Missing your referendum voting link?
If you are a GP member in England and you are eligible to take part in the referendum on the final 2024/25 contract, you should have by now received your voting link from Civica.
If you have not received a link to vote in the referendum:
- Check your junk folder in the email account that you have registered with the BMA.
- Log-in to your BMA account and check your membership data with us is up to date. If you are having issues updating your details, email our Membership Team to get them updated so you can receive a voting link from Civica.
- If you have still have not received a voting link, please complete our form and we will be in touch as soon as we can - normally on the same day.
- If you are not a BMA member, join us by Monday 25 March to have your say.
BMA GPC England has rejected the Government’s 2024/25 contract changes - have your say in the referendum
GPCE has rejected the 2024/25 GP contract changes.
The final 2024/25 contract will now be put to a referendum of BMA GP and GP Registrar members in England.
The referendum does not constitute a ballot on industrial action and taking part in the referendum does not pose any risk to contractor, locum, salaried or registrar members.
The referendum opens on 7 March and will close on 27 March, ahead of any contractual changes being imposed on 1 April 2024.
The referendum result will not prevent the Government from imposing its 2024-25 contract but will send a strong and powerful signal expressing the profession’s views about the contract offer and will inform potential collective next steps.
Full details of the contract imposition have been published below to allow GPs and GP Registrars to make their own fully informed judgments.
To take part in the referendum you must be a BMA member. New members must join by 21 March to vote in England.
Join the BMA to vote in the referendum and ensure your voice is heard.
Department of Health and Social Care / NHS England contract changes imposition
GPCE received notice from DHSC and NHSE of the 2024/25 contract changes at the end of January. These had not altered despite three more weeks of discussions following GPCE’s rejection at its meeting on 1 February. Summary details are set out below:
(excluding the PCN directed enhanced service)
There will be an overall increase in investment of £215m in 2024/25. This assumes:
2% pay growth for contractor GPs (£64m), salaried GPs and other practice staff (£91m):A further uplift may be made following the Government’s response to the Doctors and Dentists Pay Review Body (DDRB) for 2024/25.
- 1.68% inflation (£24m), in line with the Government’s November 2023 GDP deflator forecast for 2024/25.
- 0.38% (£35m) ONS population growth.
- This means the contract baseline funding will increase from £9.2 billion to £9.4 billion in 2024/25. This is around 5% of the overall expected NHSE budget (£186.7 billion) for 2024/25 for core/essential general practice services.
- The Global Sum payment per patient will be £107.57 for 2024/25.
There will be an overall increase in investment of £44m in 2024/25. This assumes:
- 2% pay growth uplift to the overall Additional Roles Reimbursement Scheme (ARRS).
NHS England will suspend and income protect 32 indicators (out of the 76 QOF indicators) and align indicators CHOL002 with the new NICE NM252 indicator definition of cholesterol control.
GPCE requested that aspiration payments for QOF were increased as part of the move towards a higher trust model (currently 70%). This was accepted and NHS England propose increasing aspiration payments from 70% to 80%.
NHS England will streamline eight clinical specifications into a single higher trust specification (with some detailed specification requirements moved to guidance documents).
They will also simplify the role requirements for PCN Clinical Directors, focusing on requirements for delivery of modern general practice and allocation of resources and accountability to the ICB. There will be a more flexible funding pool for PCNs by rolling the Clinical Director and PCN Leadership and Management into core PCN funding (£183m).
NHS England will streamline the IIF further and redirect funding to CAP (Capacity and Access Payment) funds amounting to £292m for 24/25. The IIF will be reduced from five indicators to two - worth £13m – with only the indicators on learning disability and FIT testing retained.
PCNs and GP practices will be allowed to agree with ICBs (integrated care boards) the deployment of any doctor that is employed or registered with bodies designated by the Medical Profession (Responsible Officers) Regulations 2010 (Schedule, Part 1 only) to deliver primary care services without being on the Medical Performers List. There will be a corresponding change to the GP contract regulations.
