Latest update
The changes to the contract were rejected by 99% of almost 17,000 BMA GP members who participated in our recent referendum, which led to GPC England unanimously voting to prioritise finding a flexible way forward with bilateral Government negotiations, regarding the unprecedented daily pressures practices are facing.
Discussions across April, firstly around how GPs can refer patients on to specialist care, have been partly successful - yielding the required assurances and safeguards the committee needed to see. However, the remaining key priority of how GPs and practice teams may practise safely when faced with patient need far outstripping the safe workforce capacity available, remains a profound concern. It is fair to acknowledge that in the discussions with the Department of Health and NHS England some progress has been made, but GPC England has been clear that regarding the 2026/27 GMS contract’s unlimited same-day urgent care demands, more is needed to enable practices to determine when their capacity has been reached, in order to practise safely.
GPC England recognises that practices are working in crisis-level environments, where every day feels ‘exceptional’ in terms of unlimited demand outstripping available workforce capacity. Being placed in a position where delivering an imposed contract is an impossibility for too many, with the subsequent rationing of care, is unreasonable and unsafe.
The changes to the contract were rejected by 99% of almost 17,000 BMA GP members who participated in our recent referendum, which led to GPC England unanimously voting to prioritise finding a flexible way forward with bilateral Government negotiations, regarding the unprecedented daily pressures practices are facing.
Discussions across April, firstly around how GPs can refer patients on to specialist care, have been partly successful - yielding the required assurances and safeguards the committee needed to see. However, the remaining key priority of how GPs and practice teams may practise safely when faced with patient need far outstripping the safe workforce capacity available, remains a profound concern. It is fair to acknowledge that in the discussions with the Department of Health and NHS England some progress has been made, but GPC England has been clear that regarding the 2026/27 GMS contract’s unlimited same-day urgent care demands, more is needed to enable practices to determine when their capacity has been reached, in order to practise safely.
GPC England recognises that practices are working in crisis-level environments, where every day feels ‘exceptional’ in terms of unlimited demand outstripping available workforce capacity. Being placed in a position where delivering an imposed contract is an impossibility for too many, with the subsequent rationing of care, is unreasonable and unsafe.
Critically endangered – facing extinction
The reality is that general practice is critically endangered – facing extinction. The imposed contract is not compatible with being able to offer cradle-to-grave holistic, planned and preventative care – the bedrock of the model of established general practice across the UK since 1948. Instead, it means daily firefighting to attempt to deliver a service on ever smaller proportions of the wider NHS budget - yet still seeing the equivalent of over half the entire population of England each and every month.
We appreciate that GPs and practices may not want to be frozen out of dialogue with Government, or get drawn into prolonged action, and instead would prefer to build on the progress made with Government, to be permitted to practise safely and autonomously in determining when their capacity is reached on a given day. The depth of feeling across the thousands of practices in England is matched by its representative committee.
Our practice list sizes and GP-to-patient ratios are expanding, whilst our ability to offer continuity of care is shrinking. We have lost over 6,000 (around 28%) of GP partners since 2015 and the chronic shortage of family doctors has led to ‘GP deserts’ across England. Traditional GP-led family practices embedded within our communities are on a path to extinction.
Collective action
Based upon feedback from the profession in 2024-25, GPC England is recommending one single action for May, focusing on the sharing of GP patient data outside practices, in the form of practice data sharing agreements (DSAs).
This action is lawful and may in fact reduce the liabilities on a partnership. We foresee that it will be welcomed by patients keen for greater transparency that will strengthen the trust between GPs and patients. Nevertheless, itwill impact integrated care systems and the wider NHS Government agenda which is increasingly seeing a ‘left shift’ of work from hospitals into practices, without any commensurate resource to meet the challenge.
Action for practices:
1. We have produced a template letter for practices to send to their local system information governance leads which will put the onus on the ICB to respond with the required information to its constituent practices.
2. We are calling on practices to cease any new potential sign-up to voluntary DSAs.
3. We are concerned that many existing DSAs may be unlawfully extracting GP patient data for secondary uses, i.e. medical research conducted by charities, commercial third parties, universities, or health service planning carried out by government agencies or local NHS organisations. Data used in this way is deemed non-essential for the direct care of patients and therefore carries no inherent and immediate risk to patient safety if data-sharing is then revoked.
