GPC England has declared a dispute with the Government; this communicates, to the Secretary of State, that the changes within the 2025/26 GP Contract relating to online consultations and GP Connect which are due to be implemented on 01 October 2025 are not accepted in their current form by GPC England. Repeated efforts have been made since April to negotiate appropriate safeguards for practices, in advance of the October implementation date. This decision was made by vote at the most recent GPC England meeting on Thursday 18 September. Doing so paves the way for further challenges, including a ballot of the profession, and potentially other legal action.
It does not mean that practices do not have to comply with the Regulatory changes being introduced on 01 October; instead, undertaking these elements of the Contract is “under protest”.
There is no requirement to move from declaring a dispute to balloting the profession, however this is clearly an option. Such a ballot requires the agreement and approval of the BMA, as the recognised Trade Union representing General Practitioners. The BMA has a set protocol for assessing and approving any branch of practice requests for a ballot, because of the legal, financial, and reputational implications of doing so. Any ballot must follow TULRCA rules (Trades Union and Labour Relations (Consolidation) Act 1992) and there are financial penalties for not complying with these. If a ballot takes place and a majority support further action, then GPC England, as part of the BMA, can encourage colleagues to take Industrial Action, which can include breaching contractual terms and conditions, if these are balloted upon.
Like other LMCs, SSLMCs is not a Trades Union and therefore cannot legally encourage colleagues to take any action which breaches their Contract whether or not a successful BMA ballot has occurred; the LMC can and will highlight and disseminate information from the BMA and, for example, co-ordinate local discussions amongst colleagues.
Another approach, used last year to support GP Collective Action, is to hold an Indicative Ballot. This does not create a legal mandate for Industrial Action but can provide a clear message in terms of General Practitioners’ approach and support for listed steps which can fall short of breaching the practice’s Contract.
That is correct, and the situation for GP partners (Contractors) is more complicated than for colleagues such as sessional GPs, who are employees. GP Contractors independently hold a separate ‘Primary Medical Services’ Contract (this includes GMS, PMS, and APMS Contracts) and if GPs were to take Industrial Action which breached this contract, then, despite a legal mandate existing for Industrial Action as a result of a successful Trade Union ballot, NHS England/ICBs could decide to issue Remedial or Breach Notices, as provided for within the GP Contract.
GPC England recognises this will naturally be of significant concern to GP Contractors, since repetitive Sanction Notices could, under the terms of the Contract, lead to a Termination Notice and withdrawal of the Contract from a partnership. Whilst there are self-evident and possibly insuperable challenges for NHS England/ICBs in taking this route, GPC England has taken KC advice in advance of such a scenario to ensure GP Contractors will be able to make a fully informed decision both at any ballot and in terms of any subsequent action.
This will be further defined in anticipation of any ballot, but the BMA may take steps to confirm membership status for General Practitioners, as it did during Collective Action last year. Colleagues are encouraged to ensure their BMA membership and contact details are up to date.
The BMA is a medical Trade Union; GPC England acknowledges that non-medical partners, despite having just as much “skin in the game” as their medically qualified partners, will not be able to vote in such a ballot.
Because this is the date on which the relevant (dispute related) Contract clauses come into effect: the Secretary of State has an, admittedly narrowing, window of opportunity to address GPC England’s concerns in relation to these Contract changes and agree safeguards to prevent practices being placed at risk of demand exceeding safe capacity on a day-to-day basis. These safeguards would have no financial implications for the Government yet would ensure colleagues working in practices can safely deliver patient care.
Unfortunately hopes for this outcome are fading.
Unfortunately, no. Although the GMS/PMS Contract is mutually held by both parties, the commissioners are entitled to vary the Contract to ensure it remains legally compliant. The Regulations represent legislated change (as they do each year) and therefore whether or not the Contract Variation is signed by the practice, the regulatory changes included within it can be enforced, and become relevant, 14 days after being issued.