- These changes will permit GP practices and PCNs to employ doctors who are already employed, for example, by an NHS trust or NHS foundation trust without the requirement for the doctor to also be registered on the MPL.
- Supporting guidance will also be issued to clarify that non-GP doctors should not see undifferentiated patients and that they continue to be required to operate within their sphere of competence.
NHS England will now:
- Include enhanced practice nurses in the roles eligible for reimbursement.
- PCNs will be able to recruit other direct patient care non-nurse and non-doctor MDT roles, if agreed with their ICB.
- Where PCNs already have one mental health practitioner (MHP) in place, 50:50 funded by the PCN and the mental health provider, funding arrangements for subsequent MHP roles will be for agreement between the PCN and the mental health provider, subject to ICB approval.
- Caps on advanced practitioners will be removed.
- PCNs will be able to claim reimbursement for the time personalised care roles spend out of practice undertaking training or apprenticeships to obtain a level three occupational standard.
- Allow reimbursement of training time for personalised care roles undertaking training or apprenticeships.
NHS England will make the following changes:
- 70% CASP (Capacity and Access Support Payments) monthly with no reporting requirements
- 30% CAIP (Capacity and Access Improvement Payments) payable on PCN confirmation that PCNs have put in place all components of the Modern General Practice Access model
- Digital Telephony data reporting: practice-level reporting of call data to commence October 2024
- Online patient registration process as well as paper registration
- Digital copy of practice boundary using NHSE mapping tools
- Strengthen reference to ‘continuity of care’ as a criterion when considering response to patients initially contacting the practice
NHS England will expand the shingles cohort to as part of the 10-year expansion of the programme, in line with JCVI advice. The expansion of the immunocompetent cohort is proposed for implementation over two five-year stages as follows, with the first years having been confirmed:
- First five-year stage: Shingrix will be offered to those turning 70 and those turning 65 years of age in each of the five years as they become eligible.
- Second five-year stage (subject to confirmation of funding): Shingrix will be offered to those turning 65 and those turning 60 years of age in each of the five years as they become eligible.
NHS England will also change the current V&I standards including:
- Shared data on vaccination status of patients with local CHIS [Child Health Information Services]
- Rationalisation of SNOMED codes used for vaccinations to improve data quality
- Improved data recording of vaccination status (including new patients registered from overseas)
- Practices must amend data they are informed is incorrect.
NHS England will continue this for 2024/25 with an unchanged IoS (item of service) payment of £11.50 and a capped total funding of £7.2 million.
NHS England will require practices to have ‘due regard’ for the needs and circumstances of Armed Forces Veterans when offering services and making referrals.
A minor amendment to the wording in regulations to update reference to Digital Primary Care: Good Practice Guidelines for GP Electronic Patient Records: Version 5 will occur.
GPCE solutions rejected by DHSC and NHSE
- 8.7% increase for Contractor GPs, salaried GPs, other employed staff and other practice expenses just to keep pace with 21.2% CPI inflation between April 2019 – April 2020.
The 2019-24 contract investment grew by 12.5% across the five years. - This would have increased the overall core practice contract funding baseline (Global Sum) by £799m from £9.2 billion to around £10 billion - just under £13 more.
- Further uplifts to then be applied as necessary following the 2024/25 DDRB Award (expected in May / June) to ensure guaranteed fair pay uplifts for salaried GPs and other practice-employed staff.
- Amendment of Personalised Care Adjustment to take account of informed dissent for childhood vaccinations citing data from affected deprived cohorts and atypical populations.
- Item of service fee for all SFE (Statement of Financial Entitlements) Para 19 vaccinations and immunisations to increase in line with CPI inflation (21.2%).
- An increase in line with CPI inflation (21.2%)
- These rates have not changed since 2019/20.
