The nationally agreed core GP contract will diminish in significance as clinical commissioning groups increasingly agree local deals with practices, the British Medical Association’s GP committee chair has acknowledged.

Chaand Nagpaul also told HSJ that CCGs should turn their attention towards developing primary care, despite the risk of a conflict of interest between their role as commissioners and GP providers.

“Looking to the future, the resource for general practice will be increasingly [for] the care and resources that sits on top of the contract,” he said.

“We need to move away from looking at the contract as being what GPs do.”

Chaand Nagpaul

Dr Nagpaul called for CCGs to ‘shift their attention’ to developing out of hospital care

Dr Nagpaul’s comments come amid increasing claims for GPs to be commissioned under locally designed contracts instead of the current nationally defined contracts.

Earlier this year, the King’s Fund called for GPs to be able to shift on to new contracts to provide significantly extended out of hospital services.

Department of Health and NHS England officials have also suggested they would like to see new forms of contract agreed which combine general practice with other services.

His comments also follows the BMA’s vociferous criticism last week of an agreement between NHS England and GPs in Somerset, which allowed them to ditch reporting against the majority of quality and outcomes framework indicators in favour of a locally developed approach.

GP engagement has room to grow

Dr Nagpaul insisted that the national contract should remain but said CCGs would increasingly commission many more locally varying additional services from practices. This would mean the core contract would become decreasingly important, he indicated.

“To me the contract is the skeleton of what general practice provides, it’s not the flesh, and we’re adding more and more flesh, and rightly so.” He said locally agreed funding would “in time… grow relative to the current GP contract”.

Dr Nagpaul called for CCGs to “shift their attention” to developing general practice and out of hospital care.

He highlighted a BMA survey of 1,400 GPs in which only 44 per cent respondents said they felt more engaged with their CCG than its predecessor primary care trust (see graphs, below).

Dr Nagpaul said the findings “should be a wakeup call for CCGs to refocus on what they should be doing… to really reframe their approach into supporting the development of primary care”.


The BMA has in recent years repeatedly warned of conflicts of interest where CCGs, which are controlled by GPs, commission primary care.

However Dr Nagpaul said that while CCGs should not hold GPs’ core contracts, they should have extended primary care responsibility with conflicts carefully managed.

This chimes with NHS England’s invite to CCGs to take on increasing responsibility for primary care.


“We have always felt CCGs are well placed to commission services in the community including from practices,” he said.