GPs could resign over new NHS rules that require practices to stay open later and on weekends unless they are given more cash, it was claimed today.
The British Medical Association (BMA) said doctors were ‘bitterly disappointed’ at the changes to their NHS England contract imposed without their support.
Union bosses have tried to negotiate terms with the NHS over the past year, amid an ongoing row about access to face-to-face appointments – but talks hit a stalemate.
Family doctors wanted extra funding to cover the rising national insurance costs and inflation.
But the final contract, given to the BMA just hours before being made public, made no mention of the additional cash it had demanded.
The BMA says GPs were already working weekends and weeknights and that the deal basically amounted to ‘lesser funding for the same service’.
Without an ’emergency rescue package’, the BMA warned practices ‘will lose staff’. It has not disclosed how much cash it wants or who would receive it.
Commentators have warned the move could trigger a wave of retirements and force practices to ration regular weekday appointments to cover the overtime.
From October, each local hub of GP surgeries, known as Primary Care Networks, will have to offer appointments until 8pm Monday-Friday and between 9am-5pm on Saturdays.
Practices must offer a full service during the extended hours, with access to nurses, pharmacists and physiotherapists.
Overnight, The Times newspaper claimed PCNs could be stung by financial penalties if they failed to see patients on evenings and weekends.
The graph shows the number of GP appointments per day in January. Since 2019, GPs have been asked to work evenings and weekends. But just 22,000 patients were seen on the average Saturday in January, compared to around 1.2million per week day
The update to GPs contract for 2022 and 2023 follows months of dispute between unions and health officials over their working terms.
Since 2019, GPs have been asked to work evenings and weekends for an extra £1.44 per patient.
GP WORKING TERMS TIMELINE
1948: contract puts legal responsibility on individual GPs to provide out-of-hour care, giving UK patients universal access to doctors for the first time
April 2004: contract takes effect allowing GPs to opt out of working at nights and weekends
April 2019: GPs asked to provide appointments on evenings and weekends
October 2022: Every primary care network must offer appointments on evenings and weekends
An extra £6 per head was given to clinical commissioning groups, which control PCNs.
But MailOnline analysis shows just 22,000 patients are seen by GPs on the average Saturday, compared to around 1.2million per week day.
Dr Farah Jameel, chair of the British Medical Association’s GP committee, said that the changes ‘have not been agreed or endorsed’ by the union.
She said: ‘We are bitterly disappointed that NHS England has chosen to ignore the appeals from the profession and the needs of patients in today’s letter.
‘Failing to offer practices something as simple as reimbursement to cover additional costs for national insurance contributions means they are losing funding that should be going towards looking after patients.
‘Therefore, a tax aimed at funding the NHS, has become a tax on the NHS itself.
‘The result will be fewer members of staff to care for the growing needs of patients.’
GPs — paid an average of £100,000 per year — complained the new contract will increase burnout among staff and exacerbate the NHS staffing crisis.
Dr David Oliver, a consultant at Royal Berkshire NHS Foundation Trust, said the move will lead to more GPs burning out with no-one to replace them.
He added that forcing practices to work extra hours could impact the standard of care during the week.
Responding to a patients’ rights group which described the new contract as a ‘great deal that patients will welcome’, Dr Oliver tweeted: ‘Well I am not sure they will “welcome” more GPs burning out and leaving/retiring with no-one to replace them.
‘I think they better think it out again.
‘…also the Patients’ Association might not “welcome” GPs having to drop sessions in the week in order to fulfil the Saturday edict.’
In a letter to doctors yesterday, NHS England said primary care networks must draw up plans for delivering appointments at evenings and weekends.
Patients must be able to book the appointments up to two weeks in advance or on the same day, ‘up until as close to the slot time as possible’.
Practices should offer a ‘reasonable’ amount of face-to-face appointments, as well as remote consultations via telephone or video calls to meet patients’ needs.
Nurses, pharmacists and physiotherapists will also be available at more convenient times under the plans.
NHS Digital data released today shows just 60 per cent of appointments in January were in-person, compared to 61 per cent in December
Fewer than half of all consultations in parts of the country are now face-to-face, with just 37 per cent of people in Bury being able to see their doctor in-person during the month
And doctors with available slots should take NHS 111 calls during the appointment time.
Primary care networks can choose to shift some of the additional working hours, such as by seeing patients between 7am and 8am or on Sundays, depending on patient need.
Not all GP surgeries are expected to offer the slots, but a sufficient number within a primary care network will operate on evenings and weekends.
Up to 2MILLION Brits went private during Covid because they didn’t want to wait for free healthcare, thinktank claims
Millions of adults have switched to private healthcare during the Covid pandemic because of difficulty accessing the NHS, a report has claimed.
Polling by the Institute for Public Policy Research thinktank suggests that 16million struggled getting health service appointments.
The survey of nearly 3,500 adults suggested one in eight of those — the equivalent of 2million adults — opted to go private instead.
Long waiting times waiting times exacerbated by the pandemic were one of the key drivers behind the switch, the report said.
The thinktank warned the UK risks embedding a two-tier health system where those who can afford to will pay for private insurance, health tourism, direct payments and ‘waiting list fast passes’.
It means that millions of others will be left to ‘put up or shut up’.
Currently 6.1million people in England are on NHS waiting lists for routine treatment such as hip and knee replacements.
Doctors should advertise that evening and weekend appointments are available to patients through their website, leaflets, waiting room posters, letters to patients and when they call to book an appointment, according to the contract.
More evening and weekday appointments for GP services were previously agreed in 2019.
Dr Jameel said: ‘GPs and their teams already provide evening and weekend routine appointments as standard.’
She added that ‘they have been doing so for some time now to accommodate local patient need’.
‘This part of the contract is a continuation of previous arrangements which will see lesser funding for the same service,’ Dr Jameel added.
The contract won’t see GPs given extra cash to see patients. Instead, the £6 per head that up to now has been sent to CCGs will go directly to PCNs,
The BMA says it wants extra funding to cover increased employers national insurance contributions, due in April, as well as the increased pressure from rising inflation.
It also called for practices to have powers to hire staff based on patient need, rather than being bound by job roles set out by the NHS, as well as a funded pandemic recovery plan.
Neena Jha, a GP in Hertfordshire, said NHS England has ‘unilaterally imposed’ Saturday shift work on GPs.
She tweeted that the GP workforce is ‘already in crisis’, with three doctors leaving the profession per day and problems securing staff to work on weekdays.
‘Isn’t this another way to push into GPs leaving, further exacerbating NHS crisis, widening door to privatisation?’, Dr Jha said.
Melanie Jones, a retired anaesthetist, warned on Twitter the move will put medical students off working as a GP.
Dr Selvaseelan Selvarajah, a GP at Bromley by Bow Health Partnership, tweeted that the move comes as primary care is already ‘struggling to meet existing demand’ and recruit and retain GPs.
Around 1.3million people currently work for NHS England, roughly 50,000 more than last year.
But the health service still had 9,000 vacancies for doctors before Omicron struck.
Dr Nikki Kanani, the NHS medical director for primary care and a GP, defended the contract, which gives extra funding to primary care teams ‘to increase checks for cancer and heart conditions for our patients’.
She said: ‘The contract for general practice will also see an increase in staff to treat more patients including more mental health practitioners and the option to book some appointments, such as for cervical screening, online for the first time, so please do not hesitate coming forward for care if you need it.’