• Major new GP contract agreed with doctors’ union after NHSE makes concessions
  • Three not five services will be introduced in 2020-21 with remaining specifications less prescriptive than before
  • New money from Conservative Party manifesto promises will boost the clinical primary care workforce
  • NHS announces a golden handshake for staff who want to be practice partners, including doctors, primary care nurses or practice managers

The NHS has made major concessions to ensure doctors sign up to the GP contract for 2020-21, which includes the primary care network agreement that incited considerable dissatisfaction among the profession through January. 

The British Medical Association’s general practice committee today agreed to the latest iteration of the PCN service specifications, which define what the networks will be required to deliver in the coming financial year, and to update the overall GP contract framework for 2020-24.

It comes six weeks after the NHS published its draft, outline PCN specifications to the consternation of many GPs and others. The BMA rejected the first iteration on 16 January but has now agreed to a deal that cuts back on the requirements for five new PCN service specifications and includes additional funding.

The contract deal agreed today also includes substantially more funding than was included in the five-year contract deal agreed a year ago – most of this is new money from the government for staff to provide more appointments, as was promised in the Conservatives’ general election manifesto.

Early analysis indicates there is more than £600m additional annual investment in general practice committed by 2023-24, on top of about £2.2bn growth promised last year, an apparent boost of more than 25 per cent.

Two network services have been axed from this year’s contract, a plan revealed by HSJ last month. PCNs will now need to deliver three from April 2020: enhanced health in care homes, structured medicine reviews and work supporting early cancer diagnosis. Personalised care and anticipatory care have been dropped and will be introduced from 2021-22.

The enhanced health in care homes service was the source of significant dissatisfaction among GPs when it was first put forward in the draft contract released in late December. While the specification remains, it no longer requires either GPs or community geriatricians to visit care home patients fortnightly - seen as an unsustainable addition to medics’ workload.

The requirement is now less prescriptive, with fortnightly visits replaced with a requirement “for medical input to be ‘appropriate and consistent’ but with the frequency and form of this medical input to be based on local clinical judgement by the PCN”.

Similarly, where locally commissioned services already exist that exceed the requirements of the network service specifications, “commissioners must… consider maintaining this higher level of service provision”.

The contract has also introduced a new care home premium payment worth £120 a bed per year to be introduced on 30 September “in recognition of the differential extra workload” for some PCNs with scores or hundreds of patients in care homes.

The network contract includes:

  • A £20,000 golden handshake to primary care staff, not limited to GPs, who want to become practice partners;
  • More money to hire additional non-GP clinical staff with PCNs now reimbursed for 100 per cent of the salaries, not 70 per cent as before;
  • New workforce roles will become available including podiatrists and pharmacy technicians;
  • Mental health professionals will be available through the additional roles scheme from April 2021; and
  • The introduction of an “investment and impact fund”, worth £40.5m in 2020-21, and which will “operate in as similar way to [the quality and outcomes framework]”.

NHSE’s network contract has overcome a major hurdle but the GPC’s approval does not mean GPs are bound to sign the new contract. The BMA will now need to convince its members that the new contract is a satisfactory deal.

There will be a special conference of England’s local medical committees in the next few weeks for GPs to discuss the outcome of the negotiations and the contract.

The LMCs are local bodies that represent the interests of individual GPs and practices and are distinct from the BMA which represents the interests of the profession as a whole.