- Providing an uplift to core practice baseline funding to enable practices to cover salaried GP expenses as a way to boost income before tax after such significant cost-of-living increases in recent years.
This can be legally implemented by practices using the BMA’s Safe working in general practice guidance and doing so does not breach your contract. The BMA’s salaried GP model contract is the existing and recommended vehicle here for limiting hours / sessions to safe levels and, legally, terms no less favourable should be offered by GMS/PMS practice employers.
BMA members also get access to free contract checking services and are strongly encouraged to use them.
- DHSC / NHSE were warned of the additional cost of full salaried GP pay restoration (compared to 2008/9 levels) during the discussions.
- These practice-employed staff pay uplifts need to be guaranteed by Government / Treasury.
- GPCE/conference position – move QOF funding into core practice funding
- QOF 70% payments to be increased to 90% upfront given 20-year body of evidence to draw on and challenging NHS England to return with evidence.
- End the DES and move funding into the core practice funding baseline
- Allow practices to use a proportion of enhanced access appointments for continuity of care for their own registered patient lists
- Rewind and refresh the central tenets and purposes of PCNs to support constituent practice workload
- Retire IIF indicators from 5 to 1 (HI03) – retire CAN02
- Pay the 30% CAIP (Capacity and Access Improvement Payments) upfront, without dependence on dysfunctional ICB budgets to support requested IT solutions
- Mandate PCNs/practices to use ringfenced proportion of CAP funding for GP supervision of ARRS staff
- Recycle a ringfenced proportion of the CAP to fund a national Safeguarding DES
- Mandate use of CAP monies to increase Care Home Premium payment to £12 per month/£144 per year
- Protect the GP status/requirements of PCN CDs (£44m)
- Recruitment of GP Nurses
- Recruitment of GPs with extended roles
- Allow PCNs to best match the needs of the registered patient population against local recruitment challenges
- Budgets to be drawn down from ICB allocations to ensure oversight of ‘additionality’ and spend against recruitment
- No Consultants, no Staff Grades or 'Primary Care Doctors'
- Allow initial MHPs/Paramedics to be outside host Trust arrangements
- Better NWRS (national workforce reporting system) scrutiny.
- 85-90% CASP (Capacity and Access Support Payments) monthly with no reporting requirements.
- 10-15% CAIP (Capacity and Access Improvement Payments) payable on PCN confirmation that PCNs have put in place all components of the ‘Modern’ General Practice Access’ model.
- Cloud-based telephony data reporting: PCN/Place-level aggregated reporting.
We suggested training hubs be encouraged to develop recruitment and retention programmes for Trust-based roles seeking to transition into the primary care setting – specifically nursing roles, but not exclusively.
We proposed that NHSE mandate ICBs to commission a service level agreement from Trusts of Occupational Health support to all NHS GP staff and contractors. This could have been subcontracted at a system or place level. That would lead to greater productivity of the primary care workforce, and greater efficiency at scale, levelling up access to occupational health, improving outcomes for the workforce and embedding integration of wider partnership mutual aid across the ICB footprint from existing Trust budgets.
GPCE requested a public commitment to setting up a task group to investigate enabling amended regulations for 25/26 to permit GMS/PMS partnerships to limit their liabilities. DHSC agreed to look at this in the coming year.
GPCE proposed a relaunch and refresh of the New to Partnership Programme, including eligibility to all those GMS/PMS partners joining a partnership from 1 April 2023 onwards, so long as they remain in post for a minimum of 24 months. The proposal included a golden hello payment weighted to deprivation indices, and a £1,000 budget to draw down on funding practice business fundamentals training to spend from 1 April 2024. The Primary Care Minister has discussed looking into this with us.
GPCE requested a limit to the routine CQC inspection window from April 1 – September 30 to allow primary care providers to focus on prioritising patient access and same day urgent care during periods of increased system pressure over the winter months. From October 1 – March 31 inspections should be restricted to those where concerns have been specifically flagged to the regulator, commissioner or LMC. DHSC/NHSE suggested this is taken up with CQC directly.
