What does the abolition of NHS England mean for GPs?

Today’s big news is the Government’s plan to abolish NHS England, 12 years after its inception, as part of the Prime Minister’s drive to cut bureaucracy. Here, Eliza Parr explores what this shake-up might mean for GPs

Given recent news of NHS England board members stepping down and plans to cut staff by half, Prime Minister Keir Starmer’s announcement this morning may not come as much of a surprise. This is a Government clear on its intentions to reform the NHS and to cut bureaucracy. 

But getting rid of NHS England and consolidating management under the Department of Health and Social Care (DHSC) is a pretty seismic change in the way the health service is currently run. And there are some key questions surrounding the decision which will certainly impact general practice.

So, what might this all mean for GPs?

Focus on primary care

There is an argument that bringing NHS policy entirely under Government control will be positive for primary care. Since taking up his role last summer, health secretary Wes Streeting has been emphatic that care and resources need to move away from the acutes and into general practice. The Government-commissioned Darzi report was crystal clear on this point. And many suggested that the recent injection of cash into the 2025/26 GP contract signalled that the Government is serious about investing in general practice.

Former BMA chair and GP Committee chair Dr Chaand Nagpaul says any new management structure within DHSC should have a strong focus on primary care policy, if the Government wants to remain true to its word.

He tells Pulse: ‘If the Government is now taking charge of the NHS, then it needs to implement an organizational arrangement that is true to delivering its own policy, as per the Darzi report, which was unequivocal about the need to both substantially increase investment in and develop general practice and primary care. That’s what I would want to see.’ 

Primary care professor and GP Professor Sir Sam Everington welcomes the news of NHS England’s abolition for this reason, noting that ‘everything’ Mr Streeting has said indicates he thinks ‘primary care is the solution’. 

‘I’ve never known a time when politicians have been so clear about the importance of primary care to solve the problem,’ he tells Pulse. 

But he highlights that to drive forward positive change for GP practices, there will need to be ‘a complete connection between the grassroots and the top’. 

Dr Rocco Friebel, associate professor of health policy at the London School of Economics, also says this change could ‘refocus’ policies on the NHS frontline – but stresses the need for sufficient capacity to manage this change.

‘Ministers will now have to own the NHS’s day-to-day problems, but they’ll need serious capacity in Whitehall to manage something this complex. If the Labour government gets it right, there’s a real chance to refocus on patients and frontline staff – but if they don’t, it could make an already stretched system even more chaotic.’

So removing a layer of bureaucracy in the management of the NHS could mean that new policies are truer to the Government’s goals – and bolstering general practice is clearly high on Mr Streeting’s agenda. But given that NHSE will be absorbed into DHSC over two years, any improvements won’t be instant.

GP contract and negotiations

Many in the health service may happily wave goodbye to NHS England if it makes their working lives simpler. 

GPCE member for Derbyshire and Nottingham Dr Peter Holden says that NHSE’s abolition is ‘probably no bad thing’ as it is a ‘reduction in layers of management’. Indeed, central policy on general practice will surely be simpler if it’s coming from one place instead of two. 

Another potential simplification is in GP contract negotiations. For recent contracts, the BMA’s GPCE, which acts on behalf of the profession, has negotiated the contractual arrangements with NHS England, which essentially acts on behalf of the Government. Anything agreed by NHSE ultimately requires ministerial sign-off. By removing this middle layer, negotiations are likely to become simpler (but by no means easy). 

Dr Holden says GPs will no longer have to deal with an ‘interlocutor’ putting ‘their own spin on it because they’ve got their own targets to deliver’, and that there is ‘one less person to satisfy in the negotiating forum’. 

He tells Pulse: ‘If we’re going to negotiate, we have to deal with the negotiating team who have a mandate from NHS England. You would start to agree something, and then the Government would say “hang on, is that within our policies?” 

‘So you then get [DHSC} people wanting their two pence. So you take two steps forward to go one backwards. So if they’ve got rid of NHSE, you’re going to be dealing directly with the people who set the policy. So it should make negotiations easier.’

Drawing on his own experiences as a negotiator, Dr Nagpaul also points to the opportunity for ‘direct dialogue’ with the Government – but says this could be a ‘good or a bad thing’.

He says: ‘What used to happen is that the middle tier was at times creating an extra layer that you had to penetrate. You’d negotiate with NHS England, and then it would require ministerial sign off. 

‘So you could go so far, but then that didn’t mean that the Department would agree necessarily with what had been discussed with NHS England. So in some ways, this does cut out the middleman.’

Despite this simplification of the process, Dr Nagpaul says the question now is whether and how DHSC will change its infrastructure in order to ‘actually support negotiations with the profession’ in NHS England’s absence.

‘I think the crucial point here is: will the Department of Health have a staffing infrastructure that has necessary staff, including medical input, that can understand general practice and provide the necessary level of input in the negotiations for a new GP contract, because that’s what you need.’

Londonwide LMCs chief executive Dr Michelle Drage points out that the NHS management changes laid out today could in fact be useful for negotiating a wholly new GP contract – which is one of the BMA’s key negotiating asks.

‘There’s no track record of things improving when there have been NHS changes, however, change provides an opportunity for a new contract for GPs to actually be more directly negotiated with Government, which I think is an opportunity which should be exploited,’ Dr Drage tells Pulse. 

The success of GP contract negotiations depends largely on political will. And whichever way the NHS is organised, decisions around the structure and investment in general practice are the health secretary’s to make. But doing away with NHS England – the ‘middleman’ in negotiations – is likely to give GP representatives a more direct line to Mr Streeting, with potentially more chance of bending his ear. 

The future of ICBs

It’s not clear yet how this news will impact the running of ICBs. NHS England has often cited an aim to give more power to local systems via ICBs. Sometimes this was a helpful way of shirking responsibility, such as when its primary care director said she wanted to ‘step back’ and let ICBs test out their own plans to overhaul same-day GP access.

Whether the DHSC will continue this line of thinking is not yet known. But given the news this week that ICBs have been asked to cut their workforce by 50%, it doesn’t look like ICBs will be equipped to take on more responsibilities. 

The impact on ICBs will, however, be important for GPs. Dr Nagpaul points out that for GPs on the ground, NHS England is a ‘remote organisation’ and ‘their reality is based around ICBs’ and the borough teams within them. 

‘This change can be far reaching, because it could affect the way in which ICBs behave. It could affect whether ICBs have autonomy, or whether they actually become part of implementing government agendas,’ he tells Pulse. 

Dr Nagpaul says the impact on ICBs will depend on the Government’s ultimate intention – whether abolishing NHS England is about reducing ‘unnecessary duplication’ or if it is more about ‘controlling day-to-day’. If it’s the latter, he says, ICBs are likely to be ‘much more accountable to government policy, rather than local’ and could come under ‘greater scrutiny and performance management’. 

Professor Everington says he would expect all ICBs to be ‘incentivising and driving government priorities’, and that DHSC should exert tight control on their finances. 

‘I think the centre should be controlling budgets and really saying “here’s your budget for the year and we expect you to stick to it”. So that’s about financial accountability and control. I think the ICB’s role, because of its local knowledge, is around transformation.’ 

In terms of local policies which will impact general practice, the Government has been clear on its intention to introduce a ‘neighbourhood health service’. The Labour Party’s manifesto pledged to trial ‘neighbourhood health centres’ which will have GPs and other community health staff ‘under one roof’.

Given the focus on local neighbourhood care, ICBs are best placed to drive forward this proposal. But how much control DHSC will exert is not yet clear. The 10-year plan for health, expected in May, is likely to shed more light on the plans.