We attempt to answer the most frequently asked questions about the 2025/26 GP contract for England – to the best of our current knowledge
What is the ‘patient charter’ and who is going to write it?
Practices will need to display a ‘patient charter’ on their websites setting out the standard of care they are contracted to provide, according to the contract, but will practices be allowed to write this themselves? No. This will be written by NHS England, and will include what patients ‘can expect from their practice’.
What will it say? The Department of Health and Social Care said the charter will set out ‘in black and white’ what patients can expect from their GP. It will also set out ‘what to do if patient expectations aren’t met’ and ‘what is expected of patients’.
When will it become available? NHS England has said it expects to publish the charter ‘by the end of the financial year’. It is unclear whether GP practices will be able to contribute to the document in any way, or if they will just be required to publish it as they receive it. But we know from NHSE comms that it will include the new requirement for online consultation tools to be switched on for the duration of core hours.
What happens if Streeting doesn’t write to the BMA committing to a new GMS contract?
The BMA may have agreed to the contract deal but they stressed it is conditional on health secretary Wes Streeting confirming in writing that he will negotiate a wholesale new GMS before the end of Labour’s term in Parliament. GP Committee England chair Dr Katie Bramall-Stainer gave a deadline of 19 March – the date of the special conference of England LMCs.
The GPCE chair seems pretty optimistic she’ll receive said letter, saying she is ‘on the same page’ as ministers and civil servants on the topic. But why does she need a letter and why the deadline? Well, there is an upcoming three-year spending review due by May, and KBS needs Streeting to write to the Treasury to demand the new GMS contract features in the plans (so far we know asks include ‘ringfenced practice reimbursements’ for salaried GPs).
So what if the letter doesn’t come? Since GP leaders have stressed the conditionality of their agreement, they will surely be forced to reject the 25/26 contract. But by 19 March, less than two weeks out from the start of the financial year, this will inevitably lead to another contract imposition. And given that the BMA has already accepted the new contract in principle, they wouldn’t have much room to criticise its contents once 1 April comes around.
What is happening with collective action?
When announcing the contract, the BMA said collective action was over as it was no longer in dispute with Government. But it quickly emerged it wasn’t quite so simple. Because, as you may remember, the collective action never actually broke the GP contract in the first place. It was more of a case of working at safe levels and not taking on unfunded work. As such, the BMA and LMCs both have now said this can and should actually consider. ICBs are now the target though, instead of the Government, it was suggested.
However, there are two bits of the collective action menu of options which are no longer relevant due to the contract deal. They are:
- Stopping A&G – because the 2025/26 contract will now see practices funded by £20 per request – although as an enhanced service this is of course voluntary.
- Switching off GP Connect – because by October practices will be required to allow community pharmacy to send consultation summaries into the GP practice workflow anyway.
The other actions on the list, such as capping appointments, GPs are encouraged to continue.
The BMA has warned that if negotiations around an entirely new contract fail, the GPCE will ‘need to potentially discuss re-entering dispute and action escalation again’.
For now, it seems GPs are left to decide among themselves if they wish to continue any actions (which, arguably, was always the case).
Is the contract funding uplift meant to cover National Insurance contribution increases?
The NICs rise has been a nightmarish worry for GPs since announced in the Autumn Budget. It seemed rather insane to impose a tax on a tax-funded service. But so far only the House of Lords has acknowledged that from the House of Parliament – passing a proposed amendment to exempt practices last week.
Pulse has finally been able to ascertain with certainty that the Government is not intending to exempt GP practices from the NICs hike. This from both GPC members and NHS England itself. This means that although sizeable, the nearly-£1bn extra for GPs that the contract gives, will be significantly eroded (also by the rise to the minimum wage).
But what happens if the Lords amendment is approved by MPs? Our crystal ball holds two predictions: it likely will not be. And if it were, some sort of clawback is probably on the cards.
Why the tightening up of rules around out-of-area registrations?
We have posed this question without receiving an answer but it doesn’t take a genius to guess it may be related to the fallout surrounding the 2017 launch of Babylon’s GP at Hand service and everything that has happened since. Another recent example that could have influenced thinking was North West London’s GP Pathfinder practice’s rapid expansion.
There will now be a contractual requirement that GP contractors work ‘collaboratively’ with ICBs to implement out of area registration, and according to NHS England, this will ‘provide safeguards when practice lists are expanding rapidly with the registration of out of area patients’.
It makes reasonable sense that ICBs and LMCs should have a say on practices wishing to register swathes of patients outside of their own area, as this has a destabilising effect on other GP practices.
In a webinar last week, NHSE clarified that ‘this is not about people having a small number of patients who are outside their area’.
What is the long-term future of PCNs?
