National Contract Variation Notices are now being issued to GP practices by ICBs, as commissioners, in relation to the contract changes being implemented for the 2026/27 financial year.
All Commissioners are supposed to issue national Contract Variation Notices to their GP Contractor practices: in recent years, because of the alignment of PMS and GMS Contract wording, the contents of the Variation Notice will be the same, but the title will refer to these two types of Contracts. APMS Contracts are likely to be varied in the same way, but that is a matter for local ICBs.
The Commissioner is allowed to vary a GMS (or PMS) contract unilaterally if the reason for doing so is to ensure the Contract complies with current legislation. The variations to the 2026/27 GP Contract, as in previous years, are enacted through legislation and the Variation Notice reflects the wording of the Contract. Because of this, although there must certainly be a natural tendency to return the Variation Notice with certain clauses struck out, or not sign it at all, this doesn’t affect the fact that the Contract will be considered as varied fourteen days after the Variation Notice is issued. Commissioners cannot vary these Contracts in other ways unless these are mutually agreed, for example, the existence of branch surgeries and their opening hours represent contractual clauses that may be mutually varied by agreement.
In summary, in terms of the GMS/PMS Variation Notices practices are receiving from ICBs:
- There is no requirement to sign and return these, although as the other party to the Contract it is good practice to do so.
- The contents of the Variation Notices appear to accurately reflect the changes in the Regulations.
- If no return is made, or if the Variation is returned with one or more clauses struck out, then, regrettably, this will not have the effect of voiding the Variation in full or in part since this is a reflection of a changed legal position, and commissioners are entitled to impose (and enforce) a variation if this is solely written to put into effect a changed legal position, which changes to the GP Contract are.
- Signing and returning the Variation doesn’t mean you agree to the new/amended clauses; and from the perspective of imposition, practices that do not do so are in the same position as practices that have signed and returned the Variation Notice fourteen days after it is issued.
- Practices may be recurrently contacted by ICB colleagues in order to demonstrate to NHS England every effort has been made to obtain a returned Variation from practices.