Debate contribution: GP GMS Contract 2025-26

Debate contribution by Mr Mike Nesbitt on 19 May 2025.

MLA

Mr Mike Nesbitt

Party at the time

Ulster Unionist Party

Date

19 May 2025

Type

Debate contribution (made as a minister)

Business

Ministerial Statement

Heading

GP GMS Contract 2025-26

Assembly identifier

Official Report component 4967888

Read the official Assembly record

Text

I thank you, Mr Speaker. When I took up post, the last thing that I was looking for was a fight. I have huge respect for the tens of thousands of wonderful colleagues who deliver excellent healthcare every day in Northern Ireland, including, of course, GPs. In fact, I could argue that a GP saved my life, because it was my doctor, fresh into post, who had the professional curiosity that alerted him to the possibility that I had a heart condition. He sent me for tests, which ended with my being fitted with two stents, a pacemaker and a defibrillator. Please believe me when I say that I have a personal interest in supporting primary care. That personal interest is matched by a professional one. Members will be well aware of my ambition as Health Minister — the so-called shift left — to focus on prevention and early intervention, switching focus from our acute hospitals to concentrate on primary, community and social care. I am not saying that, as Minister of Health, I am the best friend that GPs could have hoped for, because I am sure that every Minister has cherished primary care, but I hope that they understand that it is a key focus of mine. That said, I did not come into post to make promises that I could not keep or agree to demands that the budget cannot satisfy. Regrettably, I have been faced with such a demand by the British Medical Association Northern Ireland General Practitioners Committee (GPC) in relation to the GP contract for 2025-26. Believe me, I share its frustration that, year after year, there have been inadequate budgets for health and social care, but I must question the wisdom of tabling unachievable demands at a time when budgetary pressures are at an all-time high. I also have to respectfully wonder what it hopes to achieve by treating an ally of primary care as an adversary. All, of course, is fair in love, war and funding bids, but those tactics make absolutely no sense to me. By way of background, I will start with an issue from last year's negotiations: the question of indemnity, which has been allowed to become toxic over a number of years. Last year, my Department offered £5 million repurposed from the existing funding baseline as a short-term fix pending agreement on the full and final settlement. When I took up post, GPs were accusing my Department of unilaterally changing the agreement in the letter of offer. My officials were insistent that that was not the case, and, from reviewing the agreement and the letters exchanged at the time, I tend to agree. However, I offered independent arbitration, promising to make good any financial shortfall, should the GPs be right. The GPs did not take up that offer. I still do not understand why not, but the suspicion has to be that they recognised that they were seeking to shift the terms of a deal to which they had previously agreed. This year, the offer is to put that £5 million back into the pot to use for core services and to provide a new, fresh, additional £5 million for indemnity. That is a good outcome. I recognise that the BMA states that £5 million is not sufficient to cover the full costs of indemnity, but let me explain to Members that the value of the offer on indemnity is based on data on the actual subscription costs paid by GPs in Northern Ireland. The data was provided by the three medical defence organisations that provide the overwhelming majority of cover to GPs here, and it was subject to external expert analysis provided by the Government Actuary's Department. I am content that the offer that my Department has made on indemnity is fair and meets the needs of the service. As to criticism from GP representatives that the offer is not open to locums, I make no apology for that. My Department contracts with GP practices for the provision of services to the population. It is therefore entirely appropriate that the support we offer be targeted to those practices.

