General Practice: Critically Endangered - Facing Extinction
Many thanks to those of you who logged in to last week’s webinars. It was great to connect with over a thousand GPs joining and contributing to where we are now, and the future direction of travel ahead of coming back to you with more information next month regarding the 2026/27 contract. We expect to receive the final position from government at the end of the month. GPC England will also then meet, scrutinise and vote thereafter, and we will start webinars on the new contract – and your opportunity to feed back on it – at the start of March.
For those of you unable to join us, we will be publishing a shortened 30-minute podcast next week of myself in conversation with my deputy chair, David Wrigley. We will also be sharing ‘bite size’ briefings on what we need to see from NHS England to fill the vacuum of ‘Neighbourhoods’ as well as expanding on the themes we covered around our profession being critically endangered, and facing extinction:
The loss of our habitat through starvation of premises funding; over-exploitation via being expected to absorb rising demand; greater clinical complexity; workload shifts and greater bureaucracy, compliance and regulation all with fewer GP:Patient ratios is classic over-harvesting. Our pollution isn’t chemical – it’s cognitive overload: paperwork, box-ticking, regulation, red tape and IT friction leading to productivity and morale collapse. GP substitution grows with new roles with no boundaries and unlimited supervision; destabilising the GP eco-system instead of strengthening it. And climate change – the constant policy churn, the drives on access and media pressure allowing no time for our species to adapt before the next reorganisation lands.
We will be expanding on this in light of the new contract next month. We know how vital these discussions are to the whole profession, we want your feedback and to bring you along with us so please feed in any queries you have to info.gpc@bma.org.uk
Dates and links to register for the March 2026/27 contract webinars will follow in the next newsletter.
Focus on: Vaccination by non-registered healthcare workers
GPC England has published a ‘Focus on guidance on vaccinations by non-registered healthcare workers, following an update by the UK Health Security Agency (UKHSA) to their guidance on the national minimum standards and core curriculum for vaccination training.
UKHA’s guidance outlines the requirements for vaccinating staff, including the role non-registered healthcare professionals should play in the provision of vaccinations. This clarification around the role of HCSWs may not be in line with existing interpretation and could potentially significantly impact upon the way in which practices design and deliver mass vaccinations programmes.
Read the GPC England guidance: Vaccination and immunisation programmes
Letter to CMO about vaccination programmes
We have written to the Chief Medical Officer, Professor Chris Whitty, to highlight our concerns about lack of funding uplifts for GP practices providing routine and seasonal vaccination programmes. Despite an agreement from NHS England to uplift the payments for routine childhood vaccinations by £2 per dose, funding for GP vaccination programmes has fallen significantly behind inflation during this time, losing over a quarter of its value. Safeguarding and increasing uptake for these programmes should be a priority for the Government and the NHS, especially in light of the risks we’ve seen in recent years from infectious diseases alongside falling rates of vaccination. We will continue to pursue all avenues, to support practices.
NHS England Chaperones & Prevention of Sexual Misconduct in the NHS Guidance
We are writing to NHS England further to the publication of their document Improving chaperoning practice in the NHS: key principles and guidance following its publication in December. This guidance, and its implementation, form a key part of the actions listed in the Update on actions to prevent sexual misconduct in the NHS released on the same day.
GPs and their practices treat the protection of patients and staff alike with the utmost seriousness, and whilst we support the principles behind this guidance and recognise the potential for staff isolation, the fact that so many consultations are one-on-one presents issues for practices regarding keeping all who use, and work in, the service safe.
ICBs will be expected to provide support for practices in implementing these new standards, but some aspects of the guidance will be challenging to implement fully, with the chaperoning guidance in particular presenting practical difficulties as the document represents a significant expansion of the typical practice policy. We would highlight the following:
GPC England will be reflecting on the need for proportionality, common sense and patient/parent choice to reassure GPs and their teams, and we will continue to keep you updated.
Joint primary care parliamentary reception
Last week we jointly held a parliamentary drop-in reception, alongside other organisations for MPs and their staff on the crisis in primary care. Over 20 MPs attended the event, hosted by Liberal Democrat Primary Care Spokesperson Helen Maguire MP, including the Shadow Primary Care Minister, Luke Evans, Dr Simon Opher MP, Ian Sollom, Lee Pitcher, Dawn Butler and Pippa Heylings.
We briefed attending MPs about the current crisis in general practice particularly focussing on finance and GP under and unemployment. We also spoke about our concerns regarding neighbourhood models and the Carr-Hill formula review. Over the coming weeks we will continue to brief MPs from across all parties on these issues and our asks to resolve the current crisis and ensure general practice is supported to meet the needs of patients now and in the future.
Practice Finance research: results and call to action
We would like to thank everyone who took the time to share practice accounts data via our recent survey. We have now analysed the initial results. Key insights have been shared with NHSE and the DHSC, ensuring their awareness of the financial pressures facing GP practices in England.
You can see the key insights for yourself here.
But it’s not too late to help with this research. The survey remains open on a rolling basis, so we can build a growing and increasingly robust resource that will be of immense importance during the new substantive GP contract negotiations.
Professional obligations and protecting patients first and foremost
Some LMCs have reported concerns from GP partners who have received contract breach notices from ICBs in circumstances where practices believe their actions were taken to comply with professional duties under Good Medical Practice (GMP).
GPC England is seeking examples to better understand the nature, frequency and consequences of these situations. In particular, we are keen to hear from GP partners where alleged breaches arose from decisions made to protect patient safety, maintain professional standards, or act ethically in line with General Medical Council expectations – for example in relation to workload pressures, safe staffing, continuity of care, or limits on capacity.
GPs are legally and professionally required to practise in accordance with GMP, putting patient safety, dignity and quality of care first. Where contractual requirements or commissioning expectations appear to conflict with those professional obligations, practices may feel they have little choice but to act in the interests of patients, even where this risks challenge from commissioners.
Understanding how ICBs are interpreting contracts, and how breach processes are being applied in these circumstances, is essential to informing GPC England’s national policy work, supporting LMCs locally, and strengthening our collective position in discussions with NHS England and DHSC.
If your practice has received a breach notice that you believe relates directly to actions taken to comply with GMP, we would welcome a brief outline of the situation. This may include the nature of the alleged breach, the professional considerations involved, and any outcomes to date. Examples can be shared confidentially and anonymised as necessary.
Please share details with your LMC or with GPCE via info.gpc@bma.org.uk. Your experiences are vital in ensuring GPs can uphold their professional responsibilities without fear of inappropriate contractual sanction.
GPC England by election Cheshire / Mid Mersey representative
Voting for the by election for a Cheshire / Mid Mersey representative to GPC England has now opened. The term for this role is the remainder of the 2025-26 session which concludes at the close of ARM 2026.
To be eligible to vote in a constituency, you must be a GP working in the Cheshire / Mid Mersey area. To submit your vote, please go to https://elections.bma.org.uk/ the deadline for voting is 20 February 2026 at 4pm.
You will need a BMA web account to access the election – if you are not a member or are unable to access the election please email elections@bma.org.uk with your GMC number and the team can check for you.
GP pressures – workforce and appointment data
The latest GP workforce data showed that in December 2025, the NHS had the equivalent of 28,777 fully qualified full-time GPs. While there is a general rise in FTE GPs since July 2023, GP practices still employ the equivalent of 587 fewer FTE GPs than in September 2015. In addition, the number of GP practices in England has decreased by 7 over the past year to 6,174.
This fall in both GP numbers and practices coincides with a rise in patients: as of December 2025, there was 63.9 million patients registered with practices in England with each FTE GP responsible for an average of 2,220 patients. This is an increase of 282 patients per GP, or about 14.6%, since 2015.
Despite this, 30.9 million standard appointments were delivered in December 2025 – an average of 1.47m appointments per working day, higher than Dec 2024 (1.41m) and Dec 2023 (1.36m).
Read more about GP pressures on our data analysis page, which shows the level of strain GP practices in England are under: Pressures in general practice data analysis
How to get the most out of the LMC Support Network
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Find out more at the WhatsApp community and website at www.lmcsn.co.uk
GP wellbeing resources
A range of wellbeing and support services are available to doctors, and we encourage anybody who is feeling under strain to seek support. Please take a moment to check in on your colleagues’ wellbeing and look out for each other.
Support comes in various forms, from our 24/7 confidential counselling and peer support services and NHS practitioner health service to non-medical support services such as Samaritans. The organisation Doctors in Distress provides mental health support for health workers in the UK, and confidential peer support group sessions.
We have produced a poster with 10 top tips to help maintain and support the wellbeing of your colleagues and yourself.
The Cameron Fund supports GPs and their families in times of financial need, whether through ill health, disability, bereavement, relationship breakdown or loss of employment.
The RCGP also has information on GP wellbeing support.
Please visit the BMA’s wellbeing support services page, refer to our extended directory, or call 0330 123 1245 for the counselling line or peer support.
Read the GPCE bulletin: General practice: critically endangered | practice finance research | new vaccine guidance
General Practice: Critically Endangered - Facing Extinction
Last Thursday, GPC England met at BMA House for the first meeting of 2026; this week marked ‘Blue Monday’ - the lowest emotional point of the winter. You won’t be alone in struggling to find the joy in general practice currently, especially given relentless online demand and respiratory illnesses which have taken their toll on practices and GPs nationwide. We are seeing some of our busiest days, with record numbers of patient contacts leaving us feeling unsafe and unsupported - taking us further away from face-to-face continuity of care with our patients, the true bedrock of general practice.