4. We are advising that practices take steps with their LMCs to use this opportunity to review and assess each existing DSA the practice may currently be signed up to, and determine those where they may wish to cease data sharing.
5. Practices are encouraged to engage and discuss this action with their PPGs.
Listen to our new podcast about the dangers facing general practice
Read an opinion piece from the GPCE chair
Campaign materials
Resources – from 1 April 2026
Headline Government GP contract changes for 2026-27
The GMS contract can only be varied if the requirements in the National Health Service (General Medical Services Contracts) Regulations 2015 are followed. The variation must take effect no earlier than 14 days after the notice is served, where reasonably practicable.
The combined 2026/27 uplift for both practice core contracts and the PCN DES is £485m, bringing the total to just under £13.9 billion, including Advice and Guidance funding. This is a 3.6% cash increase, or 1.4% real-terms growth relative to the GDP deflator & CPI inflationary measures. This includes:
1. a pay assumption of 2.5% in 2026/27, to revisit post-DDRB recommendations, and;
2. some funding to cover the costs nationally of other cost growth pressures, including from premises and list growth.
A series of refinements to the Quality and Outcomes Framework for 2026/27 to align with updated NICE guidance. This includes:
- updating the childhood vaccination indicators to reflect the introduction of the MMRV vaccine,
- introducing a new diabetes indicator requiring delivery of all eight NICE recommended care processes,
- adding two new obesity related indicators to support referrals into structured weight management programmes and medicines optimisation
- updating the Heart Failure indicators to reflect the NICE recommended ‘four pillars’ of treatment, and
- streamlining by combining and simplifying existing measures.
These changes are supported by an additional 18 QOF points (c.£25m).
Updated QOF guidance will introduce additional improvement thresholds for the three childhood vaccination QOF indicators (VI001, VI002 and VI003) for 2026/27. Intended to recognise and reward practices, particularly those in more deprived areas, that may not meet the existing achievement thresholds but demonstrate meaningful and sustained improvement in vaccination uptake.
GP contracts will be updated to specifically set out the requirement that practices must not ask patients to call back, or make contact, on another day. In parallel, they will amend the existing ‘appropriate response’ requirement to provide greater flexibility for non-clinically urgent contacts. Practices will still need to provide patients with a timely appropriate response confirming next steps, but this will be required by the end of the next working day (rather than within the same core-hours period). This does not mean the patient’s non-clinically urgent request must be fully dealt with by then; rather, the patient should understand how and when their issue will be managed.
The GP contract regulations will be amended to explicitly require that requests identified as clinically urgent, as determined by the clinical judgement of a GP or appropriately trained professional, must receive a same-day response.
The GP contract regulations will be amended to explicitly require that online consultation tools must not cap the number of requests that can be submitted during core hours.
The GP contract regulations will be amended to require that practices offer RSV vaccination to all registered older adult care home residents and all patients aged 80 and over who have not previously been vaccinated, in line with JCVI recommendations. Practices will receive an Item of Service fee for each vaccination.
Practice contracts will be amended to embed Advice and Guidance within core funding, requiring practices to use A&G prior to or in place of a planned care referral where clinically appropriate and to follow locally agreed referral pathways, including Single Point of Access models once introduced.
The GP contract regulations will be amended to align with existing Cloud Based Telephony (CBT) requirements, to require practices to provide timely data and information related to online and video consultation services, enabling consistent monitoring of access, patient experience and system performance.
The GP contract regulations will be amended to require practices to share data with the Lung Cancer Screening Programme to support the operation of the programme.
The GP contract regulations will be amended to mandate the use of online registration in all cases of registration. Practices will be required to enter information from paper registration forms into the national online registration system and ensure that changes to practice boundaries which are submitted through NHS England’s digital catchment tool, are approved by the ICB.
The GP contract regulations will be amended to expand the provisions on nominated dispensers, requiring practices to reconfirm the nominated pharmacy whenever a new prescription (not a repeat prescription) is issued.
The GP contract regulations will be amended to require practices to have a dedicated, monitored email address for receiving information from community pharmacies in the event that GP Connect is unavailable and for new or emerging pharmacy activity that is not yet supported through GP Connect, e.g. the introduction of independent prescribing in community pharmacy. The email address must be kept up to date and shared with the Directory of Services.
