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January 2015

Medics for the Community Fund Launch
The Community Foundation for Tyne & Wear and Northumberland is launching a new charitable fund, Medics for the Community, in order to better connect the local medical community with the many local charities that provide support and activities that complement and ease the burden on medical services.  Sir Len Fenwick and Professor Chris Day have kindly offered to host the launch at 6pm on Monday 16th March 2015 at the Great North Museum. 

here for further details

1st October 2014

Urgent primary medical care services for out of area registered patients when at home

At the beginning of September, GPC wrote to NHS England expressing a number of concerns about how the above scheme would work in practice and made it clear that we had no confidence an implementation date of 1 October was viable. The letter requested that the scheme's introduction was delayed until agreement could be reached between NHS England and its Area Teams and GP practices.

In their reply NHS England acknowledged that they had been unable to secure services for patients who register out of area, but who may need access to urgent care near or at home. As a result they announced that it would not be practical to allow GP practices to proceed to register patients who live out of area without home visiting duties until
5 January 2015.

However, concerns remain. NHS England takes the view that as the regulations, at the point of registration, require GP practices to determine whether it is clinically appropriate or practical to accept an application for inclusion in their list of patients without access to home visits etc. (as set out in 26B of the GMS Regs) there is no basis on which to amend the regulations at this time. Until services for patients that register out of area are in place nationally the criteria to set aside home visits cannot be met. 
Although the regulations remain in place, a practice should only register patients without home visits knowing that they have sought and obtained assurance themselves from area teams that such arrangements were in place for individual patients.

GPC's view is that it would neither be clinically appropriate nor practical to register patients without home visits whilst there is no assurance that arrangements for their care outside of the practice area are in place, even though the regulations now technically allow it.
Practices are therefore strongly advised that they should not currently register any patients under the new regulation.

30th September 2014

This morning's announcement on GP access, and GP contract changes

As you may have seen, Chaand issued this comment following the announcement this morning: “GPs naturally wish to improve access to patients. But this announcement does not address the current reality of what patients and GPs are facing; we need immediate solutions to the extreme pressures that GP practices are facing, with inadequate numbers of GPs and practice staff to manage increasing volume of patients, who are already having to wait too long for care.
“The BMA has already set out a range of solutions to address the immediate access needs of patients. We urge the government to prioritise caring for the needs of patients today, rather than promises for tomorrow."

23rd June 2014

Clinical Commissioning Groups are failing to involve GPs and deliver improvements to care, warns new BMA survey
Clinical Commissioning Groups (CCGs) in England, a flagship of the government’s health reforms, have failed to deliver overall improvements to patient care or involve more GPs in the running of services, according to a new survey of GPs carried out by the BMA.
The survey was launched today at the BMA’s Annual Representative Meeting (ARM) in Harrogate as delegates debate the future of the NHS.
Key findings in the survey of 1,393 GPs include:

