GP contract discussions

It follows an announcement by Dr Doyle that the groups consulted on changes to the contract would be expanded. This would significantly dilute the BMA’s role. Alongside the BMA GPC, the RCGP, the National Association of Primary Care, Healthwatch England, National Voices, and the NHS Confederation would also be consulted. Dr Steve Taylor, DAUK GP co-lead, said: “We wanted to make it clear that the BMA is the correct and legally-established organisation to negotiate the GP contract.

High-quality care

“It is best placed to ensure the contract is workable for GPs and delivers safe, high-quality care for patients.” Dr Taylor noted that the Royal College of GPs (RCGP) has stated that GP contract negotiations are not their role. In the letter, DAUK stressed that constructive evidence from across the system should inform any new contract. DAUK has published Your GP, here for you, a modern patient-centred GP contract designed to strengthen continuity, improve access, and ensure GP services are properly funded. The document was written after consultation with GPs, health leaders and the public. It builds on the 2022 cross-party Health and Social Care Committee review The Future of General Practice.

Your GP, here for you

Your GP, here for you has quickly gained the support of many GP leaders, the public, and health leaders. Dr Taylor said: “We’ve already been consulting widely. It’s vital that the full range of available evidence is used.” He added: “We want to see contracts that reflect the realities of general practice, not compromises forced through around a diluted table.” Read the letter in full below. All of our committee members are volunteers. They speak to the media and campaign on the issues facing doctors in their own time. Please support their work by joining DAUK or donating to our GoFundMe. [pdf-embedder url=”https://dauk.org/wp-content/uploads/2025/12/New_NHSE_GP_contract_could_lead_to_more_practice_closures.pdf” title=”New_NHSE_GP_contract_letter”]

Doctors’ Association UK (DAUK) and GP Survival have reacted angrily to the changes to the GP contract imposed without warning or consultation by NHSE, which includes stipulations that GP services are to be offered 9 am to 5 pm on Saturdays as well as expanded during weekday evenings. 

In a joint statement, they said: 

“We are furious that NHS England have chosen to ignore the collective plight of frontline GP teams. The unilateral termination of negotiations by NHSE demonstrates a complete lack of respect for GP teams who have worked tirelessly throughout the pandemic whilst also contributing to the largest vaccination programme in the history of our nation.

“The deal being imposed upon GP contractors needs to be legally tested as it represents a fundamental change to GP contract terms and conditions with no clear defining reason for it.

“We seek to understand the evidence underpinning the mandate that providing routine appointments in the evenings and weekends will improve patient outcomes. There is evidence that continuity of care helps to reduces hospital admissions and improves patient satisfaction. Spreading a thin workforce even further will adversely affect patient safety.

“We are surprised NHSE felt they had no other option than to impose an authoritarian style of leadership. This approach should not be the future of health care decisions. There must be a collaborative approach between patients, staff, commissioners, NHSE and the Government. Only when this approach is adapted will we see the best outcomes for our patients.

“As frontline GPs we seek a contract which enables us to provide the high-quality care our patients deserve. GPs are not obstacles to overcome to achieve further aims, but highly trained professionals with an intimate knowledge and understanding of the communities they serve.

“No amount of spin will placate our dedicated and experienced workers who continue in their attempts to support a failing NHS during extraordinary times. NHS England have failed GP teams, failed the patients they serve, and most significantly have failed the National Health Service.

“We wholeheartedly reject NHS England’s current proposals and we demand they resume negotiations without further delay.”

The Doctors’ Association UK welcome the drive by NHSE to encourage vaccine uptake amongst cohort 6 patients (those aged 16-64 with underlying health conditions) to ensure as many people as possible take up the COVID-19 vaccination. Local GP’s are continuing to arrange the majority of these jabs (and will continue to make contact with patients themselves), but NHSE’s text message campaign will provide patients with alternatives which may be more accessible for them, such as attending a vaccination centre or a pharmacy led service.

Dr Ellen Welch is a GP with the DAUK and says: “I have an appointment for my second vaccination today, which as a pregnant healthcare worker was important for me to have to feel protected. I would encourage everyone, especially those at increased risk, to make the most of this opportunity. To be able to return to a sense of normality, it is essential we vaccinate as many of the population possible.”

