Five-year contract 'a float to stop GPs drowning', says GPC

The GPC has defended the five-year GP contract during a debate at the BMA's annual representatives meeting in Belfast where delegates called for the deal to be withdrawn immediately.

Dr Krishna Kasaraneni (Photo: JH Lancy)
Dr Krishna Kasaraneni (Photo: JH Lancy)

BMA leaders voted against the motion on Wednedsay, which had also called for GPs to be allowed a vote on the five-year deal.

GPC executive member Dr Krishna Kasaraneni told the conference that the profession had not been balloted on the new contract because the GPC was concerned that a potential change in government could derail the plans.

'[Did we not have a vote] because we considered the strengths and the potential risks of delaying contract reform such as this in the light of potential change to government? Were we right in making sure we actually implemented this and not let the wider political climate delay our contract reform to save general practice?' he said.

'This isn’t the lifeboat that is going to save general practice. General practice is drowning. GPs, we’re drowning. This is a float that we wanted to put out there to stop that. We did not want to stop to ask GPs "do you want to be saved?" This is the way to start doing it. You trusted us to lead the profession for GPs, we’ve done it.'

Primary care networks

However delegates speaking for the motion argued that the contract was a 'framework to herd GP practices and their patients into new primary care networks' (PCNs), which would fundamentally alter the way that all GPs worked.

Surrey GP Dr Richard Mithen said: 'Why can’t we have a say? This will significantly change the way our businesses and ourselves within our business work. Where’s the voice for the locum GP, GPST or salaried doctor, they have no say in the world they work in,' he said.

'We’re told on the ground that signing is not really voluntary - if you don’t want to be left behind and you fear the drop in practice income then you need to sign and that leads to a herd mentality,' he added.

Under the five-year contract GP practices are expected to group together into PCNs that will cover around 50,000 patients. While this is voluntary, practices that do not take part will not benefit from the extra £1.8bn that will be paid to PCNs over the next five years. This includes funding to employ around 20,000 new members of staff in primary care.

PCNs are due to go live next Monday and practices have faced significant extra workload in recent months because of the tight deadline they were given to set up their networks.

Integrated care

The GPC also faced accusations that the introduction of PCNs was the first step on the road towards integrated care providers (ICPs) at the BMA's annual representatives meeting. Anna Athow, who proposed the motion for the BMA's London Regional Council, said the contract was 'pivotal to covering the whole of England with integrated care systems and integrated care providers (ICPs) - the English equivalent of US accountable care.'

'[The contract] is a framework to herd GPs and their patients into PCNs. These new PCNs are the building blocks of the integrated care systems (ICSs) and work under ICS/STP direction. They must obey long-term plan objectives to cut spending and commit to shared saving schemes, whereby the less hospital care your patients receive the more money the ICSs make,' she said.

'These structures have never been seen in the NHS before and totally change the GP/patient relationship.'

However GPC chair Dr Richard Vautrey said that the GPC was totally against ICP contracts and PCNs were the way to protect practices from such integration.

'The BMA and GPC has fought against and lobbied against the ICP contract since its conception. Practices would give up their GMS contract to be part of an ICP contract and then those fears that some highlight would come true,' he told the conference.

'The PCN arrangements [are based on] the GMS contract - we retain our independence and our ability to advocate for our patients as independent contractors. This contract protects us from the ICP contract. We need it, we need it to work and practices around the country are already starting to make it work.'

Read the motion in full:

That this meeting is opposed to the five-year framework agreement and calls for its withdrawal immediately. It insists that all GPs and trainee GP BMA members must be allowed a vote on it.

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