I am writing to all colleagues in relation to the National Contract Variation Notices GP practices have started to receive from ICBs as commissioners, in anticipation of the Contract changes to be implemented from 1st October 2025.
There are two elements to this LMC advice: firstly, the process of issuing Contract Variations, which is straightforward, and secondly, the specific Contract Variation proposed for October 2025, which is not.
All Commissioners are supposed to issue Contract Variation Notices to their Contractors: 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 the 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 2025/26 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 can not vary the 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.
However, for October 2025 the Variation Notice includes changes that GPC England agreed in March 2025, when the contract was negotiated, [it] would be subject to further negotiation to create safeguards in relation to the plan to require practices to have their online consultation platform open throughout core hours (that is 8am-6.30pm during weekdays except Bank Holidays). GPC England do not consider this to be safe they have presented this point to NHS England and the DHSC multiple times since, and do not believe satisfactory safeguards have been introduced as intended. However, it must be recognised (and is a point put forward by NHS England) that some practices, because the demand generated is minor, or because processes within the practice can sustain the necessary capacity, do currently leave their online platform on throughout core hours. Most practices do not and switch their online platforms off when demand exceeds safe capacity, as indeed do other commissioned providers, such as Urgent Care and Walk-in Centres.
In addition, the varied regulations make the same requirement of practice phone services and premises: although it is now unlikely any practices switch off their phone service during core hours since this doesn’t preclude an appropriate message in terms of signposting patients in relation to their clinical nature of their presentation.
As noted in an earlier LMC update, this approach underpins a political imperative that the three “routes” whereby patients can access their GP practice (by physically attending, telephoning, or using an online platform) should be equivalent and comparable. If the GP: Patient ratio was 1:1000, or close to it, there is little doubt this approach could be safely met.
Colleagues should note that these varied regulations do not preclude alternative subcontracting arrangements being in place as agreed by the ICB under Para 15.9 of the Contract: however, the LMC suggests that practices should check these exist, especially if “shoulder” arrangements (for example, from 8-8.30am or 6-6.30pm, even if only on certain days) are in place whose original commencement is buried in the mists of time. The LMC recognises this may be the position for multiple practices and will contact the ICB in advance to highlight this potential situation.
Many practices may participate in practice learning half days when subcontracting arrangements are in place: these can continue.
GPC England is meeting on 18th of September, and the intention is to present and discuss at that meeting the negotiated position that has been reached, both in relation to online consultation arrangements and also GP Connect, another aspect of the 2025/26 GP Contract whose implementation was deferred until October 2025. It is quite probable GPC England will not support NHS England and the DHSCs arrangements, which may be a further negotiating lever, or a launch pad for more formal dispute recommendations. Neither GPC England nor SSLMCs believe it is appropriate for GP practices to work in an unsafe environment nor deliver patient care in an unsafe way: this was the cornerstone of the BMAs Safe Working Guidance.
The LMC has circulated a “Medico-political update” as it would be an understatement to say that the wider NHS, alongside General Practice, is unfortunately fulfilling the ancient Chinese curse of living in interesting times.
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, as 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.
GPC England (as part of the BMA, a Trade Union) can provide advice to practices in terms of the way these regulations can be implemented: a legal opinion is being sought already on a number of points. The LMC, whilst not a Trades Union, is allowed to distribute, highlight, and comment on the advice GPC England provides. The BMA can only encourage “employees” to breach their contract in quite narrowly defined circumstances which include a legal ballot. However, there are always a number of approaches to ensuring safe care is delivered within the GP contract and it is to be expected these will be used.
GPC England will issue further advice once the Committee have considered the issue as
representatives of the profession. I appreciate this issue is going to the wire, but I hope the above advice is helpful and there will be more later in the month.
Dr Julius Parker, Chief Executive