Helen Salisbury: The promise of a comprehensive new GP contract

For the first time in four years, negotiations between the Department of Health and Social Care and GP representatives in England have resulted in agreed changes to the GP contract, rather than funding and contract changes being imposed unilaterally.1 Although GPs have not been granted everything on their wish list, major steps have been made towards making good the losses of the past few years, which may at least pause the closure of general practices.

Most of the extra funding that has been agreed will go into core funding at practice level rather than being channelled through primary care networks or granted only with strings and tick boxes attached. General practices will receive approximately £9.60 more per patient each year, and, after we have covered the bill for increased staff costs imposed in last autumn’s budget through changes to National Insurance and the living wage, we will be able to spend whatever is left on providing the staff and facilities that patients need. The average annual payment per patient is estimated to be £121.90—which is not a lot to fund unlimited GP appointments, and considerably less than many patients pay to insure the health of a pet.2

Although we are no longer in dispute, some of the changes that were introduced through collective action last summer are unlikely to be reversed. The Safe Working Guidance, which advises a maximum of 25 consultations a day, has thankfully become the new normal, and we are not about to go back to the sort of unsafe working conditions that saw some GPs consulting with twice that number of patients. GPs are newly confident about saying no to unfunded work and pointing out commissioning gaps to their integrated care board rather than simply absorbing the extra work themselves.

Funding increases are welcome, but the real prize is the promise from health secretary Wes Streeting that an entirely new contract will be negotiated within the lifetime of this parliament. With the last major changes taking place in 2004, it is increasingly obvious that the current contract is no longer fit for purpose. The amount paid per patient is variable, as clearly some patients need more care than others, but the current formula does not accurately reflect differences in health needs between different populations; in particular, it pays scant attention to deprivation, a huge driver of demand for GP services.

We also need a better definition of the core services that GPs should provide if we are to control the growing mismatch between supply and demand. There are not enough hours in the day to see patients who are sick if we are also expected to offer preventive care3 and to answer all the questions patients would like to ask us. The newly negotiated contract contains an expansion of online access, due to take effect in October, and we need to be careful about the details agreed if we are to avoid being distracted from our core task; we really cannot answer every online query about bioidentical hormone replacement therapy or vitamin supplements.

What I would like to see in the next contract is an emphasis on continuity and a return to traditional, holistic, relationship based care for families and communities. Given the clear evidence that this is the most cost effective way of providing healthcare, who could object? We need the funding to employ more GPs—so we can reduce each doctor’s personal list to a manageable size—and to pay for the premises they need to work in.