  • Almost three out of ten GPs believe their local CCG has introduced policies that have adversely affected their ability to care for patients
  • Barely one in ten GPs feel that they have been given more freedom to make clinical decisions for their patients
  • Despite being members, almost two thirds of GPs feel they either have little influence over their CCG or are told what to do by the CCG rather than being asked to contribute their views
  • Two thirds of GPs say that their everyday workload is preventing them from becoming engaged with CCG work
  • Six out of ten GPs feel that being involved in CCGs is adding to  their already stretched workload
  • Almost seven out of ten GPs have not been offered  by their CCG  the £5 per head of extra investment promised by the government to support the care of vulnerable older patients. GPs reported that if they were given access to the funding they could employ additional community nurses and deliver more home visits to older frail patients
Dr Chaand Nagpaul, Chair of the BMA’s GP committee, said:
“There are clearly pockets of the country where CCGs are working effectively, but the overall picture is of a system that has failed  to deliver the improved, clinician-led care that we were promised.
“CCGs were supposed to empower healthcare professionals and patients to get more involved in the delivery of care in their local area. It was the centre piece of the government’s reforms and the justification for an expensive reorganisation in the NHS.  These results demonstrate not only that CCGs have failed to engage with most GPs,  but many report they are implementing policies that may be damaging patient care.
“It is also clear that the workload crisis in general practice – highlighted by the BMA’s Your GP Cares campaign – is also placing a barrier in front of those GPs who do want to get involved. GPs simply do not have the capacity because they are being overwhelmed by increasing patient demand and falling funding.
“It is vital that CCG boards engage their member GPs, understand their pressures and implement policies to support them at this challenging time”
Dr Beth McCarron-Nash, the BMA’s GP lead on commissioning issues, said:
“It is worrying that most GPs have not been approached by their CCGs about the crucial £5 per head funding needed for them to provide much needed additional support for vulnerable older patients. Given the pressures on GP practices across England, this resource is crucial and could make a real difference to improving the care of older patients.
“It is unfortunately a symptom of the failure of many CCGs to involve grass roots GPs in their work. We need to urgently get this funding into GP services so that practices can start employing more GPs and nurses so they can spend more time supporting vulnerable patients in the community.”
You can access the survey
here (

13th June 2014


national survey on GP premises. As you will be aware, GPC is calling for a national strategy for GP premises investment and development as one of the key planks of our Your GP cares campaign.

The survey results will inform a high level premises seminar we are holding on July 10th. The seminar, with an opening address from Earl Howe, Parliamentary Under-Secretary of State for Quality, will bring together stakeholders to discuss continuing issues around development, renovation and upkeep of primary care premises, and to propose joint potential solutions.

To inform the debate we are asking each practice in the UK to complete a
short survey on their premises situation.

I have sent a message to all GPs in the UK, but am also asking LMCs to circulate the survey link to maximise coverage of all practices.  
One response per practice is all that is required, so practices may wish pass his on to practice managers or a lead GP for completion if appropriate.

Complete the survey now

I am urging
all practices to complete this short survey that will only take 2-3 minutes to complete. This will strengthen our negotiations with Government in prioritising the urgent funding and development of GP premises, addressing both current and future needs.

In addition we are looking for any case studies of practices that can highlight the constraints and realities of inadequate premises, and how this is affecting practices and their patients, as part of our
Your GP cares campaign. You can enter this in the last page on the survey, or respond to us at

The closing date for the survey is Friday 4 July.

With best wishes

I am writing to inform you that we have launched a major
Chairman, GPC

13th May 2014

Launch of new BMA Campaign - Your GP cares

Thank you to everyone who helped to support the launch of Your GP cares. The campaign is now live! Our launch day plans involve media publicity, launch of our webpages and social media activity. We also have plans in the coming months to engage politicians, policy makers and patients further in the campaign, along with GPs themselves of course. More details of that to follow.
The success of Your GP cares is heavily dependent on your support. Now the campaign has launched can I please ask you to do the following today:
·        join the campaign via the BMA website ·        help us raise awareness of the campaign with your colleagues and contacts ·        engage with the campaign on Twitter using #YourGPcares and following the BMA @TheBMA if you are active on social media ·        if you have further case studies to illustrate the issues the campaign is highlighting please email them to ·        join in the conversation on BMA communities
We will be launching a full suite of campaign materials, including posters and leaflets, at LMC conference that you and your practices will be able to use to help explain the campaign issues to patients. However, so that you have access to something now, there are two posters that you can download from the website and can start using straight away if you so wish.
We will be in touch in due course to keep you updated on campaign activities throughout our programme of work in the run up to the next UK General Election.

13th March 2014
Latest DDRB Report Recommendations and BMA Reaction

Here are the main GP-related recommendations from the DDRB report, available here

- For independent contractor GPs, an uplift of 0.28 per cent to be applied to the overall value of GMS contract payments for 2014-15. This is intended to result in an increase of  1 per cent to GP contractor income after allowing for movement in expenses. As Chaand's press release (see below) makes clear, we strongly dispute this interpretation.