Indeed, in March this year, the Public Accounts Committee questioned whether the Department of Health was incentivising GPs to work as locums, to the detriment of the service. I trust that colleagues from that Committee will therefore be supportive of the approach to fund practices directly for the costs of indemnity. The BMA's GP membership has now rejected that offer. That was one of three key demands. The second concerned the hike in employers' National Insurance contributions. I take the view that it is deeply unfair to ask GPs to fund those increases, so, despite the deficit position that my Department faces, I had already decided that it would not be fair or reasonable to ask practices to meet the extra costs. That is why we put £3·5 million on the table to cover the full costs. When GPs said that that may not be enough, I promised that, if they could produce evidence for that — receipts that proved that it was not enough — I would make up the shortfall. That is another offer that the BMA has rejected. The third GP demand was for more money. Let me be clear: I wish that I had far more money to invest in primary care. I wish that I had more money to invest in all the really important areas, but the financial realities of repeated Budget settlements that Members endorsed and approved prevent me from doing that. It is simply not the case, however, that extra investment is not being made or, as I read in a public statement last week, that money is even being cut from primary care. In the 2023-24 financial year, the total investment in general practice across Northern Ireland was £388 million. I have already confirmed that the total investment in GP services this year will be over £414 million and will include pay uplifts from last year and the recently announced investments in multidisciplinary teams (MDTs) and in the primary care elective service. I expect to make a further increase of £10 million to £20 million, or perhaps of £20 million to £30 million, once the pay review body recommendations are decided on for this year. We have already offered a further unconditional £1 million, yet the BMA NI GPC told me that it wanted £80 million. On at least two occasions, I asked its chair to give me a one-pager outlining what new services it would offer in return. That never came. The extra £80 million is not being demanded for reform or expansion or, indeed, for measures to improve public access to GP services. It would simply be for more of the same. Given the sheer scale of the pressures facing public services across all Departments, that is not a realistic approach to take. That is therefore the position. Giving GPs another £80 million to do what they are already doing, with a vague promise that they will sit down to discuss the severe access issues, is not an option that I can contemplate when there is already a funding gap of half a billion pounds and more in the Department of Health's budget overall. I have been consistent in stating that I will not sign off on catastrophic cuts in order to reduce that funding gap. For the avoidance of doubt, "catastrophic cuts" are cuts that put lives at risk, such as closing an intensive care unit bed. To summarise, there is £5 million of new money for indemnity, £3·5 million of new money for employers' National Insurance and £1 million of other new money. That is £9·5 million in total. That £9·5 million was hard to source. The Health budget now has a shortfall of in excess of half a billion pounds. I repeat: the shortfall is north of £500 million. I face the quadruple challenge of tackling waiting lists; mitigating the damage being done to other services from the diversion of £165 million from my existing budget to tackle those waiting lists; funding further reform of healthcare; and balancing the books. I met the BMA NI GPC on Tuesday 29 April. It was clear that it did not like the offer and was determined to ballot its members. We asked it this direct question, "Will you advise your colleagues on which way to vote?". The GPC was equally direct, saying that it would simply state the facts. "Our members will decide" was its position. Two days later, its chair was publicly urging members:

"to REJECT the government contract offer."

Over the past 12 months, MLAs from across the House have written to me to highlight the challenges faced in accessing some practices. We still have many exceptional GP practices, but, from the messages that we receive directly from patients, I can see that some people are still having to phone hundreds of times in the hope of securing an appointment to see their GP. That is not sustainable. My Department's contract proposals included a number of small but significant changes to help improve patients' experience of accessing services.

Some of those things are simple to implement and do not involve any additional cost to practices, such as making sure that practices make some of their appointment slots bookable so that patients do not always have to call back another time when the daily capacity has been reached; making sure that practices make the most of the digital functionality that they already have to make ordering repeat prescriptions easier; and making sure that, when patients walk in to make an appointment, they do not have to buzz their way into the practice and are dealt with appropriately by a member of staff there and then, rather than having to go outside and phone in.

I also wanted GPs to establish patient participation groups to give patients a voice in how they are served by their practices and for practices to undertake patient satisfaction surveys. Some of the proposals had already been included in the previous year's contract, with the only changes being to some of the wording. Yet, instead of agreeing to those, the BMA offered only to join a new working group to consider them. That was not acceptable to me nor would it be acceptable, I suspect, to most Members. Furthermore, I asked the BMA to commit to sharing with its members our latest proposals for addressing the now wholly untenable access issues. Regrettably, they gave no assurance that they would forward that paper. The time for general open-ended discussions on improving access is over. I think that I am entitled to see concrete proposals from the BMA. The BMA's Northern Ireland General Practitioners Committee has asked to meet me following the ballot result, and I remain 100% committed to dialogue with the BMA and all the other professional groups and trade unions in the health service. My record speaks for itself on that. I met the General Practitioners Committee's chair earlier today. My permanent secretary is due to meet the BMA tomorrow to jointly discuss how we expand and enhance GP services and how we can shift resources gradually but steadily from hospitals to community-based services. I had to tell the chair that the GP contract on offer for 2025-26 is at the very limit of what I can do. In financial terms, the cupboard is bare, and there is no point in pretending that I can serve up a sumptuous three-course meal. There is nothing to be gained from further contract negotiations, which would only offer false hope that a better offer might be forthcoming; it will not be. We are at the end point for this year. I have, therefore, taken the decision to go ahead and implement the contract on offer. I do so mindful of the pressures that GPs are facing in relation to National Insurance bills and the longstanding concerns about indemnity cover. I want the funding that I have been able to earmark for those areas to be released and to provide immediate assistance. Further delay will help no one. As always, I will continue to engage closely with the BMA and GPs. My door is always open for genuine engagement and discussions. I remind Members of the importance of distinguishing between GP contract negotiations and pay negotiations. Pay is a separate process, and I await publication of national pay review recommendations on pay increases this year for GPs, other doctors and the wider health service workforce. I have said that, all things being equal, my intention is to implement the pay increase recommendations as promptly as possible. That will put further pressures on my overall budget, particularly if the proposed increases are well above inflation. The likelihood is that my budget shortfall will grow even further. That is another reason why I cannot go any further on the GP contract this year or, indeed, on the so many other parts of Health and Social Care that are crying out for additional funding. I will now listen carefully to what Members have to say. I can only hope that no one will turn it into a party political issue. I commend the statement to the House.