The GP contract regulations will be amended to require practices to engage with support from their ICB where unwarranted variation has been identified in contractor performance, including where practices are not meeting their requirement to see all clinically urgent patients on the same day, or where a practice is at risk of contractual breach.
The PMS contract regulations will be amended to mirror the GMS contract regulations to give commissioners equivalent powers to object to sub-contracting arrangements where patient safety, financial risk or delivery of contractual obligations may be affected. Supporting guidance will be issued to clarify expectations.
The GP contract regulations will be amended to require practices to display opening times for all modes of access (walk-in, telephone and online consultation) on their website, in their practice leaflet and within practice premises. As a minimum this must be core hours for all modes of access.
Both the GP contract regulations and the Network Contract DES will be amended to require that practices and PCNs participate in the General Practice Staff Survey, including sharing staff contact details with their ICB so personalised survey links can be issued.
Both the GP contract regulations and the Network Contract DES will be amended to require that practices and PCNs participate in the General Practice Staff Survey, including sharing staff contact details with their ICB so personalised survey links can be issued.
The Network Contract DES will be amended to include explicit requirements for PCNs to ensure that eligible older adult care home residents are identified and offered seasonal and routine vaccinations in line with national recommendations, with supporting guidance to clarify roles and responsibilities.
The Network Contract DES will be amended to provide clearer requirements for improving cancer referral practice, early diagnosis, and screening uptake. The updated wording introduces explicit expectations around reviewing referral quality against NICE Guideline NG12, strengthening and standardising safety-netting (including use of electronic tools), and setting out clearer responsibilities for proactively identifying and supporting eligible patients to engage with cancer and non-cancer screening programmes.
It will become a core requirement for PCNs to identify and prioritise cohorts for continuity of care using risk stratification tools as part of their core activities.
The Network Contract DES will be amended to remove the restriction that ARRS funding can only be claimed for recently qualified GPs and increase the maximum reimbursement amount that can be claimed for GPs via the ARRS (up to a maximum of the top of salaried GP pay range plus employment on costs).
The Network Contract DES will be amended to require PCNs to work collaboratively with their ICB to achieve greater alignment between the PCN registered list and the neighbourhood, where an ICB, working with the Local Authority, defines a neighbourhood around a natural community that does not match current PCN geography.
Why this contract impacts you
The future of NHS general practice services is relevant to all GPs and GP registrars in England working in NHS primary care settings. 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 salaried or 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 practise 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 and patient care are safe and of the standard patients deserve and practice staff are trained and want to deliver. 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 practise and numbers of GPs.
The ongoing dispute between GPs and the Government
The BMA GPCE has been in dispute with Government since 1 October 2025. Our dispute centres on three key promises made by Government, which were conditions of GPC England’s acceptance of the 2025/26 GMS Contract: written commitments (March) and (August) on negotiations towards GMS contract renewal and unsafe contract changes that came into effect on 1 October 2025 around online patient requests and queries and switching on access to GP connect by other NHS providers.
On behalf of all practices in England, we stated that:
1. changes to online patient requests and queries and third-party access to the patient record (via GP Connect) must be safe for patients and staff and
2. the Government rapidly delivers desperately needed General Practice resource restoration to ensure long-term safe and continuous patient care for the communities GPs serve.
The GPCE chair wrote to the Secretary of State for Health and Care to confirm the above. Our position was reconfirmed in a subsequent letter, which detailed what was needed to exit dispute and address our concerns. Specifically:
- DHSC must stop delaying and provide written confirmation of the timeframe for negotiations and commit to the much-needed increased funding envelope for GMS contract renewal within this Parliament.
- DHSC and NHSE must secure the technical solutions within online consultation tool platforms and GP Connect, which prevents unsafe online patient requests or queries and unsafe / illegal use of patient data.
Since 2010, a staggering 25% of GMS contracts have been lost. Despite a growing population, we have fewer GPs than a decade ago – a shortfall the Health Foundation, estimates is actually over 6,000. Years of under-resourcing have set the partnership model up to fail.
The headline investments of 2025-26 did not paint a full picture; much of this funding returned to the Treasury to cover mandatory increases in National Insurance and the Living Wage. Consequently, GPs continued to struggle to find work whilst patients continued to clamour for access and continuity of care.