DAUK’s Dr David Nicholl says: “We have learnt this week that of healthcare workers who are vaccinated, their families had a rate of COVID-19 at least 54% lower than the families of healthcare workers who were not. We already know that the vaccine is safe, we now know that it also brings protection to our nearest and dearest. This is especially important for the clinically vulnerable in the cohort 6 group. As such the Doctors’ Association UK would encourage anyone who gets called, to get vaccinated, to get themselves and those they love protected as quickly as possible”

As frontline GPs working in primary care we, like the rest of the country, are both excited and relieved that a vaccination for COVID-19 is in sight. Over the last week we have received some news regarding what a COVID-19 vaccine program may look like, and some primary care networks (PCNs) and GP surgeries are poised to take on this role and sign up.

Whilst this is brilliant news, the current offering from NHSE in terms of the Direct Enhanced Scheme (DES) falls short of making it feasible for many more GP surgeries and PCNs to deliver, with a huge number being unable to take up the offer. This will have significant implications for us all, and could threaten the success of the vaccine program as a whole. It is imperative that we act now and remedy these issues, in order to give us the best chance of defeating this virus.

Background

We must understand the background and atmosphere in which we are rolling out this programme, in order to identify possible pitfalls and problems. Prior to the pandemic, the Health Foundation reported In March 2020 that workload pressures were growing across general practice. Despite a 2015 target for 5,000 additional GPs by 2020, the number of qualified permanent full-time equivalent GPs in the UK has fallen. There are now 1,700 fewer qualified permanent GPs than in 2015.

Recently, the DAUK ran a survey of almost 900 GPs in which 78% reported the pandemic has had a negative effect on their mental health. Additionally, only 1.8% of respondents felt well-supported by NHSE. Furthermore, the Medical Protection Society (MPS) found 1 in 3 GPs report being subjected to verbal abuse during the pandemic.

All of this is occurring against a background of rising health inequalities, and a stalling life expectancy. Currently, primary care is working at maximum capacity, dealing with issues as a result of the pandemic as well as ongoing routine work. This limited workforce, with a limited capacity, needs to be kept at the centre of any plans to roll out a vaccine whilst recognising the current issues we are facing.

Issues and recommendations

We welcome the introduction of a potential vaccine and believe primary care has an invaluable role to play in its delivery, having seen the innovation with which those working in general practice have managed to roll out this year’s biggest ever, seasonal flu vaccine. It is this expertise we need for the COVID-19 vaccine, but it is imperative that we set primary care up for success in the delivery of this.

Below we list the current limitations of the DES based on the information we have received so far, which means many practices are struggling to agree. We set out what the potential solutions are, which would ensure higher primary care take-up and thus a greater chance of success in our only way out of this pandemic.

Flexibility and further information

Without the full specifications of the program being released it is difficult to ask GPs to commit to delivering the vaccine. We need the full details of the DES to be released to GPs in a timely manner, in order to allow them to make a decision regarding whether or not they are able to take this on. If this is not possible, there must be flexibility to sign up at this preliminary stage, but if it proves difficult to safely deliver the vaccine alongside routine clinical care, there must be the option to step down from this responsibility.

Funding

On the current DES, all payments for the vaccine program will be made retrospectively. This is a huge undertaking and poses a significant financial risk to primary care, who will have to shoulder the financial burden. We cannot ask this of GPs when so much is at stake nationally. We need significant, upfront funding to allow surgeries to purchase equipment needed, pay for temporary staff, and make urgent renovations to their buildings in order to be able to deliver this vaccine safely. Additionally, primary care needs to fully cost this service. There needs to be a higher fee to acknowledge the huge ask and realistic costs of this programme.
Additional further funding is necessary to cover delivery of the vaccine to housebound and nursing home patients, as this will require higher time constraints.

Furthermore, we need clear guarantees that if a patient chooses not to attend for the second vaccine, payment will still be made. The time, logistics and practicalities of delivering this program will otherwise incur high costs that primary care cannot singlehandedly shoulder.

We have seen the significant funds that the government has pumped into other areas including the private sector, for services such as Track and Trace. The funding that has been allocated to this DES is hugely insufficient and significantly lower in comparison.

