Flexibility and funding must be central to new GP and PCN contract

The new General Practice and Primary Care Networks contract must enable greater flexibility for and put more trust in primary care for it to truly be able to deliver at a local level. 

That’s the message from health leaders as negotiations on the new GP and primary care networks directed enhanced services contract take place between NHS England and the BMA.

Primary care and general practice account for more than 90% of a patient's direct experience of the NHS and is delivering more activity than ever. Latest monthly figures show that over 28 million GP appointments were delivered in August – 1.28m a day, up from 1.21m in August 2022.

With the current contract for primary care services up for renewal, the NHS Confederation – the membership organisation that brings together, supports and speaks for the whole healthcare system in England, Wales and Northern Ireland – engaged with its members over the summer, who have made a series of recommendations that they believe must be central to the contract, if the potential of primary care at scale is to be truly realised. 

The recommendations made in ‘Supporting general practice at scale: fit for 2024/25 and beyond’ summarise the thoughts and responses of over 250 primary care leaders, who now want to see their views reflected in the terms of the GP and PCN contract. 

Primary care has a vital role to play in moving care away from hospital settings and into the community, where patients want to be treated, but right now primary care contracts do not enable this.

The short-term recommendations made by our members aim to address this and include: 

• More local autonomy whilst retaining a core national focus on areas of high impact, while providing continuity and assurance to providers with a clear, concise long-term vision.  
• Streamlining of national commissioning while increasing commissioning at a local level.
• Greater flexibility in the use of ARRS funding to allow for local determination of the skill mix required, with training and supervision, to meet the needs of the local population and make primary care a more attractive place to work.
• Both the General Medical Services and Primary Care Network Contracts should rise annually with a new pay uplift clause.

The report’s recommendations follow on from the vision laid out by primary care leaders for at-scale general practice, which, in the context of the Fuller stocktake, outlines the ambitions primary care should be striving for with the right support, built on the principles of personalised care for those who need it most, delivered through integrated neighbourhood teams and via a joined-up approach to prevention and streamlined access.

Ruth Rankine, director of primary care at the NHS Confederation said: “Primary care underpins a strong healthcare system and delivers the majority of NHS activity, so it’s vital that this contract gets it right in terms of enabling local leaders to deliver the best care possible, while creating an environment that allows primary care to grow and flourish. 

“Leaders are focused on tangible, practical and realistic priorities that can address some of the immediate pressures facing general practice and PCNs across the country and want to see these reflected in the new contract when it emerges. 

“Overall, they are most keen to see an increase in trust and flexibility through the contracts so primary care can deliver for local people based on local needs, with a key focus on prevention and addressing health inequalities. 

“They also want to see support for the basic infrastructure with dedicated funding and uplifts that mirror the rest of the system, which should not only help in the delivery of high-quality care at a local level, but better conditions should also help make primary care a more attractive place to work. 

“We know all the answers do not lie simply in contracts and that is why we have also included non-contractual asks which we believe can make the difference alongside contractual reform.

“The combination of specific short term, and high-level recommendations in our report, if taken together, should help enable general practice and at-scale primary care to best deliver for patients in the short and medium term, reorienting the health and care system further towards a local population health approach that works for all. We hope that NHS England and the BMA take them on board.” 

About us

We are the membership organisation that brings together, supports and speaks for the whole healthcare system in England, Wales and Northern Ireland. The members we represent employ 1.5 million staff, care for more than 1 million patients a day and control £150 billion of public expenditure. We promote collaboration and partnership working as the key to improving population health, delivering high-quality care and reducing health inequalities.