- For salaried GPs, the minimum and maximum of the salary range to be increased by 1 per cent for 2014-15. As a result of the DDRB’s recommendation, salaried GPs on the model salaried GP contract should receive an uplift of at least 1% to their salary.

- For the trainers’ grant,  an increase of 1 per cent along the same lines as basic pay for other doctors.  

- Given ongoing doctors in training contract negotiations, no recommendation on any change to the GP specialty registrar supplement.

Responding to the Government’s pay announcement, Dr Chaand Nagpaul, Chair of the BMA’s General Practitioners’ Committee, said:

“Today’s announcement from the Government on doctors’ pay is a kick in the teeth for GPs at a time when there is overwhelming evidence that GP workload is escalating to an unsustainable level while resources are continuing to fall in real terms. General practice is carrying out an estimated 340 million consultations this year, up 40 million from 2010, and are at the forefront of treating the 18 million patients in the community suffering long term conditions.

“It beggars belief to suggest that an 0.28% uplift in the GP contract will translate into a 1% increase in GP pay at a time when expenses are projected to continue to accelerate. This decision fails to recognise the expanding role and workload in general practice that shows no signs of abating.
“It will inevitably result in yet another pay cut. To add insult to injury, this decision comes on the back of several years of effective pay cuts. GPs will justifiably feel they are being unfairly treated as well as devalued. This settlement will also be a blow to patient services as it will effectively reduce resources for GP practices and frontline services.    
 “Large numbers of GPs over the age of 50 are considering retiring or quitting early because GP morale is being completely undermined. Job satisfaction is at its lowest level since 2001 and we are seeing record numbers of GPs reporting high levels of stress. Not investing in general practice will make it even harder to retain and recruit more GPs. This is at total odds with the government’s stated aim of expanding the GP workforce and giving general practice the resources it needs to deliver more care in community settings.
“Today’s announcement is likely to make the morale and workforce crisis in general practice much worse.”

12th February 2014

Message from the sessional GPs chair

As we face one of the biggest periods of change to affect general practice, national and local representation of sessional GPs has never been more important - and the BMA's sessional GPs subcommittee, which I chair, is actively working on your behalf.
We have seen the formation of clinical commissioning groups, and now practices are looking to form federations or work in collaborative ways. If we want to take control of our future, it is essential that sessional GPs engage with these changes. Representation of sessional GPs at local medical committee (LMC) level remains limited, yet involvement in your LMC is one of the most important ways for sessional GPs to understand and influence what happens at a local level. Now is the time to stake your claim and secure your future in a general practice that upholds the standards and principles that we value as GPs.
See here for webpage
To stay up to date with these changes, which directly affect you, I urge you to visit the sessional GPs subcommittee webpage which includes information about local sessional GP groups and links to individual BMA sessional GP support.

Best wishes,
Vicky Weeks
Chair, GPC sessional GPs subcommittee chair

8th November 2013

BMA’s GP committee sets out its vision for the future of general practice

The BMA’s GP committee (GPC) has set out its vision for a coordinated, integrated and community based model of general practice that seeks to tackle the pressures facing primary care, as well as providing solutions to the wider challenges in the NHS.
Developing General Practice: Providing Healthcare Solutions for the Future calls for a new approach to delivering care across general practice in an environment defined by rising workload pressures and falling resources.  It is published alongside new research from the BMA’s Health Policy and Economic Research Unit that reveals a GP workforce under strain and at risk of burnout.
The key recommendations include:
General practice needs a more integrated and personalised model of patient care that is delivered by a team built around the GP practice. This would involve working more collaboratively with diagnostic, specialist care, community health and social care teams.
·        Improving urgent and out-of-hours primary care services. This could include a clinician led first point of contact, telephone triage service and reforms to the tendering process for out-of-hours care, such as NHS111.
·        Improved accessibility and local accountability by looking at innovative ways of working such as practices collaborating to provide extended surgery opening times across a community or using the latest technologies, such as Skype, as an alternative to face to face consultations.
·        Empowering patients as partners through measures such as strengthening the patient voice in local Clinical Commissioning Groups and through the further development of practice-based patient participation groups.