We see and hear the immense effort you’re putting into adjusting staffing, systems, and subcontracting arrangements following on from October. We’re also grateful to those of you raising concerns about the sustainability and safety of the implementation. Your GPCE representatives discussed managing pressure, particularly when demand consistently outstrips capacity, and when we inevitably encounter situations where full compliance with the three access modes across the full hours of the day is just not feasible.
To this end, we will be holding two webinars at the end of the month - these will be of most interest to GMS contractors but will be open to all GPs - please sign up below.
This week your elected officer team will be meeting DHSC and NHSE to press on with discussions around the Government’s consultation on the 2026/27 GMS Contract and discussing our recent practice finance survey results, and we shall we following-up again with NHS England the week after too. Following these discussions once a final contract has been proposed, GPC England will vote on the final offer.
The committee also received:
We know how vital these discussions are to the whole profession, we want your feedback and to bring you along with us, so please do join us either over lunch on the Wednesday, or on the Thursday evening:
Practice not to blame for A&E attendances
GPC England chair Dr Katie Bramall recently responded to a Guardian article: Huge rise in number of people in England’s A&Es for coughs or hiccups, 31 December. Dr Bramall said:
England’s general practice meets unsustainable pressures with record productivity: 250,000 additional GP practice appointments are being delivered a day compared with 2019. It is the fall in the number of inpatient beds gumming up the A&E system, not a fall in GPs’ capacity to treat patients.
With that said, we have thousands of GPs looking for NHS work across England right now. Just 105 more GPs could have delivered the 1.9m appointments for people seeking help for headaches that the article mentions who went instead to A&E over the last five years.
We are still 750 GPs short of where we stood a decade ago, with GPs receiving only 34p per patient per day. The government is keen to progress its “neighbourhood” model, but without more GPs and more funding for them, patients won’t see any meaningful change.
Late last Thursday (15 January) NHS England published a press release claiming AI note taking 'could save clinicians up to 2 or 3 minutes for each patient consultation, freeing up more time for them to see other patients'.Practices are reminded of the guidance NHS England publishes and the necessary steps they must take should they choose to make use of these technologies. Patients must be made aware that consultations are recorded for interpretation by computer and their rights of access to any recordings made, and any interim transcripts created by the AVT should be made available for review. Errors, or 'hallucinations', in the AVT output, in addition to immediate correction, should be reported to the MHRA via itsYellow Card reporting scheme.
OpenSAFELY
Practices in England are reminded to continue to activate the OpenSAFELY data analytics service if they haven't yet done so. This service the full support of the BMA and RCGP. Read more >
Power in numbers: uniting sessional GPs for change
3 Feb, 7–8.30pm
This is the second event in our national engagement series created to bring sessional GPs together, amplify your experiences, and ensure your voice drives the BMA’s work on your behalf.
At our first event, you told us the top three issues facing sessional GPs today:
We listened, and this event is all about what the BMA can do to act on your behalf, and the rights you hold as a sessional GP. Register your place >
GP wellbeing resources
A range of wellbeing and support services are available to doctors, and we encourage anybody who is feeling under strain to seek support. Please take a moment to check in on your colleagues’ wellbeing and look out for each other.
Support comes in various forms, from our 24/7 confidential counselling and peer support services and NHS practitioner health service to non-medical support services such as Samaritans. The organisation Doctors in Distress provides mental health support for health workers in the UK, and confidential peer support group sessions.
We have produced a poster with 10 top tips to help maintain and support the wellbeing of your colleagues and yourself.
The Cameron Fund supports GPs and their families in times of financial need, whether through ill health, disability, bereavement, relationship breakdown or loss of employment.
The RCGP also has information on GP wellbeing support.
Please visit the BMA’s wellbeing support services page, refer to our extended directory, or call 0330 123 1245 for the counselling line or peer support.
Read the GPCE bulletin: GPC meeting update | GP contract webinars | ambient voice technologies
As 2025 draws to a close we bring you the last newsletter of the year, updating you on what’s been happening over the past few weeks and looking forward to what the new year may bring.
The approach from Government earlier this month was followed this week by our attendance at the Department of Health, where we met with DHSC, NHSE and Number 10 officials to discuss the 2026/27 GP contract proposals. We spent a significant period of time feeding back on their proposals, robustly articulating the need to protect and promote practices and GP workforce needs to ensure a sustainable and equitable general practice that serves patients and their communities. Our verbal feedback will be followed by detailed written responses and further meetings with them in the new year.
We submitted several high-level papers and counter proposals from our perspective under a series of themes, and in a departure from usual practice, we have published our contract proposals, and they can be accessed on the BMA GPC England contract webpages >
These proposals build on our historical contract asks around the need to restore resourcing levels for general practice and the GP unemployment crisis, and complement several key publications developed to support the profession and practices, working towards hope, safety and stability.
The safe working guidance supports and enables practices to prioritise their delivery of safe, high-quality patient care, within the regulatory and professional expectations of the GMS/PMS contract. Patients first – GPCE’s vision for general practice outlines the essential changes that need to happen to stop the loss of local practices, retain experienced NHS GPs in their surgeries, and to fund practices to take on more GPs and more practice nurses to deliver more appointments. The value of a GP paper sets out the intrinsic value and importance of GPs in affording and securing the nation’s healthcare for the next generation.
Following on from this week’s 2026/27 contract consultation at DHSC, Katie recorded a podcast which covers our thoughts on the process and next year’s contract for GPOnline’s ‘Talking General Practice’.
Lastly, we would like to sincerely thank each and every one of you, your practice staff and teams in continuing to deliver above and beyond, despite the challenges and adversities posed. This effort and commitment to your patients and communities does not stop over the holiday period, and we recognise and appreciate the efforts from all of you in working tirelessly in making this happen.
Wishing you all a very merry Christmas and happy New Year.
| NHSE and DHSC have opened the 'consultation' on their proposed changes to the GMS contract for 2025/26. We have set out our objection to the unilateral decision to change the annual GP contract consultation and negotiation process for 2026/27, breaking with established custom and practice, on behalf of GPC England, GPs and GP registrar members of the BMA and the wider GP profession. We have also provided NHSE/DHSC with a number of high-level proposals relating to our key aims of ensuring patient safety, improving practice funding and reducing GP underemployment. These are necessarily high-level given the imposed changes to the contract processes this year but outline key requirements that are essential to support general practice at this time. Read the proposals > |
OpenSAFELY – action for all EMIS/TPP practices
| NHSE has sent a reminder email on Thursday 18 December to EMIS/TPP practices yet to activate OpenSAFELY, on the back of formal emails sent in July and November. Paper letters have also been sent. These letters and the whole OpenSAFELY data direction should not come as a surprise, we have made repeated reference to it in most of our BMA GP newsletters in recent months! Please remember and remind practice colleagues that OpenSAFELY has the full support of the BMA’s GPC England and the RCGP and it's a legal requirement to comply with the data direction. Read the activation instructions > OpenSAFELY provides vital research for the NHS and delivered public good during the COVID pandemic. The platform is now available for studies beyond COVID. Practices remain data controllers of the underlying GP data, whilst NHS England remains data controller of the results of studies, and oversees all access and governance. |
Save the date: webinars
The GPC England officer team will be hosting a series of webinars in early 2026. A range of topics will be covered including updates regarding contract and policy development, and the latest committee and profession plans and next steps. Further information regarding registration details and additional dates will be provided in the new year, but please note the following for your diary:
Sexual misconduct in the workplace
This month has seen the publication of an update to the NHS England guidance on actions to prevent sexual misconduct in the workplace. This work was published in the wake of historic allegations of sexual abuse at Royal Stoke University Hospital and Russells Hall Hospital, which have been reported in the media. However, there are actions recommended in this update for all NHS employers, and these are important for GPs and their practice teams to be aware of.
Chaperoning policies should be reviewed considering the updated guidance. While there is a clear statement that practices should be able to set their policy according to their needs, and recognition of the challenges we can face in primary care, we would reiterate the need to ensure that all chaperones are formally trained, and used for any intimate examination. In addition, they should be given enough information before chaperoning an intimate examination to ensure they understand why it is necessary. The guidance is clear that in the event of a patient declining a chaperone, a risk assessment should be made as to the clinical safety of the patient and the risk of compromise of professional standards, and postponing the examination may well be a reasonable outcome.
ICBs are tasked in the update to ensure all primary care providers are signed up to the Sexual safety charter with a deadline of 2 February 2026 to contact providers to offer support in completing the assurance checklist in this document. Documenting compliance here is likely to be useful in demonstrating wider compliance with legal duties held by all employers around preventing sexual harassment. Primary care providers are also encouraged to adopt the national sexual misconduct policy that is due for release next month, and ensure staff have accessed the national e-learning on this topic. There is also clear guidance as to reporting incidents of sexual misconduct.
Further information can be found on the NHS England website. We would advise LMCs to be prepared for queries from member practices on the updated guidance, especially in the new year when ICB teams will be enquiring about compliance.
Premises letter
In our latest letter to Karin Smyth MP, we shared findings from the recent GP premises survey. We had written previously and were offered a meeting which we are in the process of arranging. We are hoping to explore a strategic system response with Government to the issue of GP property costs.
