What will the Government proposals for the 2025/26 contract mean for GP practices?

This morning, the Government unveiled the very first few details of the next GP contract. Health secretary Wes Streeting wrote to the profession mentioning a £889m funding uplift and reiterating Labour’s commitment to ‘bring back the family doctor’. As the proposal is now with the BMA for consultation, Pulse’s Eliza Parr, Maya Dhillon and Anna Colivicchi look at what it could mean for GP practices next year

We had been told, as recently as two days ago, that there would be no details on GP funding arrangements for 2025/26 until ‘early in the new year.’ Giving evidence to MPs on Wednesday, the health secretary warned GP practices against ‘taking decisions ahead of seeing the allocations’ for next year, and that funding details would not be available until January. 

However this morning the Government revealed the first few details about the GP contract for 2025/26. As well as an extra £889m, proposals include: adding practice nurses to ARRS; the removal of ‘red tape’; reducing the number of QOF targets; and incentivising continuity of care.

The Government will consult with the BMA’s GP committee on its proposals over the coming weeks before revealing the full contract in spring 2025. But there are still a lot of unknowns at this point, which will be concerning for GPs worried about their finances in the coming year. Below, we review what we do know and what remains to be answered.

Will the extra funding be enough to stabilise practices?

The biggest promise within the announcement today was for an extra £889m to be allocated to practices, ‘on top of the existing budget’. Mr Streeting told GPs that this is a 7.2% cash growth – or 4.8% real-terms growth – to general practice funding, although it is unclear what the current baseline is to calculate that increase. GPC England said that they were told that this headline figure ‘represents new money’ but that if their modelling in the coming weeks reveals this not to be the case, Government ‘will be held to account’.

The BMA seemed to react positively to the announcement, with GPC chair Dr Katie Bramall-Stainer saying that she hoped today will be looked back on as ‘a positive starting point for an evolving conversation’.  The RCGP echoed this and said that the funding ‘will help stabilise general practice’ and provide some ‘much-needed certainty’. But other organisations were more sceptical, including the Doctors’ Association UK (DAUK), which argued that GPs ‘need more detail’ and are concerned this is ‘nothing more than smoke and mirrors’.

While the letter sent from the health secretary to the profession was meant to provide ‘reassurances’ for the sector, it failed to mention the huge impact that the national insurance rises will have on practices, and carried no promise of funding to offset those specifically. GP leaders have warned that the NI increases could cost practices £260m extra next year. The DAUK warned that the money ‘will all be eroded’ unless the Government makes GPs exempt from the increased NI contributions and said that otherwise GPs could still be ‘set for another year of defunding’.

It is also worth remembering that the GPC had outlined demands to end collective action earlier this year (before the Budget and its implications), including GP practice core funding to rise by at least £40 per patient for 2025/26, which would mean an uplift of around £2.5bn.

 ‘We welcome any increase in funding for general practice, however, we are concerned that while this sounds like a lot of money, in reality it is not,’ said Dr Lizzie Toberty, GP lead for the DAUK. ‘The Government has created a huge problem for general practice by not exempting GP practices from the increase in national insurance contributions, it means a huge proportion of this money will be swallowed up meeting the new NI obligations.’

The uplift announced today will be for GMS and the PCN DES in 2025/26, but GP leaders hope to ‘secure additional money’ in the coming weeks from ‘separate pots’, ringfenced to support elective recovery. However, these funding pots fall outside the remit of the health secretary’s announcement today, so we will have to wait until next year to know if additional funding is on the cards.

Will other health professionals be added to the ARRS?

When details of the current GP contract came out in February, the then-Government indicated that ARRS would be expanded to cover nurses. It seemed they had listened to concerns from the primary care community, with thousands having signed a petition calling for flexibility to employ practice nurses alongside GPs in the additional roles scheme. 

But weeks later, NHS England confirmed that only ‘enhanced’ practices nurses would be added to ARRS this year, which meant only those holding a level seven or above postgraduate certification in a specialist area. The vast majority of general practice nurses (GPNs) were therefore left out of the ARRS. And they continued to be excluded in August, when Mr Streeting confirmed the inclusion of newly-qualified GPs in the ARRS, as one of his first measures as health secretary to help tackle GP unemployment.

But today, DHSC has indicated that all GPNs will be included in the additional roles scheme, as part of 2025/26 GP contract arrangements. While details are thin on the ground, the announcement said the Government will ‘remove red tape and make funding available’ for practice nurses to be employed via the scheme. Mr Streeting’s letter to the profession also reiterated confirmation that GPs currently hired under ARRS can continue employment into 2025/26, despite this extra funding being announced initially as an ‘emergency measure’ for the current financial year.

The department has confirmed that the ARRS will expand to include all practice nurses, rather than only those who are ‘newly-qualified’, as is the case for GPs. However, PCNs can only hire nurses who have never previously worked for any of its constituent practices. 

Full details on adjustments to the ARRS will be revealed following consultation with the BMA in 2025, Mr Streeting told GPs. Before that, it’s not clear how much extra funding will be directed towards hiring nurses, or whether it will be ring-fenced from the main ARRS funding pot, as it is for GPs. 

The BMA hasn’t yet given a view on this proposal, but a move to include GPNs in the scheme is in line with previous GPCE asks. In January, the committee said it would be ‘appropriate’ to include practice nurses in the ARRS, along with GPs. 

However, when it comes to GPs in the ARRS, the GPCE has since been critical of their inclusion, arguing that the money should be moved to core funding to give practices autonomy over who they hire. And the DAUK repeated this call today in response to DHSC’s announcement, saying they ‘remain very concerned’ about the ongoing employment of GPs through the ARRS. 

How will the proposals affect QOF targets?