Dr Chaand Nagpaul, Chair of the BMA’s GP committee said:
“Our vision for general practice is a bold plan to address both the immediate pressures facing GPs and develop a long term strategy for patient care by improving coordination, integration and quality. “We need to look at new ways of working that can help GPs play a central role in delivering care that is more efficient and responsive to the needs of patients who increasingly need services that are more personalised and closer to home.   “To make these ideas a reality general practice needs greater investment to enable an expansion of the GP workforce and to fund new and innovative ways of working.  We must end the uncertainty about future funding which is holding back GPs from meeting short term challenges and setting long term goals that could be a solution to alleviate some of the pressure on the NHS as a whole. “Our plan comes at a crucial time for general practice which is under strain from spiralling levels of patient demand and falling resources. The BMA’s new research highlights that many GPs are facing burnout and feel that current pressures, especially the uncertainty over future funding, are making it difficult for practices to undertake long term strategic planning. These are barriers that we must overcome. “The BMA is keen to hear the views of grassroots GPs about the future of general practice and I would encourage every GP to share their views with us so we can continue to develop our proposals for the future.”

21st October 2013 Health Tourism
As you can see below, the BMA has been in the news extensively responding to Hunt's new figures alleging that health tourism costs the NHS £500 million each year.  BMA reps are lined up for various TV interviews today as well. Our statement in response is below:

Dr Chaand Nagpaul, Chair of the BMA’s GP committee, said:

“Anyone seeking to access NHS services should be eligible to do so and we must consider any proposals for improving the current system of reclaiming healthcare costs from European or other governments whose citizens are treated by our health system

“However, there is limited evidence to suggest that migrants or short term visitors are consuming large parts of the NHS budget. The government’s estimates are based on a number of assumptions that result in a figure significantly higher than previous estimates.

“GPs and other healthcare professionals do not have the capacity or the resources to administer an extended charging system that could require GPs to extensively vet every single patient when they register with a new practice. This would cause inconvenience to all patients and put additional strain on already overstretched GP services that are currently under pressure from rising patient demand and falling resources. It is doubtful that the expensive bureaucracy required to support an extended charging system would recoup enough money to cover the costs of setting it up in the first place.

“We must also be careful about creating a climate where some people are deterred from seeking treatment when they need it. Not only would this present a risk to the health of that individual, it could also prevent the NHS from identifying individuals with contagious diseases and result in further costs to the NHS should a patient's condition deteriorate to the extent they require more expensive emergency treatment later on."

On Wednesday, the HSCIC published the GP earning and expenses figures for 2011-12 ( This revealed yet another pay cut for GP, which equates to an 8% decrease in income since 2008, and with GPs iniquitously being the only group of doctors denied even the pay freeze that applied to the rest of the NHS

These figures again portray a wholly misleading and exaggerated picture of GP pay, with the inclusion of non-NHS income, which is not paid for by the taxpayer and hence not public sector pay. It also lumps together areas of work well beyond that paid for by the GP contract, such as GP training, CCG work, or out of hours sessions. Making comparisons of GP pay with contract pay for hospital doctors is therefore meaningless unless all overtime, additional duties and private work was lumped into the latter. Further these crude pay headlines belie the significant increased workload that GP have taken on in recent years -working harder for less. The inclusion of dispensing income for a proportion of practices - a totally separate additional activity and income stream - to calculate national “average’ GP income adds to the misportrayal. None of this is of course understood by the public who simply read headline figures, and even where it may be understood by media or politicians this is wilfully ignored.