The survey, which gathered responses from nearly 2,000 GPs and Practice Managers, (almost one-third of general practices in England), reveals widespread concern about the condition, capacity, and sustainability of GP premises. Notably:
LMC legal advice
As part of ongoing processes planning we are continually seeking and updating legal advice to help support and protect practices and LMCs. Please find the links below for the legal background and briefings which have been previously shared with LMC colleagues, and are provided to help explain current and future contexts around planning and next steps.
Resident doctors’ and GP registrars’ strike action guidance
GP registrars have the full support of GPC England, general practice and the wider profession during the strike action.Read GPC England’s letter of support to GP registrars >
If you or your practice would like to contribute to the strike fund for GP registrars who may need to use it, you can do so >
Read our guidance for practices, LMCs and GP trainers, advising on how practices can support their GP registrars and manage strike days. Read the guidance >
Read also the guidance on striking as a GP registrar >
Covid and flu specifications
NHS England has published a joint COVID and flu specification for 2026. This moves the COVID vaccination programme to a practice level, removing the need for COVID vaccinations to be delivered via a PCN. However, practices will still be able to deliver just the flu programme.
We continue to raise with NHS England the impact that that the lack of uplift to item of service payments is having on the viability of both programmes, with a number of practices informing us that they are closely considering whether to continue participation in the flu programme in future years.
UKHSA guidance on consent for vaccination
The UKHSA has produced further guidance with regards to consent processes and non-registered healthcare professionals in the provision of vaccination. This is following the concerns raised with them over the updated minimum standards in vaccination training and the significant uncertainty that it caused, particularly around the role of HCAs in vaccination clinics.
We are continuing to discuss this issue with the UKHSA and other relevant bodies to develop more expansive guidance.
Survey on sessional GP unemployment
Earlier this year, the sessional GPs committee conducted a survey to capture the full scope of GP underemployment and unemployment across the UK. The findings confirm the severity of the issue:
These findings highlight the urgent need for action to address the GP workforce crisis. The insights from this and previous surveys will continue to be instrumental in shaping our work, strengthening our lobbying efforts and pushing for policy changes.
Power in numbers: uniting sessional GPs for change
3 Feb 2026, 7–8.30pm
This is the second event in our national engagement series created to bring sessional GPs together, amplify your experiences, and ensure your voice drives the BMA’s work on your behalf.
At our first event, you told us the top three issues facing sessional GPs today:
We listened, and this event is all about what the BMA can do to act on your behalf, and the rights you hold as a sessional GP. Register your place >
GP wellbeing resources
A range of wellbeing and support services are available to doctors, and we encourage anybody who is feeling under strain to seek support, such as the BMA’s counselling and peer support services, NHS practitioner health service and non-medical support services such as Samaritans. The organisation Doctors in Distress also provides mental health support for health workers in the UK. We have produced a poster with 10 top tips to help support the wellbeing of you and your colleagues.
The Cameron Fund supports GPs and their families in times of financial need and the RCGP also has information on GP wellbeing support.
Visit the BMA’s wellbeing support services page or call 0330 123 1245 for wellbeing support.
Read the GPCE bulletin: GP contract consultation | safe working guidance | our vision for general practice
Read the latest Sessional GPs newsletter
No more point scoring – let’s prioritise practice wellbeing and patient safety
Yesterday, the Secretary of State for Health, Rt Hon Wes Streeting MP, wrote to all GPs in England. This is an unusual move, and it is in response to the GPC England officer team being firm in stating what we need for NHS general practice and with regards to the new requirements from October 1st, including mitigations for safer management of online consultations that I know a lot of you are really struggling to cope with. We are here to help - if you feel you are getting unfairly pressured by your ICB, please contact your LMC or let us know via info.gpc@bma.org.uk.
In response to the Secretary of State’s letter, the GPC England chair, Dr Katie Bramall said:
“I want to thank the Health Secretary for recognising the hard work of GPs and practice staff. A record 40 million patients used NHS GP services in October. We warned this would happen - current pressures faced by practices are unsafe, unsustainable and need to be addressed. We’re worried that government doesn’t understand that safe, meaningful patient care can only be delivered when practices are supported and resourced. 34p per patient per day – less than the price of an apple – was already inadequate resourcing and the online access policy change further exacerbates this.”
When GPs entered into dispute with the Government on 1st October 2025, it was underpinned by
the very real and present dangers of practices being overwhelmed by unlimited online queries. As the HSSIB (Health Services Safety Investigations Body) said yesterday in relation to electronic patient records, we must be wary that ‘systems which are poorly implemented, difficult to use, or do not meet the needs of staff and organisations can introduce avoidable patient safety risks, which can contribute to serious harm'. They previously published a report on online consultations in July 2025 confirming 'a proactive approach to identifying risks to patient safety must be undertaken'.
GPC England met yesterday on Thursday 27th November where we discussed the current political situation and what our next steps should be. The safety of our patients and working in the best interests of you and your team remains our first concern. We don’t need any further point scoring. We need to work constructively to promote wellbeing in practices and safety for patients. We have repeatedly sought to work with government all year to make their aspirations a safe success but, in recent weeks, attempts have been thwarted by media briefings and nameless sources engaging in attacks on the integrity of the profession. For more information , please see our campaign page.
Our door remains open, and we continue to stand ready to put things right, as is our duty to the staff and patients we represent, to ensure care is safe for patients and practice staff alike, and to now move forward constructively.
We have had an approach today from the Government’s side which is welcomed, and we hope to keep colleagues informed with next steps.
This week, we learned that the government is going to consult on 2026/27 changes to the GP contract more widely. The fact is that relevant stakeholders are consulted in every annual contract cycle to capture a full breadth of views, but we are pleased that the government recognise this is a departure from their usual process.
GPC England may also decide to consult more widely, and we are confident there will be more consensus across various stakeholders than the government perhaps realises, and this provides an excellent opportunity for mutual collaboration.
If it comes to it, we can see how and why the government might want to avoid April 2026 changes being termed a contractual imposition, and there is a risk that they won’t even try to make it palatable, or potentially use the opportunity to deliver what will be a very difficult contract for the profession. We stand ready to deal with all eventualities.
However, the way things stand the government know they will have to engage with GPC England separately regarding the statement of financial entitlements - and they have confirmed that will be the case, so too have they confirmed their commitment to GMS renewal within this Parliament.
We now await with interest what their proposals are for 2026/27 - and we still await to hear back following the sharing of the safety concerns arising from the online consultation survey from over 1,300 practices – 1/5 of all practices in England. Thank you to those who completed this and we are using the data right now. You can read more on it here and below.
Online consultation survey results
Thank you to everyone who took the time to respond to our online consultation survey. More than 1,300 responses were received - one in five practices in England, representing nearly 14 million patients.
The survey showed significant concerns about the GP contract changes relating to online requirements introduced on 1 October 2025. 73% of responding practices said they had to change how they work because of the contract change, and many reported negative effects on both patients and staff. 42% of practices have had to reduce face-to-face appointments, reducing the time patients spend with their GP. 45% of these practices said they’ve had to redeploy staff to accommodate for the changes, and over half had seen a negative effect on patient care. Despite our warning of the risk of patient harm, 74% of practices had seen an increase in workload, 68% reported an increase in stress, and 54% said there was an increase in working hours.
Our current dispute with the Government includes this issue, after it failed to meaningfully engage with GPC England to deliver the necessary safeguards prior to 1 October 2025, as per our conditions to agreeing the terms of the 2025/26 contract.
We have repeatedly said that patient access must be clinically safe. To ensure that happens, practices must retain the ability to manage their consultation systems safely, including when demand exceeds safe capacity, rather than being forced to prioritise convenience over patient need in a woefully under-resourced environment. We urge colleagues to continue using our safe working guidance.
Watch a video of what GPs really think about the online consultation changes
Read more about the survey results and our dispute on the GP contract campaign webpage
BMA analysis of the budget
The Autumn Budget published this week included a range of measures which will likely impact GPs. From the perspective of employers, the National Living Wage, for workers aged 21 and over, is set to rise by 4%. It will be important that additional costs for GPs as employers are reimbursed and we will push for this.
Tax thresholds are being frozen, which will mean employees will pay a greater share of their income in tax as their salaries rise. Alongside the freeze in personal tax rates, the threshold at which employer National Insurance Contributions are paid will also be frozen, again placing upward pressure on GP employer costs.
Higher than expected inflation means that NHS budgets will grow at an even slower rate going forward. £300 million in additional capital investment was announced to support new technologies across the NHS. There was also a commitment to deliver 120 operational Neighbourhood Health Centres by 2030, with the government confirming these would be delivered via a Public Private Partnership funding model.
Pension changes should not affect the vast majority of us as the NHS pension is not a salary sacrifice scheme so the changes announced in the Budget on this aspect will not affect you.
Read the full BMA analysis of the Budget: Budgets and fiscal events - Budget - BMA
OpenSAFELY
Practices using SystmOne or EMIS Web are reminded to activate the NHS OpenSAFELY Data Analytics Service in their clinical systems following the data direction that was issued on 9 June 2025 by the Department of Health & Social Care. We understand NHS England have written to practices this week who are yet to activate to remind them. Instructions are available here. Activation is a legal requirement of the Health and Social Care Act. OpenSAFELY has the full support of the profession.