This contrasts with Contractual Variations that must be mutually agreed; for example, the ICB cannot unilaterally alter the practice boundary included in your Contract, any change to this requires both parties’ agreement.
The 2025/26 changes to the Regulations are emboldened below:
7.5 Contact with the practice
7.5.1 The Contractor must take steps to ensure that all of the following means of contacting the Contractor are available for patients throughout core hours:
(a) by attending the Contractor’s practice premises;
(b) by telephone; and
(c) through the practice’s online consultation tool within the meaning given in sub-clause 16.5ZD.2.
7.5.1A The Contractor must take steps to ensure that a patient who contacts the Contractor through:
(a) any of the means listed in sub-clause 7.5.1(a) to (c); or
(b) a relevant electronic communication method within the meaning given in sub-clause 16.5ZE.3,
is provided with an appropriate response in accordance with the following sub-clauses.
7.5.2 The appropriate response is that the Contractor must:
(a) invite the patient for an appointment, either to attend the Contractor’s practice premises or to participate in a telephone or video consultation, at a time which is appropriate and reasonable having regard to all the circumstances;
(b) provide appropriate advice or care to the patient by another method;
(c) invite the patient to make use of, or direct the patient towards, appropriate services which are available to the patient, including services which the patient may access themselves; or
(d) communicate with the patient:
- to request further information; or
(ii) as to when and how the patient will receive further information on the services that may be provided to them, having regard to the urgency of their clinical needs and other relevant circumstances.
7.5.3 The appropriate response must be provided:
(a) if the contact is made outside core hours, during the following core hours;
(b) in any other case, during the day on which the core hours fall.
7.5.4 The appropriate response must take into account:
(a) the needs of the patient, including the need to avoid jeopardising the patient’s health;
(b) where appropriate, the preferences of the patient; and
(c) any benefits to the patient of providing for continuity of the health care professional involved in their care and treatment.
No, although these are the most immediate concerns. GPC England has highlighted a number of other concerns to the Secretary of State; some of these relate to existing commitments which have not yet been confirmed, for example, funding envelopes for the 2026/27 GP Contract and a start date for a national GMS Contract renegotiation. Many colleagues also continue to express concerns that the NHS 10-Year Plan may undermine individual GP practices unless explicit political commitments are made in relation to support funding and GP leadership of the Neighbourhood Health Implementation Programmes.
However, any ballot, if held, would be likely to focus on General Practitioners’ contractual commitments and responsibilities.
This depends on your individual circumstances as it is recognised that practices currently have very varied arrangements. The LMC can’t cover every scenario, but the following principles may assist; they are also likely to be updated over the coming weeks.
- Check your website: remove any reference to the ‘operational times’ of your on-line consultation platform.
- Ensure access to your online platform “button” or “link” is clearly visible or signposted to patients.
- If your on-line platform is currently available for patient use throughout core hours (8am-6.30pm weekdays) and you are confident in your operational capacity to manage demand, you do not necessarily need to take any action. The contractual changes require practices to keep their online platform open for the duration of core hours for non-urgent (that is, routine) appointment requests, medication queries and administrative requests.
- However, if they believe the issue for which they are contacting the practice is urgent, patients can be informed, from a certain time during the day, that their query may not be managed during that working day and be offered alternatives. Such alternatives may include phoning or attending the practice.
- The “certain time” noted above is not defined in the Regulations and is not necessarily needed if practice capacity is sufficient.
- Practices should bear in mind, however, that there may be an upsurge (albeit perhaps temporarily) in online usage by patients associated with the publicity around this contractual change around 01 October.
- The LMC recommends all practices switch their online consultation platform off outside Core Hours, or, at the very most, open from 7 am rather than 8 am.
- If your practice currently switches off its online platform completely at some point during the day, in order to manage known or anticipated workload, this approach would not be compliant with the Regulations after 01 October. Accordingly, practices will need to review their operational arrangements.
