have any questions about the Conference, please email info.lmcconference@bma.org.uk
GPC elections
Nominations for seats to the General Practitioners Committee are open in the following regions:
These seats are for a three-year term, 2023-26 sessions, subject to GPC structure review which is currently ongoing which may impact the seat to which successful candidates are elected. You must be a BMA member to stand in this election.
Please note that in previous years there was a requirement that only GPs who paid the voluntary levy could nominate themselves for election. That requirement has now been removed.
To submit your nomination for any of the above seats please visit https://elections.bma.org.uk/
The deadline for all nominations is 12pm Wednesday 1 March 2023.
For any questions relating to the role or GPC please contact info.gpc@bma.org.uk
If you have any queries regarding the election process, please contact elections@bma.org.uk.
Welsh LMC conference resolutions 2023
The Annual conference of Welsh local medical committees was held on Saturday 4 February in Llandudno. The agenda highlighted the concerns of Welsh GPs around the sustainability of practices amid ever increasing workload and financial pressures. The conference was chaired by Dr Sara Bodey (North Wales LMC) with Dr Tim Davies (North Wales LMC) as deputy chair. Please see the attached resolutions from the conference.
Wellbeing
As we continue to face overwhelming pressures in general practice, we encourage practices to focus on their own team’s wellbeing.
A range of wellbeing and support services are available to doctors, from our 24/7 confidential counselling and peer support services to networking groups and wellbeing hubs with peers, as well as the NHS practitioner health service and non-medical support services such as Samaritans.
The organisation Doctors in Distress also provides mental health support for health workers in the UK, providing confidential peer support group sessions.
See our poster with 10 tips to help maintain and support the wellbeing of you and your colleagues.
Please visit the BMA’s dedicated wellbeing support services page for further information.
GPC England committee pages and guidance for practices
Read more about the work of the Committee
Read practical guidance for GP practices
See the latest update on Twitter: @BMA_GP / Twitter @TheBMA / Twitter
Read about BMA in the media: BMA media centre | British Medical Association
Contact us: info.GPC@bma.org.uk
Read the last GP bulletin: Meeting with minister O’Brien | new GP contract webinars | claiming for PIP
Read the latest Sessional GPs newsletter
GPC England reject ‘unsafe and insulting’ contract offer
GPC England (GPCE) met yesterday 2 February, where we discussed the negotiations for the 2023-24 contract, the final year of the five-year contract deal, the committee’s strategy going forward, and the Junior Doctors and GP Trainees ballot for industrial action.
At the meeting, GPCE voted to reject the ‘insulting’ proposed changes to the GP contract in England, which completely ignore the unsustainable and unsafe pressures practices are under right now.
With no additional investment to counter the damaging impact of soaring inflation on practice expenses – and to cover rising fuel bills and increasing staffing costs – this year’s offer from NHS England risks safe patient care, brings the very future of practices into question and will cause even more GPs to leave when they are needed most.
If the Government and NHS England refuses to negotiate an improved offer, and a contract is imposed on practices, this would send entirely the wrong message to patients and a profession speaking up to defend patient safety. We would therefore be forced to consider all options, including the potential for industrial or collective action. More information / guidance will be shared shortly. Read my statement here
GP workforce and workload pressures
GP practices continue to experience significant and growing strain with declining GP numbers and rising demand, as shown by the latest GP workforce figures. In December 2022, the NHS lost the equivalent of 17 full-time fully qualified GPs compared to the previous month, and there are now 1,990 fewer fully qualified full-time GPs than in September 2015.
This long-term decline coincides with a rise in patients. In Dec 2022, 62.2m patients were registered with practices in England, with a record-high average of 9,689 patients per practice. As a result, the average number of patients each full-time equivalent GP is responsible for has now reached 2,273 - a 17% increase since 2015 - demonstrating the mounting workload in general practice.
This is in stark contrast to the Government’s Delivery plan for recovering urgent and emergency care services published earlier this week, which fails to address the workforce crisis in the NHS. In response to this plan, Phil Banfield, BMA Chair of Council said:
“The NHS cannot afford to wait two years for the fraction of help that the Government has proposed in this plan today. If the NHS has any chance of surviving that long, then we need to see immediate funding as well as steps taken to retain and boost our workforce.”