Neighbourhood Health Services and NHCs (Neighbourhood Health Centres)
The UK Government has announced plans to create 250 new NHCs (Neighbourhood Health Centres) in England, in line with the 10 Year Health Plan. 120 NHCs are intended to be operational by 2030 and are expected to bring a range of services (including general practice, physiotherapy, and others) together in a single ‘co-located’ space, with the stated goal of improving access to care and improving prevention. It remains unclear how these NHCs will interact with existing GP practices and other community services.
The Government also aims to use Public-Private Partnerships to fund the construction of the new NHCs, which has raised serious concerns about repeating the failings and long-term costs of prior Private Finance Initiative programmes. We must not see a repeat of the cripplingly expensive Private Finance Initiative from the 2000s which some parts of the NHS are still paying off with eye watering payments to private companies.
GP wellbeing resources
A range of wellbeing and support services are available to doctors, and we encourage anybody who is feeling under strain to seek support, such as the BMA’s counselling and peer support services, NHS practitioner health service and non-medical support services such as Samaritans. The organisation Doctors in Distress also provides mental health support for health workers in the UK. We have produced a poster with 10 top tips to help support the wellbeing of you and your colleagues.
The Cameron Fund supports GPs and their families in times of financial need and the RCGP also has information on GP wellbeing support.
Visit the BMA’s wellbeing support services page or call 0330 123 1245 for wellbeing support.
Read the GPCE bulletin: Our response to the secretary of state I GP Contract update | online consultation survey
Read the latest Sessional GPs newsletter
LMC England Conference 2025 update
The 2025 LMC England Conference took place last week in Manchester, where we debated our current dispute around not just the lack of any safeguards to mitigate patient harm with recent online access changes, but also the broken government promise over a new GMS contract, with motions calling for GPC England to prepare for mass non-compliance, onward balloting of the profession, and collation of undated resignations of practice contracts. The resolutions from the Conference will be published shortly. For more information about the LMC Conference see here:
In my conference address, I expressed my own and the wider profession’s frustration and profound disappointment in this government. Back in March there appeared to be goodwill, good faith, and a promising future. But, instead of working with us to implement what was needed to keep patients and practices safe, we face broken promises, squandered opportunities, and a disregard of our consistent patient safety concerns.
Then came July, and the Ten Year Health Plan – no mention of Mr Streeting’s written commitment to renew GMS but instead describing brand-new single and multi- neighbourhood provider contracts: unevidenced, unfunded, uncosted, unprotected, and unknown.
Clearly, the truth hurts. We have subsequently seen government and our detractors not just brief against us in the press, but following Conference, Mr Streeting has instructed NHSE and DHSC to cancel all current meetings with GPCE. We will be holding an extended series of webinars starting next month, sharing with the profession exactly what was agreed, and when, as well as teasing out what comes next.
Next week, as we discuss below, we will be releasing the findings of our online consult practice survey. Over a thousand practices completed this, that’s more than 1 in 5 across the country – a significant number, which is immensely helpful – thank you. Government may not like what we tell them, but we will continue to act in good faith and with a cool responsible head to do what is in the best interests of our patients, our practices and the profession.
We stand together - united as a profession on the brink: practices feeling unsafe; GPs under-employed; partners exhausted, sessional GPs frustrated. As your GPC England officers, we stand ready: to get back round the negotiating table and to stand ready to lead if the profession takes the decision to act. It is easy to feel the pressure, but the power to change everything is in our gift.
Thank you to everyone who took the time to respond to our recent online consultation survey. More than one in five practices in England responded – over 1,300 unique and validated responses were recorded. Together, these practices represent nearly 14,000,000 patients – over 20% of England’s registered patient population.
The survey results will help us evaluate the impact of the October 1st regulations coming into effect, which mandate GP practices in England to keep online consultation platforms open during core hours. GPCE officers have been consistent with government since Wes Streeting set out his ambition last December – current online consult tools preclude the ability to safely discriminate between urgent and routine patient need. The current contractual expectations go beyond what was agreed in good faith at the start of the year. But irrespective of semantics and wordplay from government, patient safety is at risk now.
Initial findings indicate that the regulations are putting patients at risk, and safeguards are clearly required to prevent urgent requests filtering through as routine or admin requests. In addition, practices are reporting an increased, and unsustainable, volume of requests since October 1st; with a changing attitude in patients reflecting a transactional, rather than holistic, style of medicine.
Our team is currently crunching the numbers and analysing the many free-text responses, and we will be ready to share results shortly.
GPC England dispute over contract changes
We remain in dispute with the government, however this does not mean practices can ignore the contractual changes that were implemented on 1 October 2025, nor can GPC England or LMCs recommend or endorse such an approach. Declaring a dispute is akin to declaring compliance with the new contractual requirements in the 25/26 contract agreement in March 2025, but “under protest”. Therefore, practices must:
Whilst many practices are struggling, we would remind you that support and guidance for practices in relation to the contract changes is available here: Campaigning around GP contracts in England.
As we prepare for further escalatory options, please encourage any GPs or GP registrars who are not BMA members to join so that they may vote in any potential future ballot, and ensure your own membership information is up to date.
Following the LMC England Conference, GPC England is now considering all our options and what our next steps should be. The safety of our patients and working in the best interests of you and your team is our first concern.
Access all the guidance: Campaigning around GP contracts in England
Resident doctors' and GP registrars’ strike action guidance
Resident doctors (including GP trainees) are taking industrial action from tomorrow, 14 November, after 90% voted in favour of to strike over pay erosion and insufficient specialty training places, after the Government has failed to present a credible offer to restore their pay or fix the specialty training crisis in England.
GP Registrars have the full support of GPC England, general practice and the wider profession during the strike action.
Ahead of the strikes we published guidance for practices, LMCs and GP trainers, advising on how practices can support their GP registrars and manage strike days. Read the guidance
Read also the guidance on striking as a GP Registrar.
NHS reforms - Neighbourhood health service
At the NHS Providers Conference yesterday, the Secretary of State for Health, Wes Streeting, announced plans to deliver the next phase of integration of NHS England with savings to be reinvested in ‘frontline care’. The reforms will give more power and autonomy to local leaders and systems to reduce red tape and bureaucracy, so they have more freedom to better deliver health services for their local communities. What this means for general practice and its commissioning is far from certain.
The Government has committed to reducing the running costs of Integrated Care Boards (ICB), with a more clear and focused purpose as strategic commissioners than previously. ICBs will be tasked with transforming the NHS into a neighbourhood health service, with a greater focus on preventing illness. This will mean ICBs will be leaner organisations, with half their current posts removed.
If the government plans are to have any hope of success, they will need GPs around the table leading local discussions. How general practice engages with these reforms, and what we collectively decide could make or break the current ambitions of the Ten Year Plan. The government’s key three aspirations are largely already delivered by our profession: analogue to digital (we have been paperless for years); sickness to prevention (we actively want to push prevention rather than react to political ‘access’ targets) and hospital to community – but we see precious little evidence of this happening. It is clear that general practice is the clear solution to so many of the government’s current challenges, they need to start moving away from labelling us as the problem.
Read more:Billions to be redirected back into patient care with NHS reform - GOV.UK
GP wellbeing resources
A range of wellbeing and support services are available to doctors, and we encourage anybody who is feeling under strain to seek support, such as the BMA’s counselling and peer support services, NHS practitioner health service and non-medical support services such as Samaritans. The organisation Doctors in Distress also provides mental health support for health workers in the UK. We have produced a poster with 10 top tips to help support the wellbeing of you and your colleagues.
The Cameron Fund supports GPs and their families in times of financial need and the RCGP also has information on GP wellbeing support.
Visit the BMA’s wellbeing support services page or call 0330 123 1245 for wellbeing support.
GPCE bulletin: LMC conference update I GPC England in dispute | residents' strike action guidance
Online consultation contractual changes survey
On 1 October 2025, GP practices in England became contractually obliged to make online consultation tools available to patients throughout the practice's contractual core hours (Monday –Friday 8am-6.30pm). GPC England agreed these contractual changes in February 2025 but with the important proviso that ‘necessary safeguards’ would be in place prior to the 1 October implementation date. Over the following months the GPC England Team met NHSE and DHSC many times, to explain our significant concerns about these changes, including their potential workload impact, and the need to develop safeguards including ways to prevent patients from erroneously submitting urgent requests or queries online. We also emphasised the need for practices to be able to temporarily suspend online access if overwhelmed by demand or struggling with capacity, such as during periods of staff sickness. However, these concerns have not been properly addressed and instead totally inadequate ‘safeguards’ have been suggested by NHSE and DHSC.
As a result, on 1 October, GPC England announced a dispute with the Government over these unsafe contract changes. GPC England wants to understand the impact of these changes on GP practices. This will help us in terms of ongoing negotiations with government and making progress with our dispute.
The survey should take no more than 10 minutes to complete and will close on Weds 12 November. Your responses are confidential and will be anonymised for analysis.
Thank you very much for your engagement.
Complete survey https://www.research.net/r/onlineconsultssurvey
England dispute over contract changes
At a time when many practices are struggling, we would remind colleagues that support for any practice in relation to the contract changes and more information and guidance about the dispute, including template letters to ICBs about safeguarding measures, is available here: Campaigning around GP contracts in England.
Being in dispute does NOT mean practices can ignore the contractual changes being implemented on 1 October 2025, nor can GPC England, or LMCs, recommend or endorse such an approach. Declaring a dispute is akin to declaring compliance with the new contractual requirements in the 25/26 contract agreement in March 2025, but “under protest”. Therefore, practices must:
· have an online consultation tool, which is available to registered patients throughout core hours (8am – 6.30pm), to allow them to make non urgent / routine appointments requests, medication queries and administrative requests and
· ensure GP Connect (Update Record) write access functionality is enabled.