- Practices should review the wording that is provided by their on-line consultation system supplier for patient use. This is designed to ensure that patients do not use an online route of contact with their practice for urgent needs, and the practice’s preferred alternative is identified.
- Patients should be given clear guidance and signposting in relation to the submission of any online queries
Yes, this will certainly be true a proportion of the time and represents a significant risk of uncertain prevalence. Patients should be given clear examples in terms of what might constitute urgent symptoms and what to do if unsure. In the LMC’s view, ideally, your on-line consultation tool should prevent free-texting, or at least this functionality should be switched off after a certain time in the day, but this may not be operationally possible. This approach would mean practices can be confident no information implying any clinical urgency is inadvertently provided by the patient in the context of other queries or requests and therefore no same day clinical review is required for reassurance.
All subcontracting arrangements should have been approved by current commissioners or their predecessors, and your practice does not need take any action. In some cases, especially if this arrangement is very long-standing, you may not be able to find the original agreement, but, even so, you should not ask to change this, simply because of the planned 01 October changes.
You may be contacted by the subcontracting organisation to clarify what services, or signposting in the case of an urgent clinical issue, are available to patients during the subcontracted period.
The LMC understands ICBs may seek to clarify what subcontracting arrangements are in place across their areas, as the ICB may not have up-to-date records. The LMC will provide further advice if this occurs.
Large scale subcontracting arrangements, involving multiple practices, which cover, for example, protected learning time, should be unaffected but these subcontracting arrangements are also subject to approval by the ICB.
ICBs are expected by NHS England to undertake reviews of practice compliance with the Contract across a number of areas although the timing and extent of such reviews depends on multiple factors, including ICB staff capacity, and other local and national priorities, especially as the winter period is approaching.
The LMC has already been in touch with primary care team colleagues in SW London, NHS Sussex and Surrey Heartlands ICBs. As the latter two ICBs are “clustering” from 01 October, as a prelude to the more formal arrangement expected from 01 April 2026, the LMC believes any approach within Surrey and Sussex will be similar.
ICBs may review subcontracting arrangements and test the availability of on-line consultation access for patients. The latter may be undertaken remotely. Practices may be contacted if the ICB has any queries, but the LMC understands local ICBs are currently intending to gather information for review. There has been no suggestion that ICBs are seeking to move towards any type of Contract sanction – which would need to be discussed with the LMC if intended – and any approach from the ICB will be informal, intended to be supportive, and represent an opportunity to highlight local and national resources available to support practices in terms of their “on-line consultation offer”.
Practices should contact the LMC if they have any concerns in relation to their ICB’s approach.
Practices may need to deploy staff away from offering routine appointments and/or create waiting lists for patients with clinically non-urgent problems in terms of the expected time to see a GP (or in some cases other clinician). Both of these approaches run directly counter to the service GPs would wish to offer patients, and this point has been made to NHS England and the DHSC.
The LMC believes, as is the case for other providers such as Urgent Treatment or Walk-in Centres, that practices should be able to reduce patient demand if their capacity means they cannot safely manage this. “Safe” in this context means delivering both safe care to patients and practicing in a way that is safe and effective for clinicians. Many practices currently manage demand by keeping telephone and F2F access open throughout core hours, with sign-posting messages to direct patients where care may be provided at specified times or by other organisations such as NHS 111, UTC or WICs, or ED. Many practices also switch off their on-line consultation platform at a set time or discretionarily during the day. The LMC believes local arrangements ( for example, based on the OPEL system, see below) with commissioners, should be in place to facilitate this decision if practices are at risk from excessive demand. Clearly any such arrangements would need commissioner engagement, but they also need to be straightforward, easy to put into operation, and subject to review. It is in no-one’s interests to allow unsafe practice, including excessive time spent working.