“Without a dedicated workforce and significant resource for this, now, it’ll likely fall to already-overworked GPs and their teams to pick up the workload, pushing up waiting times in general practice and jeopardising patient safety even further.” Read the full BMA statement in response here
We encourage practices to continue to review their working practices in reference to our Safe working guidance to prioritise care in order to manage the finite workforce and resources available.
Read more about the pressures in general practice here
Consultation on NHS Pension Scheme regulations for England and Wales
The Government’s consultation on their proposed amendments to the NHS Pension Scheme regulations for England and Wales closed on 30 January. The BMA’s Pensions Committee submitted a response and also produced a series of templates to help and encourage members to submit their own personal consultation responses, so our collective voice can be heard loud and clear. We believe that the Government’s proposed changes are a case of ‘too little too late’. Although they implement some of the immediate mitigations that the BMA has been calling for, such as new retirement flexibilities which are helpful for small groups of doctors, they do nothing for the majority of the workforce that is impacted by pension taxation. The proposals fall well short of the long-term solution that the NHS desperately needs, and without further action doctors will continue to incur sky-high and completely unexpected tax bills, simply by continuing to provide care for patients.
Potential Ministry of Justice legal case
Fee-paid medical members (FPMM) of Tribunals do not have access to the Judicial Pension Scheme, unlike full-time medical members. Previously litigated in 2014, the claim was rejected by Employment Tribunal and Employment Appeal Tribunal on the grounds that work of FPMM is not ‘broadly similar’ to that of regional members. Advice from a KC is that there is no scope to argue that it was wrongly decided, and it would need to be demonstrated that work undertaken by FPMM has changed since that decision in 2014. A fact-finding exercise is to be undertaken and a questionnaire for FPMM has been prepared and we have been liaising with representatives who are FPMM of Tribunals who are also keen to pursue a possible legal challenge on this.
Engagement with Primary Care Support England (PCSE), NHS England and NHS Pensions
A meeting has been held between the Pensions Committee and NHS England, NHS Pensions and PCSE to agree a terms of reference for the current series of engagement meetings held to highlight and address issues with GP pension records. It has been agreed that going forward the engagement meetings will be held on a bi-monthly basis and the next meeting is scheduled for 21 February.
NHS Pension Scheme Cost cap mechanism judicial review
A judicial review of government plans to pass McCloud age discrimination remedy costs onto NHS staff is being heard in the High Court this week (31 January to 3 February). The BMA is challenging the government’s decision to pass on the remedy costs to its members after it committed unlawful age discrimination when reforming the NHS pension scheme in 2015. The BMA’s challenge is being heard alongside a related claim brought by the Fire Brigades Union and supported by many other trade unions including the GMB, PCS, Unite, the Prison Officers and Police Superintendents Associations and the Royal College of Nursing. We expect to hear the outcome within six weeks.
Annual Conference of Representatives of LMCs (UK) 2023
The Annual Conference of Representatives of LMCs (UK) 2023 is due to take place on 18 and 19 May and will be held face to face in London at Friends’ House. LMCs have been emailed information about submitting motions (including motions amending standing orders) to conference, which should be submitted by LMCs via this link by 12 noon, on 28 February 2023. If you have any questions about the Conference, please email info.lmcconference@bma.org.uk
Junior doctors' ballot on strike action – guidance and webinar for GP trainees
The ballot on strike action for junior doctors in England is open, and this includes our GP trainee colleagues as an important group of the junior doctor workforce. They are acting as a result of the significant pay erosion they have experience over the past decade. This situation is made worse by the government also failing to address the undervaluation of the GP Flexible Pay Premia, despite making commitments to do so back in 2019.
Two webinars have been arranged to provide tailored advice specifically for GP trainees over the next few weeks at the following dates:
Saturday 11 February, 10-11am
Monday 13 February, 6-7pm
We welcome all GP trainees to click here to register your attendance for either date.
You can also download the latest GP trainee materials to share with colleagues on the BMA website. Further guidance for practices and LMCs to support GP trainees will be shared in the coming weeks.
Update on the Digital Firearms Flag
The digital firearms flag will be relaunched on SystmOne (TPP) and EMIS Web (EMIS) systems on Monday 6 February, and is scheduled for deployment on Cegedim/Vision systems in March 2023.