In return, I ask the Member whether he will take responsibility for his language. We are implementing this: we are not imposing it on the GPs. You are using inflammatory language, which is a matter of regret. I have gone as far as I can go with the financial offer. I have detailed it to you. I am not the first to make it public. The GPs were balloted by the General Practitioners Committee, so they know what the offer was. They know that it was £9·5 million. They know that £5 million of that was for indemnity, that at least £3·5 million was being made available for National Insurance and that another £1 million was being put into the pot. I twice said, "Tell me what you would do for service delivery with an additional £80 million", and I did not get a response, because the answer is that it would only be more of the same. I cannot fund that.

I have no alternative to taking this course of action, because the money does not exist. Let Hansard record that the statistic that the Member quoted is the response of those who voted. It seemed to me that the Member was trying to imply that it was 99·7% of all GPs, but that was only the responses of the GPs who voted.

I gently remind the Member that, although she says that this is a strange way to conduct a negotiation, the negotiations are over. I am not conducting a negotiation. The negotiations are over.

I thank the Member for his questions. I would love, as I said in my remarks, to fund the shift left immediately. By the way, I do not necessarily accept the figure of 5·4%, because all these things are open to debate. How do I justify not increasing the money? I justify it because, to fund that, you would be talking about catastrophic cuts. You would be talking about potentially closing an intensive care unit bed. The Member is a nurse, and he knows how catastrophic those cuts would be. I have spoken to the chair today and said, "Let's talk", and she has agreed that we should talk. What is on my agenda is the longer-term view of how we achieve that shift left, but, at the moment, with a £0·5 billion hole in the budget, I cannot find £80 million for GPs.

I think that the Member is aware that I am very conscious about access to GPs, and we wanted to make access to GPs a part of the negotiations, which would have led to a bilateral agreement between my Department and the General Practitioners Committee. We were not able to get there. In fact, we refined our asks around access; I think that we made them simple and cost-neutral to GPs. At the last meeting that I had, when they said that they were going to ballot their members, I asked the direct question, "Are you prepared to share our latest proposals on access with your members before they vote?". No such commitment was given. We are not in a good place; I accept that, and I accept that, if you cannot get timely access to the GP, the implications for the service user or patient can be extremely severe. I want to fix that, but I cannot fix it with money.

I thank the Member for his question. Yes, of course I do. As I said in my remarks, one of our proposals on access issues was pre-bookable slots, so that the people who are making dozens and dozens of calls and are sometimes frustrated to be told that all the bookings for the day are gone might be able to pre-book. I think that that would be of great comfort to many of the people who spend a lot of time on redial.

I thank the Member for his question. I made the point in my remarks that we based the £3·5 million on figures from the Government Actuary's Department and the three big indemnity insurance companies, so we have a solid evidence base. I am not sure of the extent to which we have disclosed the statistics to the BMA, but what we have done, which is much more important, is that I have given a ministerial guarantee to that committee that, if GP practices can prove that £3·5 million is not enough, which they should be able to prove through receipts, we will make up the shortfall. Therefore, they should not lose out and should not have to fund a single penny of the additional hike in employers' National Insurance contributions.

I find the Member's language inflammatory and far from helpful. Once again, I say that we are implementing, not imposing, the contract.

I am convinced that we have dealt with, on a long-term sustainable basis, the toxic issue of indemnity, which has become toxic over a number of years. Absolutely, we have done that. We have covered the hike in employers' National Insurance contributions, whether that is £3·5 million or maybe a little bit more. We have managed to put another £1 million into the core funding envelope. I know that that is well short of what the GPs want. Is it a perfect solution? Of course it is not. As I said in my remarks, I would love to give more money to every core element of health and social care delivery, but the budget is not there to achieve that.

3,136 words. Text as published by the Northern Ireland Assembly.

Assessment

Not flagged

Jev’s structured answers

Assessed 21 October 2026 at 12:36 UTC by jev-1.13.0 (requested as typesafe/jev) under rubric 2026.10-r9, methodology 1.9.

Disagree with this assessment?

Classifications can be challenged. A person reads every challenge, and any change is recorded publicly above with its reason.

Challenge this classification