Working hours and logistics

The DES specifies practices must be open from 08:00 – 20:00, 7 days a week to deliver the vaccine. We believe more flexibility needs to be allowed. Each year, practices deliver successful flu vaccine programmes, dependent on the local needs of their respective communities. Some practices run late evening or Saturday clinics, whereas others provide it in hours; these decisions are influenced by local factors which GPs take into account in order to best serve specific communities. Practices need to have the flexibility to provide a service they feel confident they can provide, for a population they know well.

The information around the vaccine also states that we will need to reconstitute the vaccine, counsel the patient and have them be observed, socially distanced, for 15 minutes after having the vaccine. All of this has not been adequately taken into account within the PCN DES, setting unrealistic expectations of the numbers vaccinated each week. Workforce and time available within primary care need to be taken into account and funded accordingly.

Reduction in workload

In order to enable a maximum number of staff to be utilised for the vaccine program, we need to reduce workload by stopping CQC inspections, making appraisal voluntary and stopping other forms of bureaucracy. This vaccine programme represents a significant workload during a global pandemic, when GPs need to rightly be focussing on appropriate clinical care.

We need urgent clarification as to what other methods are to be employed in delivery. We recognise there are plans for additional support and mass vaccines centres, but this needs to be clear and set up alongside the PCN DES with primary care input, rather than separate to it.

Information around COVID Vaccine

We are already seeing appropriate questions from both the public and clinicians on the data behind these vaccines. To ensure good uptake, we need the research data to be available to clinicians in an appropriate timeline before full agreement to the PCN DES. Without this we, as clinicians who will be rightly asked questions around the vaccines by patients, cannot morally engage in this vaccination programme. We need time to absorb, discuss and question the data before fully signing up to the DES.

Recommendations

1) The research data needs to be released to clinicians with sufficient time to allow them to analyse the data and before signing up to the DES.
2) The PCN DES needs to be delivered in conjunction with, and not separate to, bigger strategies around mass vaccination centres and additional workforces.
3) Improved funding allocated for possible hiring of venues, hiring of more staff, improving current primary care estates, purchasing necessary equipment, transport for vaccinations and storage and that this funding is allocated upfront to allow proper planning for this programme.
4) Improved funding for the administration of this vaccine to take into account the complexity and time required.
5) No restriction of funding if the patient does not attend for the second vaccine
6) Funding to be increased for the administration of the vaccine to housebound and nursing home patients.
7) Flexibility over the time and days for these vaccine centres to be open under the PCN DES.
8) Flexibility over current workload and ask of primary care to recognise this huge task being allocated under this PCN DES.

Summary

In order to enable more GP practices to take up the DES we need to allow more flexibility and limit financial risks to individual GPs.
We hope that by making the above changes to the DES, aiming to reduce the risks in signing up to the program, this will lead to a significant improvement in the ability of primary care to take up vaccination delivery which will ultimately benefit the population. Primary care wants the vaccination programme to work and is rightly placed to deliver it. However, we need to ensure that the exit strategy is realistic and appropriately supported so that it is a success.
Signed,

Dr Vinesh Patel
GP Partner, Sutton

Dr Lizzie Toberty
Salaried GP, Sunderland

Dr Kaveri Jalundhwala
GP Trainee, Thames Valley

Dr Zainab Najim
GP Trainee, Norfolk

DAUK GP Committee

NHSE agreed information being released to the public at the same time as doctors is not acceptable and will make every effort to ensure this does not repeat. As part of their media campaign, they have advised patients to wait to be contacted about the vaccine and not to contact their surgery. We welcome this move.

DAUK raised a few further concerns:

1. Practices are worrying about financial liability. We have requested more vocal and contractual support financially for PCNs taking this risk, as well as appropriate media coverage to ensure those unable to will not suffer a backlash.
2. GPs are worried that routine work will suffer at the expense of the vaccine due to staffing issues. We have asked to know what the long term strategy for this is.
3. CCGs are pressurising practices in some area. We have asked NHSE to contact CCGs and remind them to be supportive.
4. DAUK asked for reassurance that no changes will be made unilaterally to the DES without prior discussion

Download and read our full Statement here: