As has been widely published, the financial element of the 2024/25 offer is a derisory 1.9% uplift in the Core Contract. The GPC England officer team have been clear that this ‘uplift’ provides no safety, stability, nor hope for GP practices, and their patients.

The Government has stated that this year’s DDRB (Doctors and Dentists Review Body) Award which in 2023 was announced on 19 July, should also be seen as part of the financial settlement for the coming year. This Award will cover both salaried colleagues and partners – who have been out of scope of the DDRB process for the last five years, during the multiyear 2019/20 Contract Agreement. Clearly any Award is unknown at this point, but the Government has acknowledged that in 2023/24 NHS England did provide a supplementary sum designed to contribute towards the benchmark DDRB Award for GP practice salaried staff as well as salaried General Practitioners. There is, however, no guarantee that this supplementary process will occur again.

There is also a very modest increase in the overall ARRS (Additional Roles Reimbursement Staff) allocation, and confirmation that GP employer NHS Contributions will remain unchanged (at 14.38%) for the financial year 2024/25 (despite the employer scheme contribution rising by 3.1%). The balance will be centrally paid.

The current offer does include other elements, including:

• A suspension of several QOF (Quality and Outcomes Framework) points and an increase in the % aspiration payment.
• A further reduction in IIF indicators.
• Confirmation of the current eight service specifications within the PCN (Primary Care Network) DES (Directed Enhanced Service) being aggregated within an overarching specification.
• A modest set of recruitment changes within the ARRS programme.
• Changes in the arrangements for vaccination and immunisation data recording.
• Changes in the wording of the Regulations in relation to patient registration arrangements, the Armed Forces Veterans offer, continuity of care and electronic records.

Taken overall, these changes are unlikely to significantly increase General Practice workload; although this does depend on the actual wording of NHS England guidance associated with the Regulations. However, to deliver safe and sustainable services, GPs need significant investment, comparable with that seen elsewhere in the NHS. In the medium term, General Practice needs to see a fundamental shift in the balance of financial investment across the Primary and Secondary Care sectors to accurately reflect the role and workload expected of it.

General Practitioners, and particularly partners, will ask themselves what the future holds if NHS England and politicians do not support the most efficient, productive, and value-for-money sector within the NHS. The total projected deficit for 2023/24 across the NHS in England is expected to be in the region of £1.5 billion. General practice has contributed £0 to this. The signs are already clear to see: a steady decline in the qualified GP workforce, GP: patient ratios rising alarmingly, and a continuing decline in the number of practices. We have lost over a thousand over the past decade. Without serious investment the risks are all too clear: practices cannot invest in or reward their staff for their commitment, nor meet current financial pressures, such as the planned minimum wage increase from April 2024.

GPC England’s demands were evidence-based and pragmatic: for example, NHS England were asked to uplift the vaccination IoS fees and Statement of Financial Entitlement reimbursements to meet inflation. They were asked to ringfence a proportion of the current PCN DES CAP (Capacity and Access Plans) spend for dedicated purposes, such as safeguarding work, GP supervision of teams, or the Enhanced Health in Care Home beds premium – creating no financial pressure. Allowing GPs with extended roles and GP Nurses to be recruited via the ARRS programme would have created stability. Given the documented decline in GP and GP Nurse numbers, it seems counterintuitive to suggest this proposal would not bring additionality. GPC England also requested an inflation-linked Core Contract increase to replace the value lost since 2019.

GPC England unanimously rejected this proposal when it met on 1^st February, and the negotiating team was mandated to return to NHS England to improve the proposal. It is clear this may not happen, in which case this contract will be imposed on April 1^st – yes, what a joke. Should it go ahead, it will represent a third consecutive imposition. To be ready for 1^st April, the revised Regulations (including financial arrangements) need to be tabled as legislation by the beginning of March. This gives one final window for negotiation throughout February.

GPC England has committed to putting the 2024/25 offer, whatever it is, to a referendum of the profession from 1^st – 21^st March. All GPs and GP Registrars will be entitled to vote, but they will need to be BMA members. Whilst GPC England have rejected the current offer, it is far more powerful to be able to convey the views of the profession as a whole. BMA membership is not universally popular amongst GP colleagues, nevertheless, if the profession (via the national contract) is reluctantly forced to move during this year towards Industrial Action, this can only be organised by our national Trade Union. LMCs are not Trade Unions and cannot legally organise a strike.

To ensure the profession can use this route, and for each GP to vote, all GP colleagues need to join the BMA.

Membership is currently tax deductible at £41/month. You must be ‘in it to win it’. GPC England is asking the BMA to organise discounted membership rates to ensure this option is as widely available and as attractive as possible to all General Practitioners.

Colleagues will also be aware that taking Industrial Action is not as straightforward within General Practice, compared with salaried Trust employees. GPC England will provide detailed guidance on this issue, as shall we (we may circulate and publicise but not initiate Trade Union advice). The guidance will provide reassurance and confidence for partners particularly, as they hold their GMS/PMS/APMS Contracts directly.

Clearly this is a difficult and challenging situation for GPs professionally, as well as personally. However, the responsibility and consequences of the choice made by the terms of the current 2024/25 Contract offer is the Department of Health & Social Care and NHS England’s, and to the extent of their influence, politicians.

It is an election year, and, regrettably, these consequences are going to affect patients, who are also voters. The longer-term consequences of undermining NHS General Practice will also affect patients, perhaps more profoundly than what happens during 2024. The aim will always be to provide safe and professional care, but the financial, workload, and workforce challenges mean fewer and fewer of our patients will receive this care from their NHS General Practitioner.

As an LMC we will continue to keep you updated with any information going forward. We will continue to use LMC news as well as WhatsApp groups to disseminate information rapidly.  Please ensure that your colleagues are signed up to review our news, and that LMC emails are physically moved or dragged from your spam or junk folders, and into your inboxes!

Email office@cambslmc.org with any queries, or to be added to the WhatsApp group send us your contact details.

This year looks to be challenging; we need to work as a single profession around our common goal: to preserve what we know as general practice, for the sake of our patients.