There will be no further changes with SystmOne (TPP), as this has been operating with the flag. The digital marker and flag have been tested and brought before the Joint GP IT Committee since being taken down in July 2022. GPs should add the appropriate SNOMED code to a patient's record when they receive notification of a firearms certificate application or when a certificate is granted, and this will automatically add a marker to the patient’s record. If a potentially relevant condition of concern is added to their medical record during the application process or after a certificate has been issued, an alert will pop up. Further information will be on the BMA website this weekend, and NHS Digital.
Members are reminded of our guidance clarifying the conditions surrounding patient registration in GP practices in England. The main principle is that anyone, regardless of nationality and residential status, may register and consult with a GP without charge. Proof of address is not needed, and this is outlined in our guidance. It is important to ensure the right patient is linked up with the online PDS service.
GPC elections
Nominations for seats to the General Practitioners Committee are open in the following regions:
These seats are for a three-year term, 2023-26 sessions, subject to GPC structure review which is currently ongoing which may impact the seat to which successful candidates are elected.
You must be a BMA member to stand in this election.
Please note that in previous years there was a requirement that only GPs who paid the voluntary levy could nominate themselves for election. That requirement has now been removed.
To submit your nomination for any of the above seats please visit https://elections.bma.org.uk/
The deadline for all nominations is 12pm Wednesday 1 March 2023.
Voting will take place for contested seats from 12pm Thursday 2 March 2023 to 12pm Thursday 30 March 2023.
For any questions relating to the role or GPC please contact info.gpc@bma.org.uk
If you have any queries regarding the election process, please contact elections@bma.org.uk.
Wellbeing
As we continue to face overwhelming pressures in general practice, we encourage practices to focus on their own team’s wellbeing.
A range of wellbeing and support services are available to doctors, from our 24/7 confidential counselling and peer support services to networking groups and wellbeing hubs with peers, as well as the NHS practitioner health service and non-medical support services such as Samaritans.
The organisation Doctors in Distress also provides mental health support for health workers in the UK, providing confidential peer support group sessions.
See our poster with 10 tips to help maintain and support the wellbeing of you and your colleagues.
Please visit the BMA’s dedicated wellbeing support services page for further information.
GPC England committee pages and guidance for practices
Read more about the work of the Committee
Read practical guidance for GP practices
See the latest update on Twitter: @BMA_GP / Twitter @TheBMA / Twitter
Read about BMA in the media: BMA media centre | British Medical Association
Contact us: info.GPC@bma.org.uk
Read the last GP bulletin: GPs committee rejects contract offer | workforce and workload pressures | NHS Pension Scheme regulations consultation
Backing the independent contractor model
Recent weeks have seen the huge stresses on the health service appearing front and centre in the media and on political agendas, with politicians from across the spectrum having their say on how they would alleviate the current unsustainable pressures we and our patients are facing.
Disappointingly the Labour Party and its shadow health secretary Wes Streeting have come out with a number of pronouncements on how it would, if in power, overhaul general practice, firstly by phasing out the independent contractor model, replacing it wholesale with a salaried service.
As you know, GPC England is wholeheartedly in support of the independent contractor model, which, when supported properly, is value for money and invaluable for continuity of care. As GPC England acting chair Kieran Sharrock said in his response to Mr Streeting’s comments, we are not completely averse to change and are already looking ahead to what contract will replace the current five-year framework that ends in 2024, but this should not be about ‘reinventing the wheel’. We need a contract that supports general practice in all its variety, and for the government of the day to invest appropriately.
Meanwhile, we raised concerns at plans mooted by Labour leader Sir Kier Starmer to allow more direct-to-specialist referrals, outlining how it could in fact be counter-productive, creating higher demand on services, and worsening delays for secondary care.
Clearly, instead of blaming GPs for problems with the health service – the opposition should be setting its sights on the Government that has overseen a haemorrhaging of GPs over the last decade.
We are due to sit down and discuss all of this with Mr Streeting soon, to ensure that he understands the pressures on the frontline and how these can realistically be alleviated for the benefit of both staff and patients.
Junior doctors' ballot on strike action – guidance and webinar for GP trainees
The ballot on strike action for junior doctors in England is open, and this includes our GP trainee colleagues as an important group of the junior doctor workforce. They are acting as a result of the significant pay erosion they have experience over the past decade. This situation is made worse by the government also failing to address the undervaluation of the GP Flexible Pay Premia, despite making commitments to do so back in 2019.
Two webinars have been arranged to provide tailored advice specifically for GP trainees over the next few weeks at the following dates:
Saturday 11 February, 10-11am
Monday 13 February, 6-7pm
We welcome all GP trainees to click here to register your attendance for either date.