The Government is proposing to reduce the QOF targets to 44, as it said today that this will help ‘free up’ GPs ‘to spend more time with their patients’. But the details of how this will be achieved, and which indicators will be removed, were scarce.

The announcement also mentioned adding financial incentives to reward GPs ‘who go above and beyond to prevent the most common killers like heart disease’, but it is unclear if the plan is for these to be added to QOF. This comes after the previous Government had already consulted the public on the future of QOF, with a question on whether it should be scrapped altogether. 

How is the Government going to ‘bring back the family doctor’?

The Department of Health and Social Care (DHSC) has promised that its proposed changes to the GP contract mean patients will ‘experience greater continuity of care’. This is nothing new from Mr Streeting – Labour’s manifesto promised the same, and the party made a series of pledges to this effect in the year running up to the election. 

Last summer, Mr Streeting said GP practices would be given incentives to offer patients continuity of care, indicating that poorer performing practices would receive less money. And at the start of this year, Labour promised to remove ‘burdensome’ bureaucracy from GPs, but asked for better continuity of care in return. 

NHS England had also hinted before Labour’s election win that continuity of care may be included in future contracts, but sought to assure GPs that this wouldn’t come with ‘silly measures and boxes to tick’.

Pending consultation with the GPCE, it seems these plans are finally going ahead. DHSC said their proposed changes to the contract ‘incentivise improvements in continuity of care’, with a particular focus on patients with complex needs, long-term conditions, and the elderly. This is the key policy aimed at meeting Labour’s well-worn pledge to ‘bring back the family doctor’, with Mr Streeting stressing that he wants to ‘be judged by results – not promises’.

It’s not yet clear how the Government will encourage GPs to ensure more patients see the same doctor at each appointment, or how this will be monitored at practice-level. As GPCE chair Dr Bramall-Stainer told GPs this morning, the ‘devil is in the detail’. But it seems that at least some of the £889m funding boost for 2025/26 will hinge on practices’ ability to offer continuity. In the past, the BMA has highlighted that the ‘only way’ to deliver continuity of care is to ‘retain the GPs we have’.

As NHSE recognised earlier this year, any new ‘silly’ tick-box exercises would surely go down badly with the profession. But there is certainly consensus among GPs and experts that continuity of care is good for both patients and the workforce. Submissions to Lord Darzi’s recent NHS review highlighted this, with the BMA arguing that continuity of care in general practice improves mortality, patient satisfaction, and also efficiency. 

But boosting continuity of care depends primarily on the stability of a practice’s GP workforce (which is often precarious, to say the least). Mr Streeting has promised ‘hundreds more newly-qualified GPs’ through continuation of funding for ARRS GPs into next year. And an injection of core funding may help practices to bolster their own non-PCN workforce. Whether this will be enough to see material improvements to continuity in 2025/26 is another question. 

What is the red tape challenge?

The announcement also mentioned a ‘red tape challenge’ to ‘slash bureaucracy’, so GPs ‘are freed up to deliver more appointments’. A few details concerning this challenge have already been revealed.

It was announced earlier this year and will involve NHS England asking GPs, hospitals and ICBs ‘what works well and what needs to change’ before the feedback is considered by a group made up of doctors in primary and secondary care. NHS England recently said that the challenge will run in two phases: one involving ‘listening’ to feedback (until this month); and one ‘testing emerging recommendations’ until January. It is collating ‘examples of best practices’ in general practice, as the objective of this review is to ‘reduce bureaucracy through a rapid review of the issues’. The bureaucracy review will focus around five groups, which will cover: medicines and prescribing; data, digital and technology; workforce, training and education; contractual and financial flows; metrics.

What did the announcement say about access?

Regarding access, there is nothing in today’s announcement that we haven’t heard before. Amanda Pritchard, NHS England chief executive, highlighted that GP teams are delivering ‘millions more appointments a month’ in comparison to pre-pandemic numbers. She added: ‘It is vital they are given extra resources to improve access for patients and help people live healthier lives.’

There is a mention of the shift from ‘analogue to digital’ to ensure that patients can contract their surgery electronically during core hours (as well as in person or by phone) – the goal of this being to allow more people to book appointments and/or speak to a doctor. The phrase ‘analogue to digital’ has become a favourite of the Government’s since the release of the Darzi report. In the months following, Mr Streeting called for a ‘single patient record’ with NHS patient data available across all NHS trusts and GP practices. Already, a ‘ping and book’ service on the NHS app has been announced to ‘revolutionise access to cancer screening for women.’

Another familiar buzzword/phrase brought up in the health secretary’s letter to GPs is the ‘neighbourhood health service’ to move care into the community. The local ‘neighbourhood health centres’ – where patients can access GP, district nursing, physiotherapists and more under roof – has been touted by the Labour party to increase access to services. 

The Government may also have to think about how it balances increased access with a commitment to continuity of care. GP leaders have previously raised concerns about access plans which are detrimental to continuity of care. But today’s announcement brings with it extra funding – with an updated workforce plan pending and an extra £889m investment, perhaps there may be a possibility to have both improved access and a ‘family doctor.’ We will have to wait and see. 

What’s next?

Although the Government said their proposals are ‘now out for consultation’ with the BMA, the GP Committee confirmed this morning that they had not yet received anything in writing. They expected to receive further details by the end of the day, and will have a very merry time over Christmas ‘analysing, modelling and scrutinising’ ahead of negotiations in the new year. 

So we’re unlikely to see full details anytime soon. But based on these initial proposals, the mood music appears positive, with the GPCE indicating that this could mark the ‘end of the beginning’ in the campaign to restore general practice. 

Mr Streeting called on GPs today to work with the Government and bring an end to collective action. It’s clear, however, that the BMA – and the profession – will need a little more convincing.