The Doctors’ and Dentists’ Review Body (DDRB) is an independent body that makes an annual recommendation to the government on the pay of doctors and dentists. If the government accepts the recommendation, then a practice’s global sum (known as the ‘core contract’) receives an uplift (backdated to the start of that financial year) intended to cover the recommended uplift to its medical staff.
Since this is purely in relation to doctors and dentists, this doesn’t have any binding implications on the salaries of non-medical staff, although some practices prefer to have a pay system where every member of staff is entitled to the same uplift each year.
GP locums are not included in this recommendation as they are not employed by a practice, and can in theory be in control of their own rates.
Last year, the DDRB recommended a 6% increase to the pay of GP partners and salaried GPs.
What have salaried GPs been promised next year (2026/27)?
NASGP reported recently that the Department of Health and Social Care (DHSC) has warned that regardless of what the independent DDRB recommends, the government has only budgeted for a 2.5% rise next year; anything more than this may not be affordable.
This limit of 2.5% would effectively be a real-terms pay cut for all doctors, at a time when the workforce crisis and the ambitious aims of the 10 Year Health Plan, if anything, need additional investment.
Are salaried GPs entitled to annual DDRB uplifts?
Most salaried GPs should be employed under the BMA model contract, which has a standard set of terms and conditions that the BMA recommends to be included in the employment contract. Practices are required to offer terms no less favourable than these when hiring a salaried GP. One of the model terms in the contract relates to pay uplifts and it states, “Your salary will be increased by annual increments each year and in accordance with the Government’s decision on the pay of general practitioners following the recommendation of the DDRB.”
So far, so good!
However, there has been a problem for years whereby some salaried GPs, despite having this clause clear in their employment contract, don’t receive the pay rise that the DDRB has recommended.
Why do salaried GPs sometimes not receive the expected DDRB payrise?
NHS England and DHSC say that the DDRB pay award is ‘fully funded’ and passed on to practices in order for them to cover the costs of the pay rises.
However, what happens in practice is that a surgery will get the uplift – let’s say 6% – applied to just a proportion of its funding that it gets from holding the GP contract. Specifically, there are two pieces of the GP contract funding – the contractor income element and the other staff expenses element – that get increased by 6%, but the rest of the GP funding does not get increased by 6%.
As each practice is run differently – some with a heavy amount of salaried GPs and a small number of partners and some with the opposite – it can sometimes be the case that a practice spends nearly 100% of its NHS funding on staff salaries, but is only given a 6% increase to say 80% of its funding.
This leaves those practices with a shortfall, and partners then have to make the difficult decision of whether to pass on the uplift, but take a pay cut themselves, give a partial pay rise, or no pay rise at all.
The BMA has worked up some practical examples of how practices with different ways of working can be affected differently.
What is the BMA proposing as a solution for salaried GPs?
Last week, the BMA’s General Practitioners Committee published its asks from the government that it has put forward for the 26/27 GP contract negotiations. It says these are designed to ‘protect and promote practices and GP workforce needs to ensure a sustainable and equitable general practice that serves patients and their communities’. That will sound promising to salaried GPs struggling in the current underemployment crisis.
In relation to DDRB pay awards, the BMA is proposing:
- the DDRB uplift clause to be mandatory in all contracts
- For partners to be responsible for declaring that they have passed on the DDRB uplift to salaried GPs working at their practice, on the proviso that the Government ringfences additional funding for the uplift and all associated employer oncosts.
- For ICBs/local commissioners to be responsible for collecting the declarations and monitoring the implementation of the uplift.
- For a clause to be added to the GMS/PMS contract which confirms that practices must declare they have passed on the DDRB uplift once full funding has been received.
The BMA says it hopes these measures will ‘promote good practice, compliance with the salaried GP model contract and fairness in pay across general practice encouraging GP workforce retention and therefore continuity of patient care.’
Should the BMA be successful in getting these steps implemented, then salaried GPs will be more likely to receive DDRB uplifts, and shouldn’t find themselves having to have an awkward conversation with their employer about whether it is something that their employer can afford to implement. Partners should equally be relieved to find that the costs of future uplifts are passed on in their entirety and they no longer have to consider taking a pay cut themselves to fund them.