We have also updated our FAQs for 1 October 2025 online consultations
Many LMCs have also circulated information to practices. GPC England and many LMCs are aware that both NHS England and ICBs may be undertaking assurance measures.
As we prepare for further escalatory options, please encourage any GPs or GP registrars who are not BMA members to join so that they may vote in any potential future ballot, and ensure your own membership information is up to date.
GPC England is now considering our options and what our next steps should be. The national Conference of England LMCs takes place next week on 7 November. The safety of our patients and working in the best interests of you and your team is our first concern.
Access all the guidance: Campaigning around GP contracts in England
Guidance for practices, LMCs and GP trainers on the Resident Doctors’ strike
Guidance for practices, LMCs and GP trainers has been published ahead of the five-day strike announced by Resident Doctors, starting on 14 November. This provides advice on how practices can support their GP registrars and manage strike days. Read the guidance.
Letter to DHSC about dispensing practices and EPS
GPC England has written to the Minister of State for Care, Stephen Kinnock, to highlight concerns in relation to dispensing GP practices and the need for equity and fairness for patients served by such remote, predominantly rural and coastal practices.
We raised concerns about lack of financial support for the Electronic Prescription Service (EPS) in dispensing practices, in comparison to Pharmacy contractors, and software costs of the EPS.
We have called on the DHSC and NHS England to agree sustainable funding for dispensing practices, so that they won’t decline in the same way that many other rural public services have done.
e-Dec deadline reminder
This year's annual eDEC (electronic declaration) has been circulated to all practices; completing this is a contractual requirement with a closing date of 21 November. Colleagues should note there are a number of questions within the eDEC that relate to the on-line consultation implementation and should ensure when completing these that they align with details on the practice website, other patient facing material, and any information requested by commissioners.
LMC England Conference 2025
The Agenda for the 2025 LMC England Conference at The Royal Northern College of Music, Manchester, on Friday 7 November, has now been published. This will be an important opportunity for representatives from all England LMCs, who have contributed to the motions under debate, to share their views, concerns, and aims for the future.
FourteenFish survey
The FourteenFish Consult tool - a platform integral to GP specialty training - was withdrawn on 14 October. Despite the clear dependence of registrars and supervisors on this system, the withdrawal has gone ahead without a suitable replacement being in place.
GPC England shares the serious concerns raised by the GP Registrars Committee (GPRC) and that this situation is completely unacceptable. The sudden loss of a core training tool has left many trainees and educators without the resources they rely upon for safe and effective learning.
We fully support the GPRC’s call for the RCGP to take urgent and transparent action to restore functionality through a secure, integrated replacement- and to ensure that this comes at no additional cost to registrars.
We know this disruption has caused real frustration, uncertainty, and additional workload pressures across training practices. We are pressing for clear answers and accountability from those responsible and will continue to do so until a sustainable solution is delivered.
If your practice has been affected by the withdrawal of FourteenFish Consult, please encourage your GP Registrars to share their experiences using this form.
GP wellbeing resources
A range of wellbeing and support services are available to doctors, and we encourage anybody who is feeling under strain to seek support, such as the BMA’s counselling and peer support services, NHS practitioner health service and non-medical support services such as Samaritans. The organisation Doctors in Distress also provides mental health support for health workers in the UK. We have produced a poster with 10 top tips to help support the wellbeing of you and your colleagues.
The Cameron Fund supports GPs and their families in times of financial need and the RCGP also has information on GP wellbeing support.
Visit the BMA’s wellbeing support services page or call 0330 123 1245 for wellbeing support.
GPC England in dispute
I know many of you are really struggling with increased online demand. Your GPC England chair has this afternoon, written to Mr Streeting explaining when online GP pathways are opened up to unlimited consultations promising patients’ better access, but providing no more GPs to increase appointment capacity; promising to ‘end the 8am scramble’ but providing no additional appointments, that we cannot safely accommodate this unmet need. We have thousands of GPs looking for work, and the solution is obvious to expanding GP access to fund additional GPs. We want to see and speak to our patients, not firefight in front of computer screens all day. We embrace innovation to enhance the care we provide, not become a substitute for it. The government will have seen online consult platforms crash due to overwhelm. This unsustainable demand will soon be exacerbated by the inevitable winter pressures - compounding the crisis.
Politicians may champion patient safety - yet despite repeated asks from GPC England, at no point has government met with us or online consult platform developers to discuss necessary safeguards, essential to protect patients and GPs alike, to distinguish routine from urgent and emergency requests erroneously submitted online. Their promise was made in writing to GPCE on 18 February 2025. It is a broken promise which tells us much.
We are already starting to see the development of waiting lists, an inevitable consequence of there being no additional appointments to respond to this new surge. Unmet patient need and GP under / unemployment are in Mr Streeting’s gift to solve. GP waiting lists becoming normalised akin to hospital waiting lists is not the legacy government are seeking, but it may well be the one they are remembered for.
As a committee and as elected officers (and working GPs) we are looking at all options that are open to us and deciding what our next steps will be ahead of our national Conference of England LMCs on 7November. The safety of our patients and looking after you and your team is of paramount importance to us.
14 October letter from NHS England
Your practice will on Tuesday have received a letter sent from NHSE regarding the October 1st contract changes, to the entire NHS. In it, you may have noticed reference to LMC communications and wondered what this was about, and why attention was being drawn to it. At times of heightened tension, we would remind colleagues that support for any practice needing to comply with the contract changes and more information about the dispute including our suite of resources, is available here: Campaigning around GP contracts in England.
GPC England has written to the Secretary of State for Health to confirm that we are in dispute, and we have now received a response from Stephen Kinnock, Minister of State for Care.
Being in dispute does NOT mean practices can ignore the contractual changes implemented on 1 October 2025, nor can GPC England, or LMCs, recommend or endorse such an approach. To ensure compliance with new contractual requirements in the 25/26 contract agreement in March 2025, and to avoid the risk of potentially receiving a remedial breach notice from your ICB, practices must:
LFPSE template letter to use when online demand is overwhelming
Following the implementation of contractual changes to provide patients with the ability to make requests via online consultation platforms, GPCE has produced a template letter for practices to send to their ICB, in line with Learning From Patient Safety Events in the event that your practice becomes overwhelmed on any given day, and you consider there to be a potential risk of a patient safety incident occurring. The letter is intended to enable practices to notify ICBs of their concerns and should not be used as a precursor to changing the way in which services are provided in any way. We wish to reiterate however that you must continue to fulfil the obligations of your contract as outlined above.
We would be grateful if you could share any letters that you send to us at info.gpc@bma.org.uk
Information for LMCs regarding GPC England re-entering dispute with the Government
GPC England has prepared a briefing [separate attachment] with information for LMCs regarding disputes. This information is specifically for LMCs only, but please feel free to use it to inform ongoing discussions with your constituent practices. More information will be circulated to LMCs in the coming weeks / months.
Further resources and updates specifically for practices will be continually refreshed via www.bma.org.uk/gpcontract.
Please do share any questions, queries and feedback on the briefing via info.lmcqueries@bma.org.uk as this will help inform further information sharing.
National contract - Practice compliance Survey
We are aware of a number of practices having been contacted by their ICB asking them to urgently respond to a Contract Compliance Return for Patient Contact (including online consultation, telephone and attendance at practice premises).
We can confirm that there is no contractual obligation for practices to complete the compliance return, urgently or otherwise, as this is not stipulated in the GMS regulations.
Read more in our FAQs on our campaign page.
NHSE GP IT systems survey
The Clinical Systems Experience Survey for General Practice is now live, designed to understand how digital tools are working across general practice - the survey is open to all staff working in general practice who use clinical systems. It runs from 22 September until 16 November 2025. Take the survey
DHSC announcement on Carr-Hill Reform
GPCE England welcomes the Government’s recognition that the Carr-Hill funding formula is outdated and in need of reform. However, we remain deeply concerned about the framing and scope of the proposed changes.
While the principle of needs-based funding is commendable, the current approach risks destabilising practices across the country. In a fixed funding envelope, redistributing resources inevitably creates winners and losers. Without a commitment to increasing overall investment, this reform risks becoming a zero-sum exercise—rearranging lifeboats rather than saving the ship.
GPCE have consistently called for whole-contract reform, not just a narrow recalibration of Carr-Hill. The government’s focus on capitation alone ignores the broader structural issues facing general practice. We will once again press Mr Streeting to look at much wider contractual reform that we urgently need to ensure general practice survives.
Any reform must be holistic, well-funded, and co-designed with the profession. The BMA and GPCE have already fed back to the DHSC’s review proposal and look forward to remaining closely involved.
Inclisiran in general practice briefing
There are widespread concerns with the manner and speed with which NHS England have attempted to push Inclisiran, which is a black triangle injectable drug. As there continues to be a number of questions in relation to this, we have published a briefing for practices.
We would like to remind practices that the prescription or administration of Inclisiran is not part of the GMS/PMS contract (although in negotiation with the LMC it may be commissioned via a LES).
Given workload, liability and still-evolving long-term outcomes evidence, practices should not prescribe/administer inclisiran without an adequately funded locally commissioned service.