NHS England has developed a now well established Integrated Operational Pressures Escalation Framework (OPEL) process to quantify pressure within NHS organisations in a consistent way, with assurance and oversight procedures. Further details are available at:
NHS England » Integrated operational pressures escalation levels (OPEL) framework 2024 to 2026
Unfortunately NHS England, whilst including Acute and Community Trusts, Mental Health providers and NHS 111 in this process, rather glaringly, omitted General Practice. One can only speculate why this might be; perhaps NHS England does not wish to know how stretched General Practice services are, or perhaps it has no idea how to mitigate such a situation.
However, and to their credit, some ICBs have instituted OPEL frameworks tailored to General Practice: the LMC believes these should be used to address situations in which demand exceeds capacity within individual practices and to trigger mechanisms that effectively address this including patient access and use of the practice online consultation platform services.
No, any clinical negligence claims that arise from the appropriate operation of a practices online consultation platform will continue to be covered by NHS Resolution, via the Central Negligence Scheme for General Practice (CNSGP). That position will not change, and the risks potentially associated with the proposed on-line consultation changes have been highlighted to NHS England and DHSC colleagues.
The Contract Variation will also require that GP Connect (in this context the Regulations refer to the GP Connect Update Record, GP Connect Access Record HTML, and GP Connect Access Record Structured) is open.
The Joint GPIT Committee, which represents both the BMA and RCGP working with NHS England, with oversight across all General Practice IT systems within England, has issued the following statement on GP Connect. This is available at:
Joint GP IT Committee position statement on GP Connect 150925
In summary, JGPITC does not yet feel GP Connect: Update Record as implemented with the Pharmacy First Information model can command the confidence of the profession and advises that the planned date of 01 October 2025 is put on hold until the concerns have been resolved. There have recently been nationwide issues with incorrect pregnancy codes placed on patient records during Pharmacy First consultations and this is one example that illustrates why concerns persist.
The current proposal is that GP Connect Update Record commences with Community Pharmacies and is gradually widened. GPC England has also raised concerns that, as Data Controllers, this could create significant risks and liabilities that are not currently covered by CNSGP.
The opening hours of your branch surgery (if not throughout core hours) should be specified in your GMS/PMS Contract. There is no need to change these after 01 October. If they are specifically listed on your website, they do not need to be changed. Any reference to the hours during which your online consultation platform is open should, however, be removed.
When your branch surgery is closed, you should have a clearly visible message at the door telling patients what to do in terms of options for contacting the practice to obtain services; this may include attending the main site, phone numbers, the locations of other NHS services (including Community Pharmacies and Urgent and Walk-in Centres) the NHS 111 number and website, and a separate reminder that in the event of an emergency to contact 999 or attend the local Emergency Department. This advice may be appropriately replicated on your website relating to the branch surgery.
Some practices may have an accessible phone/intercom if the surgery has staff present without a direct walk-in facility: again, this should be signposted and its appropriate use made clear.
The information available to patients on attending your branch surgery premises may not be appropriate to your main surgery if this is open throughout core hours. However, there may be periods during the day when the surgery is physically closed, or has no direct walk-in facility available. If so, patients attending the practice need to have clearly visible information available describing how they can contact the practice if they need to. This covers the situation when no subcontracting arrangement (if any exists) is in place, since the practice is then responsible for delivering patient care or signposting patients appropriately, which also constitutes care.
If there are any practices that are currently closed for extended periods during the day (or on one day each week) they will need to review their arrangements, since these are unlikely to be considered compatible with contractual expectation. However, in terms of short closures, the LMC recommends practices do not rush to make potentially expensive and disruptive alternative arrangements. The situation is evolving: the key factor to ensure is that if patients attend the practice premises they have straightforward readily visible advice on how they can contact the practice to access practice services during the day.
The LMC’s recommendation is that there should be no time during Core Hours when a patient, contacting their practice by phone, cannot access information about what to do given their concerns. This may include signposting advice, including what to do in an emergency, a menu of options to remotely arrange appointments or other care, or speaking with appropriate members of the practice team.
However, during non-core hours a separate message will be needed.