You can also download the latest GP trainee materials to share with colleagues on the BMA website. Further guidance for practices and LMCs to support GP trainees will be shared in the coming weeks.
Update on the Digital Firearms Flag
The digital firearms flag will soon be relaunched on SystmOne (TPP) and EMIS Web (EMIS) systems, and is scheduled for deployment on Cegedim/Vision systems in March 2023. We anticipate the relaunch to take place towards the end of January. The digital marker and flag have been tested and brought before the Joint GP IT Committee since being taken down in July 2022. GPs should add the appropriate Snomed code to a patient's record when they receive notification of a firearms certificate application or when a certificate is granted, and this will automatically add a marker to the patient’s record. If a potentially relevant condition of concern is added to their medical record during the application process or after a certificate has been issued, an alert will pop up.
Further information will be announced in due course via the BMA and NHS Digital.
Health Education England education contract
We have had some queries regarding the HEE (Health Education England) education contract that some practices have been asked to sign. Following discussions with HEE we continue to advise that practices do not need to sign this contract if they are not happy to do so. The contract was introduced in some locations to formalise the payment mechanism for practices to be paid for training and supervision, however the contract was not general practice specific and included much which applied to hospitals.
We will now be working with HEE and NHS England towards a more suitable contract for general practices and will update you when there are any developments.
Communication between DWP and GP practices
To support the NHS move away from use of fax as a method of communication and in response to the removal of fax machines from GP surgeries, the Department for Work and Pensions (DWP) has been working with Centre for Health and Disability Assessments (CHDA), to respond to this change.
From 30 January 2023 CHDA will be using email in place of existing fax processes for some communications with GP surgeries across England, Scotland and Wales. The email from CHDA will be in the format firstname.lastname@chda.dwp.gov.uk or location.furtherevidence@chda.dwp.gov.uk. GPs should reply to the indicated location.furtherevidence@chda.dwp.gov.uk email address.
DWP has confirmed that this process meets information governance standards and is covered by existing data sharing agreements. Please note, as per the current arrangement, for all urgent information CHDA will call the GP surgery by telephone. For further information, please contact hdas.digitalchange@dwp.gov.uk
LMC Secretaries Conference - Thursday 9 March 2023 - BMA House, London
The LMC Secretaries Conference 2023 will be held at BMA House in London on 9 March. This is the one day in the calendar where LMC Officers from across the UK can come together to learn, inspire, and share. There is GPDF funding for one representative from each LMC to attend and have their travel costs reimbursed. Whilst we would like to extend the invitation to another observer from your LMC who may stand to gain considerably from listening to the day and its training, your LMC will need to cover such costs. An online application form for nominations is available here (please indicate if it is a first or second place nomination) – you will receive confirmation after the closing date of 22 February 2023. Contact the GPC office at info.lmcconference@bma.org.uk with any queries about the Conference or John Canning, doo@gpdf.org.uk, about travel and subsistence.
GPC upcoming regional elections
Please be advised that nominations are opening on Wednesday 1 February 2023 for seats to the GPC in some regions. These seats are for a three-year term, 2023-26 sessions, subject to GPC structure review which is currently ongoing which may impact the seat to which successful candidates are elected. You must be a BMA member to stand in this election. More information will follow shortly. If you have any queries regarding the election process, please contact elections@bma.org.uk.
As we continue to face overwhelming pressures in general practice, we encourage practices to focus on their own team’s wellbeing.
A range of wellbeing and support services are available to doctors, from our 24/7 confidential counselling and peer support services to networking groups and wellbeing hubs with peers, as well as the NHS practitioner health service and non-medical support services such as Samaritans.
The organisation Doctors in Distress also provides mental health support for health workers in the UK, providing confidential peer support group sessions.
See our poster with 10 tips to help maintain and support the wellbeing of you and your colleagues.
Please visit the BMA’s dedicated wellbeing support services page for further information.
GPC England committee pages and guidance for practices
Read more about the work of the Committee
Read practical guidance for GP practices
See the latest update on Twitter: @BMA_GP / Twitter @TheBMA / Twitter
Read about BMA in the media: BMA media centre | British Medical Association
Contact us: info.GPC@bma.org.uk
Read the last GP bulletin: Backing the independent contractor model | juniors strike: advice for GP trainees | update on the digital firearms flag
Read the latest Sessional GPs newsletter