Read our guidance: Inclisiran (Leqvio®) in General Practice: BMA Briefing
Read also our joint position statement with the RCGP.
OpenSAFELY
Practices using EMIS Web (Optum) and SystmOne (TPP) should continue to accept the Data Provision Notice (DPN) for OpenSAFELY to allow expansion to non-COVID-19 analyses.
OpenSAFELY has the full support of GPCE and the Joint GP IT Committee. It is a legal requirement for practices to accept the DPN. Data will only be made available under the legal direction once the practice has signalled approval. Following practice feedback, JGPITC is working with NHS England and hopes to simplify the work needed by practices with regard to completing a DPIA. Further information will be shared in due course. Official information on how to active the service is available here
GP pressures - workforce and appointment data
The latest GP workforce data showed that in August 2025, we have the equivalent of 28,408 fully qualified full-time GPs. While there is a general rise in FTE GPs since July 2023, GP practices still employ the equivalent of 957 fewer fully qualified full-time GPs than in September 2015.
At the same time, there continues to be an increase in the number of patients, and GPs are now responsible for about 16% more patients than in 2015. Despite this, over 27 million standard appointments were delivered in August, with an average of 1.36 million per working day, which is an increase from August 2024 (1.32m) and August 2023 (1.29m).
In terms of access, 44.4% of appointments in August 2025 were booked to take place on the same day, an increase from the previous month (43.7%), with 81.4% of appointments were booked to take place within 2 weeks.
Read more about GP pressures on our data analysis page, which shows the level of strain GP practices in England are under: Pressures in general practice data analysis
The RCGP has also published data from a survey which shows that three quarters of GPs say patient safety is being compromised by their workload.
NHS Pension Scheme: End of Year Type 2 Certificates 2024/25
GPs are now encouraged to submit their Type 2 End of Year certificates for 2024/25 to PCSE. Early submission helps ensure pension records are updated in good time and allows any issues to be resolved well before the deadline.
PCSE is also hosting a webinar for Type 2 practitioners (sessional GPs) on Wednesday 22 October at 6 - 7pm, to guide GPs completing their Type 2 form in PCSE Online. Webinar sign up link
Why submit early using PCSE Online?
Please look out for an email from PCSE no-reply@pcsengland.co.uk with the subject of ‘Your NHS Pension Record – Action required’.
The LMC Support Network (LMCSN)
Open to all LMC staff and members – come and get involved! Here’s how to make the most of it:
Got something to share or a suggestion? Email us at admin@lmcsn.co.uk
You can sign up for the website, forum and WhatsApp group here: lmcsn.co.uk/join-us
Together we’re stronger – led by LMCs, for LMCs.
DWP/DfC survey
The BMA’s professional fees committee (PFC) negotiates and recommends fees for doctors undertaking professional work outside their NHS contracts. The committee now seeks your valuable assistance.
PFC have reviewed member feedback indicating that the payment for completing Department of Work and Pensions (DWP) / Department for Communities (DfC, Northern Ireland) forms is inadequate; moreover it has remained unchanged since 2004. To negotiate an improved fee with DWP/DfC and highlight the value of your time, we kindly ask for your participation in a survey.
Your responses will help the PFC demonstrate to DWP/DfC that higher fees could incentivise doctors to complete these forms. We understand your heavy workload but can reassure you that it will only take 5 minutes of your time to complete this survey. PFC is dedicated to working towards better fees across the UK and robust evidence from our members is essential for effective negotiations.
The survey will remain open for three weeks. Updates on our progress will be shared in the next PFC newsletter.
Should you have any questions or wish to raise a matter related to fees, please contact us at info.professionalfees@bma.org.uk.
GP wellbeing resources
A range of wellbeing and support services are available to doctors, and we encourage anybody who is feeling under strain to seek support, such as the BMA’s counselling and peer support services, NHS practitioner health service and non-medical support services such as Samaritans. The organisation Doctors in Distress also provides mental health support for health workers in the UK. We have produced a poster with 10 top tips to help support the wellbeing of you and your colleagues.
The Cameron Fund supports GPs and their families in times of financial need and the RCGP also has information on GP wellbeing support.
Visit the BMA’s wellbeing support services page or call 0330 123 1245 for wellbeing support.
Read the GPCE bulletin: GPC England in dispute I online access template letter | GP IT systems survey
Read the latest GP Registrars newsletter: The latest updates from your GPRC
GPC England in dispute over unsafe contract changes
This week, on Wednesday 1 October, GPC England entered into dispute with the Government over contract changes that are unsafe.
The Government, DHSC and NHSE have doubled down on unfulfilled promises in terms of necessary safeguards being in place for online consultation requests and GP Connect (Update Record) write access, and GPC England has written to the Secretary of State for Health to confirm that we are in dispute.
The 1 October contract changes oblige practices to keep online consultations tools available to patients throughout core hours (08:00 – 18:30 weekdays) for non-urgent appointment requests. They also require practices to switch on access to ‘update record’ (write access) via GP Connect for other NHS providers.
To end this dispute, GPC England is calling on the Government to request NHS England to urgently:
We have also asked the Government to demonstrably focus on GMS contract renewal, with transparency regarding funding envelopes for the GMS 2026/27 financial year; for new GMS; and for novel contracts within the 10 Year Health Plan, and swiftly confirming the roadmap regarding timelines for such renewal and investment.
Watch this clip from the Labour Party conference with the GPC England Chair, Dr Katie Bramall, explaining why GPs are entering dispute with Government.
Read more about the contract changes and why GPC England is in dispute with the Government. You’ll also find links to guidance, template letters to use and posters and graphics to download here.
Implementing the contract changes – GPCE guidance
Being in dispute does NOT mean practices can ignore the Contractual changes implemented on 1 October 2025, nor can GPC England, or LMCs, recommend or endorse such an approach. To ensure compliance with new contractual requirements in the 25/26 contract agreement in March 2025, and to avoid the risk of potentially receiving a remedial breach notice from your ICB, practices must:
Guidance
A range of guidance is available on the BMA website, where you can also download the BMA’s Practice Charter as an accompaniment to NHS England’s “You & Your GP Practice” document, and template letters to send to your ICB regarding online consultations. Other guidance include:
Many LMCs have also circulated information to practices. As we prepare for further escalatory options, please encourage any GPs or GP registrars who are not BMA members to join so that they may vote in any potential future ballot, and ensure you own membership information is up to date.
Access all the guidance: Campaigning around GP contracts in England
GP Premises Survey 2025: Summary of Findings
The BMA’s latest survey of nearly 2,000 GPs and Practice Managers reveals serious concerns about the state of GP premises in England. Half of respondents say their buildings are unsuitable for current needs, and over 80% say they won’t meet future demands. Space shortages are affecting staff wellbeing, training, and the integration of new roles under Primary Care Networks within practice teams. A quarter of respondents reported having been invoiced with inaccurate service charges and less than half of these described the charges as ‘resolved’.
We heard concerning reports from tenants in NHSPS and CHP buildings about incorrect invoices, including billing for lift maintenance where there are no lifts, being charged for snow clearance when it had not snowed and mould growing in the reception area. Thank you to everyone who completed and promoted the survey it has helped to build a clear picture which will help us call for change. Please find the full results and our recommendations here.
Power in Numbers: Uniting Sessional GPs for Change
Join us for a free national virtual event on Thursday, 16 October 2025, from 19:00 to 20:30, open to all sessional GPs – BMA members or not. This is your chance to connect, share concerns, and help shape a fairer future for sessional GPs. Hear from newly elected representatives, get updates on the DDRB and 10-Year Plan, and explore support and private practice opportunities. Let’s stand together to make real change – register now.
PCSE Webinar: Updates for LMCs
PCSE is holding a webinar for ICBs and LMCs on 6 November at 11am - 12pm. This webinar offers key updates and guidance for ICBs and LMCs on PCSE processes. It also provides an opportunity for attendees to engage directly with PCSE staff to raise questions and clarify operational processes and procedures. Register here
Representation of GP Educators working for NHS England
We are aware that a number of GPs that work for NHS England as educators, training programme directors and associate deans are concerned about what the future might bring with the proposed abolition of NHS England. The Medical Academic Staff Committee has reached out to the NHS England Local Negotiating Committee and the Chair has offered to meet with those affected and update them on developments to the extent that he is aware. If you would be interested in taking part in that meeting and being contacted by MASC and the LNC about the issues please e-mail info.masc@bma.org.uk with your details.
GP wellbeing resources
A range of wellbeing and support services are available to doctors, and we encourage anybody who is feeling under strain to seek support, such as the BMA’s counselling and peer support services, NHS practitioner health service and non-medical support services such as Samaritans. The organisation Doctors in Distress also provides mental health support for health workers in the UK. We have produced a poster with 10 top tips to help support the wellbeing of you and your colleagues.
The Cameron Fund supports GPs and their families in times of financial need and the RCGP also has information on GP wellbeing support.
Visit the BMA’s wellbeing support services page or call 0330 123 1245 for wellbeing support.
Read the GPCE bulletin: GPC England in dispute I contract changes guidance | GP premises survey findings
GPC England votes to enter dispute from 1 October
At the GPC England meeting yesterday, the committee voted to go back into dispute with the Government, DHSC and NHS England from 1 October 2025 on the grounds of patient safety, workforce wellbeing, and GP risk.