GPC Contract Survey - Sept 2013

The GPC have published their own GP survey results on the contract imposition at the end of the week: GP contract survey. This showed a GP workforce paralysed with widespread low morale, excessive bureaucracy, targets, and high workload. Most worrying is the adverse impact on patient care, with reduced availability of routine appointments due to chasing inappropriate QOF targets instead, and with GPs reporting less time to spend for patients’ needs. Taken together these surveys demonstrate that GPs are “on their knees” as stated at GPC last Thursday, and is simply not compatible with the government’s aspirations to transfer a huge new tranche of work “out of hospital” into the community. The results also spell a dismal message for CCGs as “membership” organisations, with 1 in 2 GPs being less engaged with their CCG due to workload pressures. The government cannot afford to ignore these unarguable findings, and we will naturally be using these in the forefront of our immediate negotiations, as well as demonstrating that the only logical and sustainable way forward is an explicit investment strategy to increase capacity in general practice.


Your LMC are holding an open meeting for GPs and PMs in the Northern Region. The speaker is immediate past chair of the GPC - Dr Laurence Buckman on the topic - “The Future of General Practice in the Northern Region

This will be a very popular meeting and numbers have to be limited so first come first served.
HERE for details on how to reserve your place.

15th August 2013 - information for practices

You may have heard of the new service commissioned by NHS England.  This is the first use of the new powers under the Health and Social Care Act 2012 to extract confidential data from providers into the Health and Social Care Information Centre (HSCIC). The intention is to make increased use of clinical information with the aim of improving healthcare, for example by ensuring that data are made available to NHS Commissioners so that they can better design integrated services for patients.

The BMA supports the use of data for secondary uses but also recognises the importance of confidentiality.  We have negotiated the right for patients to object to the use of confidential data for these secondary uses.  We have also considered the GP dataset to be extracted which appears to be
 appropriate for commissioning purposes.  We have jointly badged the GP guidance with the RCGP, NHS England and the HSCIC as we feel it is important that GP practices understand their obligations under both the Health and Social Care Act and the Data Protection Act. The HSCA removes the duty of GPs to seek consent prior to extractions but it does not remove the duty to raise patient awareness about the extractions. 

Materials have been tested in a small number of practices and their feedback has been incorporated into a revised set of materials and resources.  From mid August, over a 4 week period, practices will begin to receive an email containing information about the implementation of The email  will include links to a number of resources and materials. Practices will also receive a separate communications pack containing patient information and materials. We are informing  practices now so that they are prepared for this information. The ICO has been involved in these discussions and has made it clear that GPs as data controllers are responsible for patient awareness raising. It is important that when practices receive this information they display the poster and make leaflets available in the practice without delay as extractions will begin approximately 8 weeks after they receive the materials. Other resources will also be included in the email communication to practices.

13th August 2013
Primary Medical Services Assurance Management Framework
The GPC recently included some information about NHS England's Primary Medical Assurance Management Framework in negotiating news. Since then, they have received a number of queries about the extent to which there is a contractual obligation on practices to provide the information requested as part of the framework. Following legal advice, the GPC can confirm that:

- There is a contractual obligation to provide the information requested in the annual practice declaration. There is a section in both the GMS and PMS regulations stating that contractors shall submit an annual return to the board. The declaration is also likely to come under the classification of information that is "reasonably required" by NHS England. There is not a specific contractual obligation to submit this information in electronic format, but practices may find that it is more convenient to do so.

-  The letters sent out by NHS England to practices about the framework state that practices will be required to submit their catchment area electronically. There is no specific contractual requirement to submit this information in electronic format, but practices again may find it more convenient to do so. We are writing to NHS England to confirm that practices who have problems submitting this information electronically, or choose not to do so, will be able to submit the information in a different format.

