LMCs reject 'outdated' GMS contract and demand move to item of service payments

LMCs have voted to scrap the 'outdated and inadequate' GMS contract and to replace it with an 'item of service' payment model to ensure practices are properly funded for soaring levels of workload.

LMC conference - this year's event is online

In a landmark vote at the 2021 LMCs conference for England, GPs backed a motion warning that the BMA GP committee was 'at risk of presiding and prevaricating over the slow death throes of GMS'.

Nearly three in five LMC representatives at the conference backed a part of the motion calling on the BMA's GP committee to negotiate a 'fee for service contract'. The move could see general practice shift back to a funding mode closer to the pre-2004 'Red Book' contract, which operated on an item of service payment model.

The Red Book was replaced in 2004 by the practice-based 'new GMS contract' - but GP leaders at this year's England LMCs conference voted that the 2004 deal was itself now 'outdated and inadequate' - and had left the profession exposed to 'unrestricted workload for a fixed fee'.

GP contract

LMCs also backed a call for practices to be allowed to offer private services alongside NHS services where those services are not commissioned from GPs by the NHS - in a move that presents a major challenge for new GP committee chair Dr Farah Jameel just a week after her election.

The vote came just a day after evidence of the depth of GP anger was made clear as the BMA revealed results of an indicative ballot showing the profession is prepared to take industrial action in the wake of the government and NHS England's controversial access plan and support package.

It also follows the latest evidence of intense workload in general practice - with data on GP appointments showing that in October this year, general practice delivered around 34m appointments including COVID-19 vaccination work - up around 5m from the previous month.

Meanwhile, the GP workforce remains in decline - with the average GP now caring for around 300 more patients now compared with 2015 according to BMA estimates. The LMCs conference has also heard repeatedly of GPs' concerns over huge amounts of workload being dumped inappropriately onto primary care from hospitals and other parts of the healthcare system.

Proposing the motion at the LMCs conference, East Sussex GP Dr Russell Brown said: 'The GMS contract does not serve us well as others seek to offload their work and their responsibilities onto us. We do not have the infinite capacity required to prop up a failing NHS.


'Years of neglect and disinvestment have left us a poor depleted and exhausted cavalry to call on. If we do nothing, general practice will collapse under the weight of these unreasonable expectations and the NHS will follow quickly. This is the argument for new investment. This is the argument for a new contract. This is the argument for a contract that directly reflects and rewards workload.'

Kent GP Dr Sarah Westerbeek said demand for general practice consultations had risen dramatically over the past two decades, growing by 38% between 1995 and 2008 - and that funding for general practice had failed to keep up.

She told the conference: 'The COVID-19 pandemic has clearly exacerbated an already fragile situation and experienced GPs are leaving the profession in their droves.'

She warned that for many GPs entering the profession, entering a partnership was simply not a viable option under a contract with 'no upper limit'. She added: 'For many of us the only way to safeguard ourselves from burning out so that we're still standing in 30 years time is to stay well clear of a contract that is not fit for purpose.'

Londonwide LMCs chief executive Dr Michelle Drage warned that general practice was on its knees. She told the conference: 'General practice isn't broken. It's been broken. And we didn't break it. We are not responsible for this mess. That's why, conference, we demand a new contract. A contract which puts the cash into the core, and we demand it now.'

Several GPs spoke against the idea of moving to an item of service contract and called for the BMA to 'keep an open mind' over what should replace the current deal - and the conference also heard a warning that allowing practices to provide private work alongside NHS work could 'blur' the lines between the two and take GPs away from their focus on NHS services.

However, the motion was carried in full - with overwhelming support for all but the section on moving to an item of service contract, which was backed by 58% of delegates.

Read the motion in full:

AGENDA COMMITTEE TO BE PROPOSED BY EAST SUSSEX: That conference believes that GPC England is at risk of presiding and prevaricating over the slow death throes of GMS, and:

  1. believes that the current GMS block contract of funding for general practice is outdated and inadequate for the current healthcare environment
  2. believes that the model of unrestricted workload for a fixed fee is a major disadvantage to general practice within the new ICS landscape
  3. calls on GPC England to negotiate a fee for service contract, including item of service payments for core general practice work, rather than the current block contract
  4. tasks GPC England with negotiating a contract that allows practices to offer private services alongside NHS services, where such services are not commissioned by the NHS for delivery in a general practice setting
  5. tasks GPC England with exploring alternative contractual models for general practice in a post-NHS world.

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