When GPC England voted to accept the 2025/26 contract back in March, we mutually agreed with Government, DHSC, and NHS England that necessary safeguards must be in place in time for the start of October’s contract changes. For GP Connect Update Record (write access) the JGPITC have tried to work with NHS England counterparts to make the tool safe, but as communicated in their statement, it is not yet safe.
We have similarly tried to work with NHS England and DHSC colleagues to explore changes to the online consultation platforms to provide additional functionality for routine appointment requests. The simplest and safest way to do this would be via tick box questionnaire setting, akin to the Florey questionnaires we wrote and uploaded in the early months of the Covid19 Pandemic. By eliminating the option for free text with such a functionality, you eliminate potentially urgent problems erroneously slipping through – creating risk for patients and their GPs alike. This would also allow the current free text option to be switched off once the practice capacity is reached, knowing that the routine functionality would be kept on.
Despite our best efforts over the past six months, our concerns are being ignored and there is presently a refusal to ensure any of the necessary safeguards we committed to are in place to protect patients and practice staff from harm. This situation has been made worse by the 10 Year Health Plan’s recommendations to proceed with novel GP contract structures, which risk diminishing GMS and undermining the Secretary of State’s written commitments of 19 March and 11 August.
We are considering all our options, including potential legal action, to ensure the most harmful aspects of this Government policy are challenged and reversed. Of course, the Government could avoid all this entirely, by simply providing the safeguards and the clarity that we need which would not cost them a single penny
Should Government double down, we will have no option but to ballot contractors across the country as to the potential next steps. It would be in patients and practices’ best interests for NHS England and DHSC to work with GPC England to agree the functionality required to deliver what the Secretary of State has asked for safely.
Read more here
Watch my 2 minute video summary here and >
Read our press statement.
October 1st contract changes - essential guides
GPC England has prepared guidance to assist preparations for the changes to the GP practice contract from 1 October, and will be producing more in the coming days:
Guidance explaining the regulatory changes for 2025/26
GPC England has published guidance to explain the regulatory changes for 2025/26 and considers what these mean for your practice and the patient contact clauses which were imposed in 2023/24. We also set out advice for exactly how to remain compliant in relation to the three modes of access, i.e. walk-in attendance at the practice, contact via telephone, and contact via online consultation.
Guidance providing practical advice on how to manage patient care safely post-1 October
The following guidance provides practical advice on how to manage patient care safely from 1 October. It contains advice on reviewing your practice’s workflow and triaging arrangements; considerations regarding the introduction of waiting lists for routine care; and reminders of how to revisit and use our BMA safe working guidance handbook.
Our contract guidance will be updated, to answer further queries from members.
Joint GP IT Committee position statement on GP Connect: Update Record
In addition, the Joint GP IT Committee has published a statement on the current state of GP Connect: Update Record following their meeting on 3 September, which has been shared with NHS England in light of plans to make this functionality a requirement.
Read more about the contract changes and access our guidance on our campaign page: GPs in England: staying safe, organised and united.
Special Representatives Meeting - 10 Year Health Plan and impact on general practice
The BMA has held a Special Representative Meeting (SRM) to debate the risk of the NHS England 10-Year Health Plan. The Secretary of State for Health and Social Care, Wes Streeting, answered questions on how the NHS 10-year plan aims to tackle the doctor unemployment crisis across the health service.
Watch the whole address by the Secretary of State: https://youtu.be/C3q5vcVqKjk
There was a dedicated section on the implications for general practice, and motions confirming our already stated concerns on the Plan, such as:
There was also a motion passed expressing that “The Plan poses an existential threat to the GP independent contractor model, the GMS contract, and therefore the very concept of the family doctor” and that it “condemns and opposes the 10 Year Plan as it is currently written”.
GPCE has previously raised concerns with the plan and the potential negative consequences on practices and their patients, especially the risks posed by its proposals on greater integration and the potential for GP services to be vertically taken over by hospitals and other large providers.
Read more about the SRM, including a full list of resolutions.
Read the BMA’s comprehensive analysis of the 10 Year Health Plan.
Ministerial briefing about the 10 Year Plan
Last week, the Rebuild General Practice campaign and the BMA convened a high-level Ministerial briefing in Parliament to discuss the 10 Year Plan, chaired by Dr Simon Opher MP and attended by Department of Health and Social Care Minister, Stephen Kinnock MP.
GPs from across the country including GPC England’s chair Dr Katie Bramall, deputy chair Dr Samira Anane and Londonwide LMCs’ chief executive Dr Lisa Harrod-Rothwell joined MPs, House of Lord members and parliamentary leaders to respond to the Government’s 10-Year Health Plan, raising urgent concerns around protecting GMS, the emerging neighbourhood structures, parity of voice for primary care at the system table digital exclusion, and the future of GP surgeries.
The meeting identified two priority areas that the government should take forwards as they look to develop and implement the plan:
The message from the frontline was clear: GPs are essential to the success of neighbourhood care, but without meaningful investment or change, the system cannot deliver for patients.
OpenSAFELY data provision notice
Practices using EMIS Web (Optum) and SystmOne (TPP) should continue to accept the DPN (data provision notice) for OpenSAFELY to allow expansion to non-COVID-19 analyses now that it has been sent.
OpenSAFELY has the full support of GPC England and the Joint GP IT Committee and, as NHS England becomes the data controller of the outputs of queried data, any data protection risks are held by NHS England. It is a legal requirement for practices to accept the DPN. Data will only be made available under the legal direction once the practice has signalled approval.
New GOV.UK Pay arrangements coming soon for locum pension payments
From 1st October 2025 it will be possible for locum GPs using PCSE's online portal to submit their Locum B forms and pay their employer and employee pension contributions to use the GOV.UK Pay service, rather than sending money via BACS and then updating the 'recording income stream' section on the portal. This should reduce the work for locum GPs and will also allow a more rapid updating of the records held by PCSE as the payment will instantly be tied to the Locum B submission. PCSE are running a webinar at 6pm next Wednesday (24 September 2025) on this. To enrol click here
National Neighbourhood Health Implementation Programme (NNHIP) survey
The Government has now rolled out the first neighbourhood health services in 43 places across England. We want to hear from you about your awareness and engagement with the NNHIP first wave of applications to join the programme that were invited in July.
We plan to use this insight to lobby for changes to the process and to help support our members who will be involved in the programme, as well as those who may take it up subsequently. It’s important therefore that we hear from both respondents who have been leading the process in their locality, but also from those who have been engaged to a lesser extent or are indeed unaware of the programme. GPC England members challenged the national medical director at last week’s Parliamentary briefing with the Minister over the importance of practice and PCN CD consent and co-production in programme design and delivery. Take part here
We are asking for people to share copies of their NNHIP plans by sending them to info.gpc@bma.org.uk, and we hope to share learning from the survey and applications to help support GPs and practices moving forward.
BMA GP pensions newsletter
We encourage you to take a look at the recent GP pensions newsletter circulated by the BMA’s Pensions Committee, if you haven’t already done so. This includes a recent win in terms of now being able to log GP appraisal work for up to 3 days and a link to NHS England’s compensation factsheet for complaints relating to PCSE’s pension administration.
Doctors to be allowed to prescribe flu medicines all year-round
The government has announced it will allow doctors and pharmacists to prescribe flu medicines year-round to reduce winter pressures and protect the NHS. Read more
England LMC conference 2025 – deadline to register
The England LMC conference will be held on 7 November at the Royal Northern College of Music, Manchester.
The deadline to register is noon, Wednesday 1 October 2025 - LMCs are asked to ensure that their LMC representatives and observers are registered correctly via this link. It is the LMC's responsibility to ensure that their representatives and observers are registered before the deadline.
If you have any queries regarding this conference, please email info.lmcconference@bma.org.uk
GP wellbeing resources
A range of wellbeing and support services are available to doctors, and we encourage anybody who is feeling under strain to seek support, such as the BMA’s counselling and peer support services, NHS practitioner health service and non-medical support services such as Samaritans. The organisation Doctors in Distress also provides mental health support for health workers in the UK. We have produced a poster with 10 top tips to help support the wellbeing of you and your colleagues.
The Cameron Fund supports GPs and their families in times of financial need and the RCGP also has information on GP wellbeing support.
Visit the BMA’s wellbeing support services page or call 0330 123 1245 for wellbeing support.
Read the GPCE bulletin:
GPC England votes to enter dispute I October contract changes | 10-year health plan
Read the Sessional GPs newsletter: Meet our new co-chairs | DDRB resources | GP support hub
Upcoming contractual changes from 1 October
We are acutely aware of the deep concern and growing frustration centred around the upcoming contractual changes on online consultations. This, against the backdrop of increasing workload will be felt to be an additional monumental task for already heavily burdened practices and their staff.
These contractual changes outline the opening of online consultation request software throughout practice core hours. The initial contractual proposals were for all consultations including ‘urgent’/same day requests. Repeatedly GPCE pushed back on this: highlighting the huge safety risk of open ended and unmonitored requests, and a concession was made around restricting the contractual ask to routine requests, with the option of urgent consultations being dealt with via telephone and/or practice walk ins, as determined by the practice. If practices are offering ‘total triage’ at present, they can continue to do this.
This change was delayed in its implementation from 1 April 2025 to 1 October 2025 as it was agreed that it would be subject to the necessary safeguards being in place to avoid urgent clinical requests being erroneously submitted online. GPCE will continue to highlight concerns around safety and clinical risk to NHSE and DHSC, outlining the need for robust safeguards and pathways to be in place.