2024-25 GP contract referendum FAQs
Am I eligible to vote in this referendum?
You can vote as long as:
- you are a BMA member
- you are practising / training in England
and are either
- a GP contractor / partner
- a salaried GP
- a locum GP
- a GP registrar / GP in training.
I’m a BMA member, but I’ve not received my email with my e-voting link. What should I do?
The referendum is being run independently by Civica. You will therefore receive your voting email from them. They will send these out in regular two-day intervals as new members join and existing members update their membership details in the coming days / weeks,. The referendum closes on 27th March at midday, so you have plenty of time.
First, however, check your junk folders the email account you have registered with the BMA. Second, log-in and check your membership data with us is up to date.
If you still haven’t received your voting email, please let us know via this form.
If, after all that, you are still having issues updating your details, email [email protected] to let us know, and our Membership Team will help you resolve it so you can get your email and voting link from Civica. Normally on the same day.
I’m not a BMA member and I’ve not received my email with my e-voting link. What should I do?
You need to join the BMA first to participate in this referendum by Monday 25th March and for any future votes. Join us!
How can I read more about the 2024-25 GMS contract discussions and the DHSC / NHSE changes?
You can also read NHSE’s letter to practices from 28th February
Why is this contract relevant to me?
The future of general practice services is relevant to all GPs and GP registrars in England. Whether you’re:
- already struggling to deliver your service contract
- struggling to keep up with the workload, regular unpaid overtime as a salaried GP and/or insufficient annual pay uplifts to match inflation
- cannot find enough / any work or cannot find work with fair working conditions as a locum GP
- having your training time ruined because you are regularly being asked to contribute to service delivery beyond your contractual requirements
- have reluctantly left NHS practice and work in the private sector because of the terms and conditions on offer
we invite you to consider these contract changes from your own perspective as well as those of your colleagues and your patients.
It is from the investment in this contract that working conditions and pay are derived for all GPs and practice-employed staff. GP Registrars may have a different training contract, but they will become qualified GPs in the not-too-distant future. Every missed opportunity to improve the GP contract means it will take us longer to get things back to a place where work is safe and patient care is safe and of the quality they deserve. Check out the BMA’s general practice pressures data analysis page to see how hard we work as a profession but how far away we currently are from safe practice and GPs numbers.
What is the significance of the Government’s use of the GDP deflator inflation measure forecast rather than CPI (as it did for the 2019-24 contract)?
The GDP deflator and CPI are both measures of inflation. However, CPI is a measure of consumer price inflation (that’s what CPI stands for) whereas GDP is a wider measure of inflation that includes goods and services bought and sold by the Government, as well as business investment spending among other things.
Inflation as measured by the GDP deflator tends to be lower than CPI. The latest forecasts suggest CPI increased by 21.7% between 2019/20 and 2023/24, whereas the GDP deflator only increased by 19.0%. So the Government using the GDP deflator means that the contract looks like it has fallen less in real terms than it would using CPI.
Using the GDP deflator is inappropriate for the GP contract. CPI is more appropriate because many of the things included in the GDP deflator are not relevant to the GP contract, and the biggest part of the GP contract – staff wages – should be linked to a measure of consumer inflation not the GDP deflator.
Why do I have to be a member to have a vote?
The national GP contract was built on GPs standing together to get the best contract for them and their patients. Only by continuing to do that will the BMA GP branch of practice be able to access the best insights from across the profession in order to design and negotiate a substantially improved contract from 2025-26 and beyond.
Should any future balloting and subsequent industrial action be ordered by the membership, strict trade union laws apply around who can vote and the membership data we hold for them.
We’ve let poor national policies divide us for too long. The collective lobbying and individual benefits BMA membership gives you cannot be found elsewhere, and it’s high time we strengthened that and secured the best possible future for the next generations of GPs and general practice staff.