18th July 2013
Dr Chaand Nagpaul elected as new leader of the nation’s GPs
Dr Chaand Nagpaul has been elected as the new leader of the nation’s GPs at a meeting of the BMA’s GP Committee today (Thursday, 18 July 2013).
Dr Nagpaul, a GP in north London, replaces Dr Laurence Buckman, who steps down as Chair of the BMA’s GP committee after completing his six year term.
Commenting on his election, Dr Nagpaul said:
“I am delighted to have been elected to lead the nation’s GPs.
“General Practice is facing a number of tough challenges as funding pressures begin to bite and the government’s competition agenda impacts on how care is delivered.
“However, primary care has a long track record of innovation that I believe has the potential to tackle the problems we face and help deliver real improvements to patient care despite the tough economic and political climate.
“I am looking forward to meeting with ministers as I do believe we need a positive, constructive and fresh approach with government so that we can work together to guide the NHS through these difficult times.”
Three GP negotiators were also elected at the meeting; Dr Peter Holden, Dr Beth McCarron-Nash and Dr Richard Vautrey.
They will work with the Chair and Dr Dean Marshall who was elected as a negotiator last year, to take forward the GP committee’s agenda in the next year.

24th June 2013
 The NHS will fail unless doctors, other health care staff, patients and their families are listened to, the BMA’s Chair of Council warns today (24/6/13), as he addresses an audience of over 500 doctors on the opening day of the BMA’s annual conference in Edinburgh.
 In his first speech as Chair of the BMA’s UK Council, Dr Mark Porter warns government that medicine is becoming a profession “on the edge” as doctors try desperately to deal with the “sheer, unparalleled scale of demand”.
 He says: “As doctors we have one of the most privileged jobs in the world - helping patients and improving the health of the nation. It’s what we do and it is often wonderful, inspiring and life affirming. But it’s easy to forget that as the NHS struggles to cope with the double whammy of cuts and structural change. I feel as if we’re becoming a profession on the edge. And a medical profession on the edge, means a National Health Service on the edge.
 “Doctors are desperately trying to just deal with the sheer, unparalleled scale of demand on existing services. And we experience overwhelming frustration that we cannot achieve the changes and improvements that we can see are so necessary to deal with this pressure.
 “We need to make sure the voice of the profession is heard, if it isn’t the NHS will fail.”
 Nowhere in that message more important than in improving the safety and quality of care in the aftermath of the report of the Francis Inquiry, Dr Porter says.  In a tribute to Julie Bailey, who fought to get her voice, and those of others, heard when she tried to expose failings at Stafford Hospital, he says:
 “I salute Julie Bailey, a woman of singular courage, who brought a measure of belated justice for those who had suffered at Stafford Hospital. She got herself heard, she stood up to obstruction and abuse.
 “We (doctors) have a responsibility to bring in a culture of quality and safety across the whole of the health service and nothing should get in the way of that.
 “We will work with government, with medical managers, with nurses and physiotherapists and with anyone else we can, to guarantee the protection of the patients in our care. But doctors must feel comfortable and safe when raising concerns - at present we do not. Many doctors express fear about the consequences, and this inhibits us from doing what we know to be right.”
 In the 12 weeks since the Health and Social Care Act in England came fully into force, Dr Porter says that although we are yet to see its full impact, the government’s response so far to the problems facing the NHS has been “inadequate and divisive”, and cost improvement programmes are “cutting resources to and beyond the bone”.
 He says: “While building a Byzantine system that no-one wanted, the government’s response to the real problems in the health service has been inadequate and divisive.
 “We are all painfully aware of the funding restraints on the NHS. It may have escaped the kind of swingeing real-terms cuts that other departments will suffer when the comprehensive spending review is published on Wednesday. But the claim that health spending is protected rings hollow when we face rising demand, new treatments to pay for, and virtually every NHS organisation is suffering year-on-year cuts.
 “The financial pressures are leading to far too many botched, quick fixes, including some drastic cuts in staffing which leave remaining staff spread far too thinly. How can we expect this to be safe for our patients?”