GPCE has also been working with relevant experts to urgently and vigorously address this matter, including seeking KC legal advice, liaising with software suppliers and developing supporting guidance and resources. A key stakeholder is the Joint GP IT Committee (JGPITC) which is an expert group of BMA and RCGP working GPs and informaticians.
The JGPITC is embedded in the GMS contract work we do and plays a vital role in ensuring that safe, robust systems are developed and implemented for use in General Practice. It is co-chaired by Dr Mark Coley the BMA GPC England Digital and IT policy lead, and Dr Tom Nichols, chair of the RCGP Health Informatics Group.
The JGPITC came into being with the introduction of the GMS contract over 20 years ago and was established "to provide an effective stakeholder and specification group for new systems allowing GPs to be confident that these are fit for purpose and offering GPs [...] vital guarantees on security and confidentiality." (cf. para 4.31 in Investing in General Practice The New GMS Contract).
The JGPITC met last week and discussed several areas of interest including a forthcoming usability study on GP Connect: Update Record and the committee's view on its current implementation. GPCE were also able to raise ongoing concerns with DHSC and NHSE about the implications of allowing online consultation access throughout the entirety of core hours.
We appreciate that without the necessary safeguards and processes for online consultations and GP Connect: Update Record, this will represent an unmanageable risk and workload for many of you.
We will continue to fight and push for flexibilities, helping to protect patients, staff and practices.
GPCE officers will be meeting with NHSE and DHSC over the coming week and we will meet as a committee on September 18th to discuss the next steps for the profession in light of the above.
GP Connect: Update Record
Over recent months GPC England has been engaging with NHS England to highlight concerns and the need for safeguards over the functioning of GP Connect: Update Record and its use with Pharmacy First in particular. GPCE agreed to the contractual requirement for this be turned on by practices from 1st October 2025, subject to further discussions on it being ready to roll out. The current implementation of GP Connect: Update Record was discussed at last week's JGPITC, and the committee does not yet have confidence that the current implementation is fit for purpose. The propagation of pregnancy coding errors earlier in the year to those practices who hadn't already turned it off as part of collection action is just one example of the problems associated with its current implementation. JGPITC has committed to working with the relevant stakeholders including NHSE make this product safe and fit for purpose for patients and practices.
QRISK
This past week we were alerted to the disablement of, and lack of update to the QRISK calculator on GP software systems. The calculator has now been enabled again on EMIS. Concerns with QRISK2 were initially communicated as a risk to NHSE’s National Director of Primary Care Dr Amanda Doyle, back in January 2025 in a letter from the JGPTIC. Despite highlighting the importance of embedding accurate and efficient processes within GP IT systems to help identify those patients most at risk, and the need to avoid increasing workload, there has been no response nor changes made to address the concerns. We will be reiterating these concerns and seeking clarification on the matter in further communications this week.
Read our letter to NHSE about the obstacles impeding the implementation of QRISK3 in GP software systems.
OpenSAFELY data provision notice
The RCGP has also published helpful information
Special Representatives Meeting - 10 Year Health Plan and impact on general practice
The BMA is holding a Special Representative Meeting (SRM) on 14 September 2025, to debate the risk of the NHS England 10-Year Health Plan which was published in July.
The meeting will be held virtually and debate the risk of the plan to the medical profession at large, including a dedicated section on the potential implications for general practice and the independent contractor model, and will help direct the BMA's response to the proposals. Read the Agenda.
GPCE has already raised a number of concerns with the plan and the potential negative consequences on practices and their patients, especially the risks posed by its proposals on greater integration and the potential for GP services to be vertically taken over by hospitals and other large providers.
Read the BMA’s comprehensive analysis of the 10 Year Health Plan.
National Neighbourhood Health Implementation Programme (NNHIP) survey
We want to hear from you about your awareness and engagement with the NNHIP first wave of applications to join the programme that were invited in July. We plan to use this insight to lobby for changes to the process and to help support our members who will be involved in the programme, as well as those who may take it up subsequently. It’s important therefore that we hear from both respondents who have been leading the process in their locality, but also from those who have been engaged to a lesser extent or are indeed unaware of the programme. Take part here
We are asking for people to share copies of their NNHIP plans by emailing info.gpc@bma.org.uk, and we hope to share learning from the survey and applications to help support GPs and practices.
Misleading weight loss advert
It was drawn to our attention that a digital weight management company had published an advertisement for weight loss medication blaming GPs by stating that “many GPs are ruling out overweight women”. Upon being made aware of this ad, we contacted the company stating that this was factually inaccurate and that the advertisement should be immediately withdrawn. We highlighted NHSE’s guidance on the commissioning of GLP1/GIPs and their provision, which precludes GPs from prescribing other than in extremely limited scenarios if commissioning arrangements are in place.
The company responded, recognising that the message in the ad was not articulated fairly or correctly, and the ad was immediately removed.
Read our Focus on guidance on Tirzepatide for weight management in General Practice.
If you come across advertising that you consider inaccurately portrays general practice or is otherwise misleading, please make us aware of this by emailing info.gpc@bma.org.uk.
Rabies vaccination
Following recent concerns about NHS England's advice on the contractual requirements of post-exposure Rabies vaccination, we have formally written to NHSE to outline the Committee's position.
We are challenging this interpretation on the basis that post rabies exposure vaccination is not listed within the SFE and therefore does not translate into a vaccination included within the 2021 contract changes.
Inaccurate blood results
A BBC investigation has discovered that errors by machines used to diagnose diabetes means that up patients have been wrongly diagnosed with type 2 diabetes and prescribed medication that they don't need.
NHS England has confirmed 16 hospital trusts use the machines, made by Trinity Biotech, which have produced inaccurate test results, and at least 55,000 people in England will need further blood tests. NHSE has also said that fewer than 10% of their laboratories were affected and all have either replaced the machines or addressed calibration issues.
If your practice is one of those affected, please contact us via info.gpc@bma.org.uk.
GP pressures
The latest GP appointment data shows that general practice teams had the busiest July on record, witha record 33.6 million appointments delivered in July 2025 - 4.3% more than last year and nearly a quarter on the same period pre-pandemic (24.3% increase since 2019).
The workforce data showed that NHS had the equivalent of 28,278 fully qualified full-time GPs in July. While the number of GPs employed by practices has generally been rising since July 2023, practices still employ the equivalent of 1,086 fewer fully qualified full-time GPs than in September 2015.
There continues to be a rise in the number of patients, with July 2025 seeing yet another record-breaking number. GPs employed by practices are now responsible for about 17% more patients than in 2015, demonstrating significant workload pressures.
Read more about GP pressures on our data analysis page, which showsthe level of strain GP practices in England are under: Pressures in general practice data analysis
GP unemployment crisis
In this unprecedented crisis, GPs are facing a painful paradox: patients are crying out for appointments, while many GPs are overwhelmed and practices are struggling to find enough funding and resources to match patient demand.
General practice is the foundation of the NHS. Without enough GPs, patients can't access the care they need, when they need it. That's why we're calling on the Government to end GP unemployment. Watch our video where GPs explain the End GP unemployment crisis.
To support you through this, we’ve also launched the GP Support Hub - a dedicated space to help navigate the challenges of underemployment, unemployment and financial uncertainty.
Blended Learning: Training great GPs requires real patients
Great GPs are made through experience. Knowledge, communication, and clinical reasoning are essential, but many skills - the “soft” ones - can only be honed with real patients.
The GP Registrar and GPC England committees have expressed concern around how ’Blended Learning’ could[SA1] [SA2] reduce GP Registrars' ’face-to-face clinical exposure from 70% to as little as 37% of a registrar’s time (BMA GP Registrar Blended Survey). There is a deep commitment to maintaining clinical and quality standards of experience and learning from both committees. Optional, well-designed blended learning may support flexibility or exam preparation, but it must not be used as a replacement for in-practice face to face experience.
GPRC and GPC England are working together and with NHSE to ensure that GP training experience and standards are safeguarded for future cohorts.
Please read the article by Dr Helen Salisbury, BMA Council member: https://www.bmj.com/content/390/bmj.r1617
England LMC conference 2025 - deadlines
The England LMC conference will be held on 7 November at the Royal Northern College of Music, Manchester.
The deadline to submit motions was noon Monday 8 September.
Registration deadline - noon - Wednesday 1 October 2025 - LMCs are asked to ensure that their LMC representatives and observers are registered correctly via this link. It is the LMC's responsibility to ensure that their representatives and observers are registered before the deadline.
If you have any queries regarding this conference, please email info.lmcconference@bma.org.uk
GP wellbeing resources
A range of wellbeing and support services are available to doctors, and we encourage anybody who is feeling under strain to seek support, such as the BMA’s counselling and peer support services, NHS practitioner health service and non-medical support services such as Samaritans. The organisation Doctors in Distress also provides mental health support for health workers in the UK. We have produced a poster with 10 top tips to help support the wellbeing of you and your colleagues.
The Cameron Fund supports GPs and their families in times of financial need and the RCGP also has information on GP wellbeing support.
Visit the BMA’s wellbeing support services page or call 0330 123 1245 for wellbeing support.
Read the GPCE bulletin: Upcoming contractual changes | GP Connect | OpenSAFELY data provision notice
[SA1]https://heeoe.hee.nhs.uk/blended-learning-platform/blended-learning
[SA2]please could we hyperlink this here
