As colleagues will appreciate, over the last few months there have been significant developments within the medico-political landscape and this update is based both on an SSLMCs perspective, and also in terms of my role as one of the Deputy Chairs of GPC England.
In March this year the 2025/26 GP Contract was accepted by GPC England, noting that a significant political demand conveyed by both NHS England and the DHSC was that the three routes via which patients can access care and services from their General Practice should demonstrate equivalency or comparability of response during core hours. These routes are via the practice premises, via phone, or through an online platform.
The detailed implementation of the online platform access was deferred until 01st of October 2025 in view of what GPC England considered the substantial risk that many – if not most – practices could not safely manage the potential workload associated with an unfettered demand via this route. The LMC has separately written to all practices about this issue which remains, from a GPC England perspective, unresolved.
Funding within the 2025/26 Agreement have led to a cumulatively substantial increase in Global Sum over the past two years [from £104.73 in 2023/4 to £123.34 in 2025/26, an increase of £18.61 or 17.77%] following the final implementation of the 2025/26 DDRB Award. The current GPC England Officer Team have had an informal “Restore the Core” mantra since their election. Continuing inflationary pressure within General Practice, particularly in terms of staff costs, have to an extent undermined the real value of this uplift to individual practices, together with the effect of paying it via the Carr-Hill Formula, which no longer accurately reflects the true costs to practices of delivering services using a capitated calculation.
GPC England also believes continuing uplifts to reimbursement ceilings under the Statement of Financial Entitlement (SFE), for example, for sickness and parental leave, which have been linked to the DDRB Award for both 2024/25 and 2025/26, represents real progress in terms of reimbursing practices in a way which more closely reflects their true costs.
However, with the Carr-Hill Formula now based on three decades old data, and the current Regulations representing a burdensome accretion of requirements accumulated over two decades and including several years in which the Contract was imposed on General Practice, GPC England’s Officer Team believe only a renegotiated GMS contract [noting PMS Contracts are now almost identical in wording and PMS Contractors retain a “return ticket” to GMS] will place General Practice on a sustainable path as a profession and as a rewarding career.
Considerable effort and influence continue to be invested in securing what would ultimately need to be a political commitment to this process and turning it into reality. Colleagues will have seen a recent letter from the Secretary of State, discussed at: Streeting reconfirms commitment to new GP contract and partnership model – Pulse Today, which includes the following (my emphasis):
“We remain committed to the partnership model and we will work with GPC England to secure a new substantive GP contract within this Parliament, including reviewing the Carr-Hill formula. This is about retaining and reforming the practice-based contract for general practice (GMS) and we will start working with GPC England in September to define the process and scope of the reforms. In doing so, we want to continue efforts to improve access and bring back the family doctor by improving continuity of care, which is not only good for patients but makes the job of being a GP deeply rewarding.”
This letter also touches on the publication of the NHS Ten Year Plan (10YP). The full document is a soporific 168 pages, with 227 citations. It is difficult to summarise but there is an Executive Summary (only eleven pages) available here: Fit for the future: 10 Year Health Plan for England – executive summary (accessible version) – GOV.UK.
Both GPC England and LMCs across England have received considerable feedback expressing concern that the 10YP represents a risk, even an existential threat, to the Partnership Model. However, implementation of the 10YP is at a very early stage and the full document above does not describe a coherent operational model. It is largely a series of aspirations, many of which have been heard before and reflect the long-standing fundamental challenges for the NHS: co-ordinating demand for care with funding, and the mismatch between where care is delivered and the greatest need for it.
I am sure a number of colleagues will be aware of their PCNs participation – if their PCN has engaged in a local application – in any National Neighbourhood Health Implementation Programme (NNHIP) submission. These were invited as part of the 10YP. GPC England is aware of a considerable variation in local engagement in such submissions across England and it is important local GPs are fully aware of any commitments their PCN CD Lead has made, particularly as there is no nationally agreed funding for any workload that might be associated with such programmes. It may be that some of this penumbra of uncertainty will clear once NHS England and the DHSC have a mandate for the 2026/27 GP Contract negotiations. However, from a GPC England perspective, the ARRS funding pool has already been confirmed as part of the General Practice financial baseline by NHS England (see Para 1.20 within the Update to the GP Contract Agreement 2020/21 – 2023/24) Therefore, further contracts such as the single neighbourhood provider (SNP) and multi-neighbourhood provider (MNP) outlined in the 10YP will need separate resourcing and indeed it is hard to see where any new staff will come from. There are, as yet, no details: however, if the described ‘left shift’ of workload is to be achieved, it will require a shift of resources.
The NHS Confederation has provided a helpful summary of the 10YP at: Delivering a neighbourhood health service: what the 10 Year Health Plan means for local
integration | NHS Confederation.
From this, colleagues will appreciate that, although the potential impact of General Practice has been widely discussed, other medical Branch of Practices (for example consultants or resident doctors) may also be affected by, for example, the suggestion that some Foundation Trusts may become Integrated Health Organisations (IHOs). Again, this is a term with many potential implications but seems to imply Trusts holding budgets to deliver NHS care of all descriptions, that is, both ‘primary’ ‘secondary’ and ‘tertiary’ from a unified capitated budget. This may result in changes to medical employment terms and conditions, place of working, and prioritisation of resources.
For this reason, the BMA has decided to hold a Special Representative Meeting (SRM) on 14th of September; to which the Secretary of State has been invited. Any colleague who attended the July 2025 BMA Annual Representatives Meeting (ARM) will have been invited to this meeting. The LMC will circulate an update following this meeting, and also the GPC England meeting on 18th of September 2025.
Against this complex backdrop, colleagues will also be aware of the evolving decision to reduce ICB headcount funding by approximately 50%. Locally, this is now anticipated to mean the abolition of Frimley ICB, and the merger of NHS Sussex and Surrey Heartlands ICBs with a current timetable of April 2026. This process is inherently demoralising for current ICB colleagues who continue to be expected, by NHS England, to undertake their strategic and operational responsibilities amid an environment of personal and professional uncertainty. Historically, after each NHS reorganisation event, commissioners lose experienced colleagues, and in-house expertise, and this is likely to be no different.
NHS England is also being abolished, presumably to be subsumed within the current DHSC, despite being substantially larger. Again, this is a destabilising process, albeit noting this is not an argument against necessary change. No details have yet been announced in terms of GP focused NHS England responsibilities, such as GP appraisal and the Medical Performers List arrangements, and indeed these may not change.
I hope this summary, and it can only be a summary, is helpful; your LMC will continue to provide updates and information as this becomes available, and colleagues are welcome to contact the LMC Office via our ‘contact us‘ form which goes to Surrey and Sussex LMCs or individual Director colleagues and myself.
Dr Julius Parker, Chief Executive