Cast your mind back, if you can, to 2019. Into a pre-pandemic world, which began with the formation of the Independent Group – later known as Change UK – and ended with the first known human case of COVID-19. In between, the UK saw two prime ministers, huge protests in London about Brexit, and the proroguing of Parliament.
It was a busy twelve months!
But something happened at the start of that year which, at the time, flew under the radar, but now, five years on, is massively impacting our healthcare system in the UK.
And that was the agreeing of a new five-year contract for GPs. Designed to stabilise general practice and enable the service to deliver many of the commitments outlined in the NHS Long Term Plan, the contract had a fatal flaw: it limited annual funding increases to just over 2%.
Of course, inflation wasn’t as big an issue in 2019 as it is today. But, over the last five years, as inflation has ticked up from 0.7% to 3% to 7%, reaching a height of 10.4% in February 2023, our GPs have been stuck with a funding model that very quickly became hopelessly unable to keep pace with rising costs.
The impact of this has been nothing short of devastating. According to GP leaders, the funding increases over the course of the five-year GP contract that began in 2019 equated to a total uplift of around 11% - way off the 28% required to just keep up with rising costs over the same period.
If you translate those figures into monetary terms the average practice, according to a recent estimate, is out of pocket by a shocking £350,000 in real terms. It’s little wonder GP practices are closing at a record level, and that, for the first time ever, GP partners make up less than half of all GPs in England.
I met last week with a practice manager and GP from a large surgery in the constituency to hear first-hand what is happening on the ground. I can’t begin to describe how frustrating it was to hear how our exceptionally hard-working GPs are being impacted by the twin challenges of diminished funding and increased patient demand.
And that second point is crucial, by the way. Don’t forget that over the last five years, as GPs have been struggling with high inflation, rising utility bills and service charges, their workload has also skyrocketed, with an average of 1.38 million appointments being delivered every day across the UK.
As hospital waits lengthen, the burden on primary care – GPs – increases consistently. As people wait for appointments their conditions become more complicated, they live with more pain and they need to see a GP more often.
The impact of the funding gap is huge, not only affecting staff and management, but the local community, too. Practices are limited in the number of staff they can employ, how big their nurse team can be, whether they can support a mental health practitioner and how well they can maintain their premises.
After my meeting, I wrote to the Minister of State at the Department of Health and Social Care to ask what specific measures the government are considering to increase funding for GP surgeries in line with inflation, and the steps we can take to reduce the burden of work currently placed on our GPs.
I await his response, but, in the meantime, after voting for the first time in their history to take collective action, GP members of the BMA have officially entered a formal dispute with NHS England. Unless the current funding model is changed, I fear this dispute may not reach a quick conclusion.
We can debate whether it’s right or not to say the NHS “is broken”, but evidence here would suggest it is certainly buckling under the strain of a poorly designed contract that must be rewritten.
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