GPs warn that years of underfunding of GP practices in England risks widespread hospital closures and a divide in NHS and private healthcare services, similar to dentistry.
Many patients are already turning to the private sector, where online GP consultations cost around £45. GPs are paid an average of just 30p a day for each patient registered with them and say the system is unsustainable.
They are now threatening industrial action over the funding shortfall, with a non-statutory vote on the 2024-25 GP contract closing on Monday.
Ministers will announce a new pay rise for the contract in a bid to prevent any action. Health Minister Wes Streeting and BMA GP committee chair Dr Katie Bramall-Stainer were in talks on Friday over the GPs’ demands. She called the 2024-25 contract increase imposed on GPs “ridiculous”.
NHS England announced an overall increase of £259m for this year’s contract, taking the total investment to £11.9bn. This includes 2% wage growth, but there will now 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 of the GP contract has amounted to £659m since 2018-19 and wants a major injection of new funding 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 GP trainees voted to reject the contract in a BMA referendum in March.
Streeting has said he wants to shift billions of pounds from hospitals to primary care. Doctors are now urging him to intervene and outline his plans to restore previous levels of funding for general practice.
Dr Grant Ingrams, a GP in practice in the city of Leicester and chair of the Leicester, Leicestershire and Rutland Local Medical Committee, said: “In Leicester we have already seen an increase in private GP services. If the government does nothing, general practice could go the same way as dentistry.
We would be looking at a two-tier health care system, where those who can afford to pay, and those who are left with whatever the government decides to fund.”
There are 10 measures practices can take if the vote supports action. These include limiting daily contacts for each doctor to 25 patients, stopping to provide services that cost the practice money, stopping to ‘ration’ referrals and withdrawing consents to data sharing agreements that use data solely for secondary purposes. Many GPs feel that the advice and guidance they are receiving could be blocking 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 pressure on secondary care.
Dr Selvaseelan Selvarajah, a GP partner in East London, said research commissioned by the NHS Confederation had shown that 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 increased tremendously,” Selvarajah said. “We have to absorb the additional costs. The contract is not fit for purpose.”
The BMA says hundreds of practices have closed or merged in recent years. Dr Paul Evans, a GP in Gateshead and chairman of the Gateshead and South Tyneside Local Medical Committee, said some GP practices in deprived areas of the country were going bust where they could not attract staff or could not afford to pay them. He said: “This is the first time I can remember GPs being so desperate. They want a better deal that will ensure the viability of their practices, but many cannot afford to continue as they are.”
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The BMA’s Bramall-Stainer said: “We have had a number of positive and welcome conversations with the new Health Secretary. After years of neglect by previous governments, there are encouraging signs that Labour appears to understand the importance of bringing back the GP.
“The sentiment from GPs on the ground suggests there is a strong willingness to take a stand against the collapse of funding, but we will not know for sure the non-statutory voting response until the outcome 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 enormous pressure and working incredibly hard to secure more appointments for patients.
“We continue to work with GPs, the BMA and government to anticipate potential measures, but in the meantime the NHS has a duty to plan for potential disruption and ensure services continue to be delivered for patients. That’s why we continue to work with local systems to help them plan for the eventuality that collective measures do go ahead.”
A Department of Health and Social Care spokesperson said: “This Government is determined to fix problems in general practice, which is crucial to making the NHS fit for the future. We will increase the share of resources going to primary care over time and help address the problems facing GPs. We will also make the future of general practice sustainable by ensuring we train thousands more GPs and shift the focus of care from hospitals to the community.”