Can I join the BMA now and still vote in the referendum?
As long as you join by Monday 25th March, you will be included in the referendum vote and will be sent an email with your e-voting link.
If you can’t join before then you are strongly encouraged to do so as soon as you can. General practice in England was built on unity, collaboration and looking out for each other regardless of contractual status to ensure patients always get the highest quality care. We are stronger together.
Where can I find out about the contract webinars?
We will email times / dates and links to forthcoming webinars and regular intervals to all GP and GP registrar members. LMCs will also have this information.
There will also be roadshows in the summer, as we will continue engagement with members throughout the year.
What happens after the referendum?
The outcome of this referendum will inform our collective next steps. There are roadshows planned in the summer and the BMA and your LMCs (local medical committees) will be disseminating further information to GPs / GP registrars throughout the coming weeks and months.
Will the BMA be producing guidance for my practice when the contract is imposed?
Yes, the BMA’s GPCE (GP Committee England) will produce and publish advice and guidance to help you consider how best to approach the contract changes. We will include this in the regular GP member bulletins and LMCs will also disseminate it to practice constituents.
We strongly encourage you to discuss this with your LMCs and neighbouring practices. It’s easy to insist that GPs and practice staff absorb more and more, but the Government is responsible for making sure enough resources exist so that staff are practising safely and patients receive safe care.
Will you be updating the BMA safe working guidance?
Yes, we will update, re-publish it and let the profession know as soon as possible.
Is there a reduced fee/membership offer to enable me to join?
You can review our current subscription costs here. Our offers are always under review and we’re listening to feedback on the concessions available.
GP contractors/partners:
Does it matter what contract my practice holds for me to vote in this referendum?
No. GP contractor / partner members holding either GMS (general medical services), PMS (personal medical services), APMS (alternative provider medical services) contracts or any other type of contract with an ICB (integrated care board) are all entitled to vote and have a say.
How much additional funding did GPCE ask for for 2024-25?
The Government / NHSE themselves coined 2024-25 as a ‘stepping stone’ year, which was meant to provide a stable foundation for more substantial positive reform from 2025-26 and beyond. We therefore provided evidence simply demonstrating the impact of inflation on the erosion of the real-term value of the core practice contract baseline funding in recent years. For the uplift offer to amount to so little (£179m for GP and practice staff pay) in the context of such significant inflation, it is unconscionable that practices can absorb this without losing staff or becoming unviable.
The cost of GP and practice staff pay erosion since 2008/9 is even greater, so that needs to be addressed this year.
Our practice has already received its e-contract variation notice. Should we sign it?
Contract variation notices are just that. The imposed changes will come into effect after the specific notice period ends with or without a signature.
Thinking about safety, stability and hope for the coming year and beyond:
- How will the contract ensure the funding available to you enables recruitment/retention of sufficient staffing?
- How does the contract support you to maintain and or develop your practice premises?
- How will the contract ensure safe working practices around hours?
- How will the contract ensure safe working conditions?
- How will the contract safeguard GP contractor / partner members in providing safe patient care?
- How will the contract address issues around home visits and ensuring effective working patterns for GP contractors / partners?
- How will the contract ensure improved working practices around appointment times?
- Does it guarantee sufficient funding to ensure all GP contractors/partners can receive the annual Doctors’ and Dentists’ Review Body pay award?
- Does it guarantee the protection of necessary CPD (continuing professional development) time that all GPs need?
- Is sufficient funding available to ensure GPs have the tools to deliver healthcare in the 21st century?
Salaried GPs:
Thinking about safety, stability and hope for the coming year and beyond:
- How will the contract ensure safe working practices around hours?
- How will the contract ensure safe working conditions?
- How will the contract safeguard salaried GP members in providing safe patient care?
- How will the contract address issues around home visits and ensuring effective working patterns for Salaried GPs?