NHS England has been clear that there is ‘no intention’ to scrap PCNs, following concerns from practices and staff that funding is only going to be renewed for one year. The uncertainty around the funding has also in the past generated problems with retention and staff feeling unstable in their roles. NHS England has said the budget is limited to one year because NHS England gets a ‘one-year budget every year’, but that this does not mean that the commissioner does not intend to continue with PCNs. ‘We’re very clear that there are lots of services that benefit from being delivered at a bigger than single practice scale,’ Dr Amanda Doyle said in NHSE’s webinar. ‘There’s no threat in any of this to working on the PCN scale.’
It therefore appears to be unlikely that we will see the end of PCNs anytime soon, as the Government and NHS England work to put in place their plans around neighbourhood teams, which seem to include PCNs so far.
How will the new continuity-of-care incentive work?
True to the Labour Party’s strong emphasis on the ‘family doctor’, next year’s contract will include an incentive for practices to boost continuity of care.
The Capacity and Access Improvement Payment (CAIP) will now be repurposed to ‘incentivise PCNs to use the intelligence gained from population health risk stratification tools to stratify those patients’. Using this data, practices will need to identify those that would ‘benefit most from continuity of care’.
But it is not clear what practices will be required to do once they have identified these patients. or whether simply identifying them will be enough to access the £29.2m of funding. NHS England has declined to clarify this point and has promised more detailed guidance in the full 2025/26 Network DES, which should be published ahead of 1 April.
Given the relatively low level of funding attached to this incentive, it’s unlikely practices will be willing to jump through lots of new hoops.
Will practices still be monitored on the QOF indicators to be removed?
The short answer is ‘no’. The long answer was given in NHSE’s webinar earlier this week, where they said there is an expectation that practices will still deliver the same quality of clinical care regardless of the targets, and that NHS England will monitor this. It is however still unclear how that will happen.
NHS England is ‘looking at ways’ in which it can ‘monitor and benchmark’ clinical quality of care without having ‘a specific measurable indicator’, it said, but it is not looking to introduce ‘a different sort of performance management in the same way’. Further clarification would be welcome.
What does this indicate for the future direction of QOF? At present, it’s difficult to know whether this will lead to more QOF targets being scrapped in the future, or if it will be abolished altogether. But Northern Ireland has already set a precedent for this, when GPs saw the full £38.9m worth of QOF funding repurposed for core services and indemnity cover last year.
Is it safe to keep online consultation tools ‘open’ during core hours and what happens if BMA and NHSE can’t agree on the Ts & Cs by 1 October?
The GPC will work with DHSC and NHS England on putting in place this requirement ‘safely’ through focus groups, to avoid ‘unintended consequences’, it has said. But what happens if they can’t agree? We think it is unlikely that the requirement will be substantially revised as it seems to be a red line for the Government.
Will the new payment for advice and guidance (A&G) increase legal liability for GPs?
GPs have long had concerns about liability when using A&G pathways. In 2023, NHS England sought to allay some of these concerns with detailed guidance on medico-legal risk and clinical liability. It didn’t give a crystal clear answer, saying liability ‘will be determined on a case-by-case basis’, with either the GP or the specialist taking accountability depending on the situation. In order to reduce risks, NHSE emphasised the importance of GPs providing all relevant clinical information when sending off a request.
Following the contract announcement, NHSE could not provide advice on whether the new enhanced service has any effect on their previous liability guidance. But medical defence organisations tell Pulse that the new payment should not have an impact, and each situation would continue to be dealt with on a case-by-case basis.
Experts tell Pulse that (MPS deputy medical director Dr Ben White) that the new payment ‘should not have an impact on medicolegal risk or liability, as long as the service is used appropriately’.
‘GPs will still be responsible for deciding on the best management plan for their patient, including whether the use of advice and guidance is appropriate.
‘As was the case before the payment was announced, GPs will need to ensure that they have provided all relevant information to enable the secondary care clinician to provide appropriate advice. In the event that they are concerned that the advice and guidance provided may be inappropriate, this would be best discussed with the secondary care clinician.
‘In regards to liability in the event of a claim, this will still depend very much on the detail of the alleged negligence, but it is possible that both the GP requesting advice and guidance as well as the clinician or Trust providing this could be named as defendants.’
Similarly, MDU head of advisory services Udvitha Nandasoma tells Pulse: ‘We recognise that A&G requests are an important part of a GP’s routine care of their NHS patients.
‘All those involved in the process will have their own professional accountability – for GPs that includes providing relevant information and actioning the response receive.
‘If issues were to arise with this process, who might be considered responsible will depend on the individual circumstances of the case, rather than a payment now being available to recognise the time and resources expended in primary care to undertake this work.’
So, perhaps that’s one less thing to worry about. According to MDOs, GPs needn’t fret about the new payment increasing their medico-legal risk – but given liability around A&G is already somewhat murky, this may not provide much relief.
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