Welsh GP contract 2024/25

Read about the outcome of resumed negotiations following the Welsh GP profession’s overwhelming rejection of the previous Welsh Government contract proposal for 2024/25.
Location: Wales
Audience: GPs
Updated: Friday 31 January 2025
Contract and pen article illustration

Background and context

After the BMA’s Welsh GP contract referendum of Dec 2024, where a resounding 99% of GP members in Wales (on a 68% turnout) voted to reject the original contract offer for 2024/25, an improved offer was received from Welsh Government and subsequently negotiated by the GPC Wales executive in resumed tripartite talks (with NHS Wales representatives and WG officials).

This resulted in an outcome which almost doubled the initial investment proposed in the original offer. 

This is a substantial additional funding injection, only offered after our referendum. Your united voice has been loud and unequivocal, and heard in the corridors of government. Together, we have encouraged the Welsh Government to reflect upon and vastly improve its original offer.

Following much debate, GPC Wales voted unanimously to accept this improved offer on 23 January. Whilst we still have reservations about the non-recurrent nature of the increased financial quantum, this was unavoidable at this late stage in the financial cycle, particularly given the challenging circumstances that many practices face. We have secured assurances on early discussions for 2025/26 in the hope that this investment can be made recurrent and an earlier agreement reached so that we can avoid the uncertainty and delayed announcements of the last 2 years.

A GMS Contract Implementation Group will now be established, which will include GPC Wales representation, to take forward the agreed negotiation outcomes, facilitate their implementation into the GMS contract and produce detailed guidance for practices. 

The full directions, statement of financial entitlement and guidance will, in due course, be found on the Welsh Government website.

 

Financial changes

The agreement represents a total financial uplift, for the financial year 24-25 and backdated to 1 April 2024, to the GMS contract of £52.1m. This sum represents an uplift of 11% of the total Wales GMS contract value. The key details are:

 

Pay uplifts and methodology

Uplifts to the global sum for staff pay have been applied according to NHS Digital’s GP Earnings and Expenses dataset, in particular the average Expenses to Earnings ratio (EER). The most recent NHS Digital ratio of 35.6% pay and 64.4% expenses has been used to calculate how the investment has been applied to the GP contract. This is the most accurate evidence-based representation of GP expenses. 

The staffing expenses element represents the total gross cost of staff pay. Therefore, the 6% uplift to the quantum includes an uplift covering the employers on-cost contributions. 

The SFE will be amended to state that the 6% staff uplift should be applied after any statutory increase in National Minimum or Living Wage have been added. GPC Wales has always maintained that we support fair pay for all employees, particularly those on lower incomes, and support a full funded pay award that exceeds statutory wage increases. You will need to consider your own practice business arrangements as to how you meet the SFE requirements. For instance, if you have already uplifted an individual staff member’s pay rate to the value of the national minimum wage from 1 April 2024 (as you were legally obliged) you will need to retrospectively apply the further 6% contractual uplift.

The non-recurrent offer of £23m, designated as a practice stabilisation payment, acknowledges these increased practice costs (such as statutory wage increases) and recognises pay awards made to other parts of the health workforce. This quantum of money will enable practices to choose whether they apply discretionary uplifts to other members of staff to account for a ’band inflation’ effect.

Without a ‘ring-fenced’ and sufficient staff pay award uplift, any pay increase given to staff would be funded from the contractor GP pay uplift. For most practices, this in-year payment should enable DDRB recommendation of a 6% pay uplift for GP contractors to be realised.

Non-recurrent funding: the practice stabilisation payment

We understand the non-recurrent funding element of the deal will be of concern, and we absolutely share your frustrations. While this settlement does not resolve every issue, it provides a solid foundation we can build upon. Accepting this deal now, at this point in the year, will provide practices with a level of immediate stability they desperately need – as we have called for in our Save Our Surgeries campaign - and will begin to tackle the critical issues facing NHS general practice in Wales.

As part of this deal, the Welsh Government has provided assurances that negotiations for the 25-26 GMS Contract will begin as early as possible, in advance of the Welsh Government’s budget being settled. Given the known, unavoidable costs from April 2025, we will push for the non-recurrent elements of the deal to be made recurrent, as well as increasing levels of resources that can realise the goals of our Save Our Surgeries campaign. 

 

Contractual changes and commitments

We have reached agreement on a number of commitments and contract changes as part of the contract deal. The contractual changes will be progressed via the Contract Implementation Group and a series of Short Life Working Groups, to be implemented in readiness for 2025-26. 

There are some agreed changes to the contract, but these will have a lead-in time prior to implementation and require practice guidance via the CIG.

The contractual changes for practices will be:

  • Covid antivirals (oral treatments) for immunocompromised patients as ‘unified’ services.
  • Learning Disability Directed Supplementary Service transferred into ‘unified’ services, with qualifying definition to be agreed (with existing DSS spend moving into Global Sum)
  • Collection of data via GP systems on frailty & ethnicity.
  • QI project 25-26 on measures of Continuity of care - subject to approval by GMS quality committee.
  • Practices to enable the repeat prescribing functionality of NHS Wales App.
  • Practices to assist patients with Welsh Identity Verification Service (WIVS). This is essentially onboarding for patients for the NHS Wales app, akin to My Health Online previously.

Commitments for immediate joint working by GPC Wales over the next few months:

  • Review of the access standards – with a focus on reviewing the reporting and evidence requirements to Health Boards for the 25/26 year; with further evaluation to take place for 26/27 and beyond.
  • Engagement in GP collaborative development discussions.

 

Short-life working groups: GPC Wales priorities

A number of GPC Wales’ key asks have been prioritised for wider discussions to inform the 25/26 negotiations. These have been recognised by all parties as areas of interest.

  • Item of service fee for vaccinations & immunisations: exploration of a new global vaccination Item of Service fee for all vaccinations 
  • Uplift to SFE sickness and parental leave entitlements: developing a mechanism to annually uplift the amounts claimable by practices for locum cover for sickness leave, parental leave and suspended doctors 
  • Uplift to the Partnership Premium scheme: to address devaluation since introduction of the scheme
  • Review of care home DSS and minor surgery/joint injection DSS: agreement secured to complete a review of both DSS specifications.

 

Quality improvement framework

Information on the projects within the QI cycle for 2024-25 was communicated to practices in August 2024. These projects are:

  • Supporting Healthy Behaviours project (continuation of 2023-24 Unhealthy Behaviours project) = 100 points (See guidance)
  • Prescribing Safety project = 70 points (See guidance)

The QI cycle will run until 31 March 2025 and completion of both projects is mandatory for those practices who have opted to participate in the QI process. 

A project to measure Continuity of Care has been allocated to the GMS Quality Committee (which features GPCW representation) who will develop a project specification which will be included in the 2025-26 QI cycle, if approved.

 

GP collaborative development discussions

As part of the revised settlement, GPC Wales has agreed to engage in tripartite discussions with Welsh Government and NHS Wales representatives to jointly explore the opportunities for different models of collaborative GMS service delivery. 

Welsh Government believes that proposed developments could incentivise co-operation between practices and their GP collaboratives and enable the shift of services – and resource- into the community, while also providing certain at-scale supplementary service for local patients.

Discussions on this will begin immediately and take place over the coming months. The outcome from these discussions would be further negotiated through the usual process before it becomes part of the contractual offer to practices.