GPs are warning that years of underfunding in general practice in England risks widespread closures and a two-tier service of NHS and private care similar to dentistry.
Many patients are already turning to the private sector, with online GP consultations costing about £45. GPs are paid on average just 30p a day for every patient registered with them, and say the system is unsustainable.
They are now threatening collective action over the shortfall in funds, with a non-statutory ballot on the 2024-25 GP contract closing on Monday
Ministers are due to announce a new pay uplift to the contract and hope it will head off any action. Health secretary Wes Streeting and Dr Katie Bramall-Stainer, chair of the BMA’s GP committee, were in talks on Friday over the GPs’ demands. She has called the increase in the 2024-25 contract imposed on GPs “derisory”.
NHS England announced an overall increase of £259m for this year’s contract, taking total investment to £11.9bn. This includes 2% pay growth, but there is now due to be a further increase following the government’s response to the Doctors’ and Dentists’ Review Body. The contract covers the delivery of core primary care services.
The BMA says the real terms erosion in the GP contract is £659m since 2018-19. It wants a big injection of new funds into general practice.
GPs say the average payment per patient under the contract has only risen from £104.73 to £107.57, an annual increase of £2.84 per patient. More than 99% of GPs and trainee GPs voted to reject the contract in a BMA referendum in March.
Streeting has said he wants to divert billions of pounds from hospitals into primary care. Doctors are now urging him to step in and outline his plans for restoring the previous levels of funding to general practice.
Dr Grant Ingrams, a GP at a Leicester city practice and chair of the Leicester, Leicestershire and Rutland local medical committee, said: “In Leicester, we’ve already seen an increase in private GP services. If the government doesn’t do something, general practice might go the same way as dentistry.
We would be looking at a two-tier health service, with those who can afford to pay, and those who are left with whatever the government chooses to fund.”
There are 10 measures practices may take if the ballot supports action. These include limiting daily contacts for each doctor to 25 patients, stopping providing services which lose money for the practice, stopping “rationing” referrals and withdrawing permissions for data sharing agreements that exclusively use data for secondary purposes. Many GPs consider the advice and guidance they are given can block timely referrals to a hospital consultant. NHS England wrote to integrated care boards and hospital trusts last week, warning of the resulting impact on mental health and community care, as well as additional pressures on secondary care.
Dr Selvaseelan Selvarajah, a GP partner in east London, said research commissioned by the NHS Confederation had shown there for every £1 invested in primary or community care, there was a return to the local economy of up to £14 through gross value added – the measure of the value of goods and services produced in an economy. He said he hoped the government would step in and avert the need for action.
“Inflation has gone up and demand has gone up massively,” said Selvarajah. “We’re having to absorb the extra costs. The contract is not fit for purpose.”
The BMA says hundreds of practices have shut or merged in recent years. Dr Paul Evans, a GP in Gateshead and chair of Gateshead and South Tyneside local medical committee, said some general practices were failing in more deprived areas of the country, where they were unable to attract staff or could not afford to pay them. He said: “This the first time I can remember GPs being so desperate. They want a better deal that ensures the viability of their practices, but many can’t face going on as they are now.”
Bramall-Stainer at the BMA said: “We have had some positive and welcome conversations with the new health secretary. After years of being ignored by previous governments, there are encouraging signs that Labour seems to understand the importance of bringing back the family doctor.
“The feeling of GPs on the ground would suggest there is a strong appetite to take a stand against the funding collapse, but we won’t know the non-statutory ballot response for certain until the result is shared with us.”
An NHS spokesperson said: “GPs and their teams are the bedrock of the NHS, but across the country they are under huge pressure, working incredibly hard to deliver more appointments for patients.
“We continue to work with GPs, the BMA and the government to avert any potential action but in the meantime the NHS has a duty to plan for any possible disruption and to ensure services continue to be provided for patients, so we will continue to work with local systems to help them plan in the event that collective action does go ahead.”
A Department of Health and Social Care spokesperson said: “This government is determined to fix problems in general practice, which is critical to making the NHS fit for the future. We will increase the proportion of resources going into primary care over time and help address the issues GPs face. We will also make the future of general practice sustainable by ensuring we train thousands more GPs and shift the focus of care out of hospitals and into the community.”