- How will the contract ensure improved working practices around appointment times?
- Will the contract deliver sufficient funding to ensure salaried GPs are paid fairly and have terms no less favourable, as required by the contract regulations, than the BMA salaried GP model contract?
- Does it guarantee sufficient funding to ensure all salaried GPs can receive the annual Doctors’ and Dentists’ Review Body pay award?
- Does it guarantee the protection of necessary CPD (continuing professional development) time that all GPs need?
- Is sufficient funding available to ensure GPs have the tools to deliver healthcare in the 21st century?
Locum GPs:
Thinking about safety, stability and hope for the coming year and beyond:
- Will the contract ensure funding for future job opportunities?
- How will the contract ensure safe working practices around hours?
- How will the contract ensure safe working conditions?
- How will the contract safeguard locum GP members in providing safe patient care?
- How will the contract address issues around home visits and ensuring effective working patterns for locum GPs?
- Will the contract ensure funding to ensure GPs entering the workforce are paid fairly within the sessional model / locum model?
- Does it guarantee the protection of necessary CPD (continuing professional development) time that all GPs need?
- Is sufficient funding available to ensure GPs have the tools to deliver healthcare in the 21st century?
GP Registrars
For those of us who have just become qualified GPs and are BMA members, will the BMA be aware that we are no longer doctors in training and are now GPs?
Please make sure you have updated your membership details. Civica will be notified of updated membership details at regular intervals, so you will receive your voting link email once they have the right details. If you need support updating your details, email [email protected].The BMA Membership Team is responding to enquiries on a daily basis. We will ensure you get your vote before the referendum closes at midday on 27 March.
Thinking about safety, stability and hope for the coming year and beyond:
- How will the contract ensure safe working practices around hours?
- How will the contract ensure safe working conditions?
- How will the contract safeguard GP registrar members in providing safe patient care?
- How will the contract address issues around home visits and ensuring effective working patterns for GP registrars?
- How will the contract ensure improved working practices around appointment times?
- How will the contract protect/support registrar GPs in ensuring a smooth transition to becoming a fully qualified GP?
- Will the contract ensure funding for future job opportunities?
- Will the contract ensure funding to ensure GPs entering the workforce are paid fairly within the sessional model/locum model?
- Will the contract facilitate the availability of GP registrar training places?
- What benefits can ST1-3s expect as a result of the contract changes?
- Is sufficient funding available to ensure GPs have the tools to deliver healthcare in the 21st century?
- How will educational opportunities be affected/protected by this new contract?
How we got here
After consideration at its meeting on 1 February 2024, the Committee unanimously voted that the proposed contract changes, which ignore the reality of the unsafe and unsustainable pressures facing practices, was unacceptable. After instructing the GPCE Officer Team to return to discussions to secure improvements, ministers, DHSC and NHSE have continued to bury their heads in the sand.
Most notably, the committee believed the well below-inflation 1.9% baseline practice contract funding uplift is nowhere near what is needed to prevent practices from continuing to reduce staffing and services or closing altogether.
Despite this, the contract currently fails to give general practice in England the resources it needs. Without this, GPCE believes that significant numbers of practices will have no choice but to make staff redundant and freeze recruitment, severely impacting patient access and ultimately reducing quality of care.
We also fear rising numbers of GP contractors and partnerships being left with no option other than to serve notice on their contracts, leading to a slew of practice closures.
Results from our recent four-week snap finance survey of one in 10 GP practices show that:
- Two thirds of practices reported that they are concerned about their short and long-term financial stability.
- More than half have experienced cashflow issues in the last 12 months.
- Almost three in four practices reported being “very/extremely worried about the impact of inflation on practice finances”; for example, due to considerable rises in practice running and salaried staff costs.
Pressures in general practice data analysis
The BMA monitors data on GP workforce, working patterns, and appointment numbers, which illustrates the growing pressures on general practice.
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