27th May 2013

LMC Conference News

1. Whole transcript of opening speech by Laurence Buckman
Summary of important motions
See BMA website for more information
GPC News 10 - Conference News

25th April 2013
The pressures on emergency care are complex and blaming general practice misses the point, says the BMA
Responding to comments made by the Secretary of State, Jeremy Hunt MP, on rising emergency care admissions today (Thursday, 25 April, 2013), Dr Mark Porter, Chair of BMA Council, said:
“There is no doubt that the NHS is under intense pressure. Spending on healthcare is squeezed, patient demand is rising and staffing levels are often inadequate. The Government’s analysis of where responsibility lies for the huge and increasing pressure on emergency care is completely simplistic. Singling out individual parts of the health service and engaging in a blame game is unhelpful and misses the point.
“Ministers should be engaging positively with healthcare professionals to improve and maintain services for patients, rather than demoralising NHS staff who are working harder than ever with fewer resources, wherever they are in the service.
 “GPs are undertaking increasing numbers of GP consultations and hospitals are facing similar levels of high demand that is only likely to rise in the years to come, and become more complex as the population grows and people live longer. These pressures are coming at the same time as health budgets contract in real terms.
“The BMA has written to the Secretary of State asking for an urgent meeting so that we can discuss how we can move forward and tackle the latest emerging crisis facing the NHS.”
 Dr Laurence Buckman, Chair of the BMA’s GP committee, said:
“The BMA has made it clear for many years that the provision of out-of-hours care in England needs to be improved, particularly in how it is resourced and co-ordinated, but it is wrong to blame the GP contract for problems with the system. The Government’s analysis of the problem is extremely inaccurate.
“Out-of-hours care has historically been badly underfunded even before the introduction of the GP contract in 2004. Despite rising patient demand, funding has remained static in the last few years. The bungled introduction of NHS 111, which was intended to alleviate pressure on the system, has just made matters worse.“
A copy of the letter sent today to the Secretary of State for Health, is below:
Dear Sir,
The BMA is extremely concerned about the overly simplistic, inaccurate analysis of the huge pressures on accident and emergency departments being promoted by the Government over the past few days. A clear message is emerging, highlighted in advance media coverage of the speech you are due to make at today’s Age UK conference, that you lay responsibility for these pressures with GPs.
In reality, the causes of the very real increased pressures are complex and not fully understood. Out-of-hours primary care will form part of the picture - we have been lobbying for many years for the ability and resource to make improvements and GPs remain very much key providers of urgent care during the weekends and evenings. But the current pressures will also be due to rising demand on the NHS, unmatched by increasing resources, insufficient staffing in A&E departments and bottlenecks elsewhere in the hospital system, as well as the bungled introduction of the NHS 111 urgent care service in many areas.
We welcome Sir Bruce Keogh’s review of urgent and emergency care and hope it will consider resourcing and co-ordination across the whole health service. We all want to see the provision of timely, effective and appropriate high quality medical care. Where this is failing we must work together to identify the causes and solutions rather than point the finger unfairly at health care professionals, the vast majority of whom who are providing a high quality service to their patients in the face of hugely increased demand and real-terms reductions in resources.
We would very much like to meet with you urgently to discuss how the medical profession can work with the government and others to find a constructive way forward.
Yours sincerely,
Dr Mark Porter
Chair of BMA Council
Dr Laurence Buckman
Chair of the BMA’s GP Committee
Dr Paul Flynn
Chair of the BMA's Consultant Committee

17th April 2013

Dear Sir/Madam

The Government in England will, from April 2014, make far-reaching changes to practice funding.  Its stated intention is to reduce the wide variation in core funding per weighted patient between practices.  This may have a profound effect on your practice income

Read Our Guidance Outlining what we know of these changes so far.

With less than a year to go before these changes are put into place, GPs deserve to have absolute clarity about the Government's intentions so they can plan their services.  

Unfortunately, despite the Government having had many months to consider these proposals, and despite repeated requests for clarity and reassurance from the BMA's General Practitioners Committee (GPC), the profession has not been given any certainty at all.  Most worryingly of all, the Government has failed to reassure us that PMS and GMS contracts will be treated equitably and as a whole or that the proposals will not reduce existing funding in primary medical services.

The Government has repeatedly stated that its plans for securing equitable funding mirror those developed in negotiation with GPC last year but the current plans bear very little resemblance to these proposals. We are deeply concerned that the Government may renege on this commitment, and instead use money currently in PMS contracts to plug funding gaps elsewhere in the NHS.  This would lead to this money being lost to general practice, seriously destabilising thousands of practices.

We very much hope that this situation will not come to pass.  We continue to urge NHS England to do the right thing by:

    In the meantime, the Government and NHS England must realise that practices will not be able to make any long-term investment decisions, such as recruiting more medical or nursing staff until they know exactly what will happen to their funding. The longer this uncertainty continues the bigger impact this will have on our patients. I will write to you again as soon as I have more information.

    The GPC has developed guidance to explain all of the imposed contract changes.  

    Read our GP contract Survival guide   We will continue to expand the Survival Guide over the coming weeks with further practical advice for practices so do keep looking.

    Yours sincerely

    Laurence Buckman
    Chairman, General Practitioners Committee

    8th April 2013

    NHS Property Services (NHSPS) Leases
    Because of the scale of undocumented occupations for GP tenants across England, the process of ownership transfer from PCTs to NHS Property Services (NSHPS) is very much behind schedule (the original deadline was 1st April). NHSPS will be issuing temporary Memorandums of Occupation (MoOs) until such time as practices can agree and sign lease arrangements. This means there is no absolute rush to sign a lease by 1st April (unless practices have taken their own legal advice and are satisfied with any draft agreements circulated by PCTs).

    GPC has urgently commissioned external property lawyers to comment on a draft model lease agreement recently shared with us by the Department, and will update on this shortly. If the lease is reasonable, GPC proposes to agree to it being used as a national template for all NHSPS-owned premises occupations. The GPC will also produce supplementary generic advice on lease arrangements for use by LMCs and members.
    It remains extremely important, however, that all GPs seek independent legal and financial advice before signing any commercial agreement, such as a lease. BMA Law can obtain preferential rates for all members for external property law advice. They can be contacted via

    NHSPS will have an option to include full repairing and insuring (FRI) terms within practice lease agreements. The 2013 Premises Costs Directions confirms that internal and external repairing and insuring costs will be included in rent reimbursements. The template actual leasehold rent determination letter, shared with us by the Department of Health (DH) and to be used by all NHS Commissioning Board Area Teams, also confirms that the Board will be including additional funding within rent reimbursements to cover the cost of any external repair or buildings insurance liabilities:

    Included in the above total amount, is the figure of [£] towards the cost of the value of your tenant responsibilities for external repairs and maintenance/or building insurance. Once the cost of any building insurance responsibility has been met, the balance should be invested appropriately in a ‘sinking fund’ to meet external repairs and maintenance which arise.

    Where there is agreement from all parties to include FRI terms within the lease, practices would need to agree a schedule of condition with NHSPS, as existing dilapidation should be noted before a lease is signed.

    Current reimbursement payment arrangements will roll over into the new financial year and Area Teams will be assuming responsibility for this. If GP tenants in NHSPS premises believe service charges are being calculated incorrectly, a record should be kept and issues should be flagged up with the new landlord company as soon as possible (this could be done by an LMC on behalf of local practices). NHSPS have assured us that they intend to achieve economies of scale on service charges (e.g. by tendering for utilities, cleaning etc) and will pass these savings onto practices.