The Government has formally responded to a list of proposals put forward by the BMA during the consultation for the 2026/27 GP contract, promising that some of these will be part of future reforms. Anna Colivicchi looks at how these could influence the ‘GMS reform’ the health secretary has committed to

GPs are facing another contract imposition, after the Government last week unveiled changes which were the product of a consultation with several stakeholders, rather than a negotiation with the BMA. But despite being just one of the parties to be consulted, the BMA had put forward its own list of proposals which they published ‘in a departure from the usual practice’.

Now NHS England and the Department of Health and Social Care has responded in detail to those asks, in a close-of-consultation letter sent to the GPC, signalling that some could be taken forward as part of GMS reform. In December, Pulse revealed that the Government would be bringing forward its own proposals for ‘a reform of the GMS contract’ in ‘the new year’, and the GPC has said that it wants talks on this to start imminently.

‘While not all proposals could be taken forward within the 2026/27 contract, the issues raised provide important input into implementation planning and the ongoing programme of GMS reform, which will continue to be developed in dialogue with the profession,’ the NHSE/DHSC letter said. So what do these proposals tell us about the future of the GMS reform?

Proposals to be explored in GMS reform

GP partners to declare they have passed DDRB uplifts to staff

The GPC proposed ‘mandatory clauses’ to ensure DDRB uplifts are passed on to salaried GPs, alongside strengthened monitoring and declaration requirements. This would mean introducing a clause to GMS/PMS/APMS contracts that requires practices to ‘sign declaration letters’ confirming they have passed on the annual uplift to their employed GPs following DDRB recommendations ‘or risk a potential enquiry’; and for the uplifts to be ‘fully funded and ringfenced’ and to specifically include all employer on costs on top of the percentage pay award offered.

The committee said in the proposals that salaried GPs are a ‘unique’ group of doctors whose terms and conditions, and the contracts of their employers, do not enforce an annual pay uplift. ‘The Sessional GPs Committee receives reports each year that some salaried GPs have not received the Government recommended pay award, despite their employers receiving some form of funding for that purpose,’ the GPC added. ‘Practices often report that while they receive funding from Government to fund the staff uplift, it is often insufficient.’ It argued that the declaration mechanism will ‘promote good practice’ and compliance with the salaried GP model contract and ‘fairness in pay’ across general practice.

The GPC said that this clause could be similar to the one in the Welsh GMS contract, which has required practices since 2021 to provide confirmation via a declaration form that they have passed on the DDRB uplift. The pay uplift is fully funded by the Welsh Government and is allocated for the purpose of staff uplifts – so it can be clawed back if not passed on to staff.

According to NHS England, these proposals raise ‘complex issues’ around funding flows, enforcement and contractual responsibilities, but will be considered as part of wider GMS reform discussions.

Clinical negligence scheme expansion

The GPC wanted the contract to include extending the current CNSGP to ‘explicitly’ cover liabilities arising from data protection breaches reflecting practices’ role as data controllers, covering:

• Liabilities arising from general practice’s role as data controllers – covering legal claims and liabilities arising from breaches of data protection regulations or mishandling of patient records.

• Patient records management – encompassing errors, loss, or unauthorised access to both physical and electronic health records.

‘By recognising their role as data controllers and providing comprehensive coverage for records management and data-sharing issues, the scheme will enhance patient safety, ensure regulatory compliance, and protect general practices from significant financial and reputational risks,’ the GPC said.

NHSE said they ‘recognised the importance of clarity and assurance’ around indemnity in this area, and it will explore with DHSC explore the feasibility and potential costs of extending CNSGP coverage with NHS Resolution beyond 2026/27.

The GPC has also raised concerns about risks associated with the implementation of GP Connect Update Record functionality, but NHS England said the have a ‘clear assurance process’ in place for for this and pharmacy suppliers will shortly be operating under the Digital Services for Integrated Care framework, which provides ‘an even more rigorous level of assurance’.

Partnership premium scheme

According to the GPC, a ‘partnership premium scheme’ should be introduced in England, designed to incentivise GPs to ‘take up and remain’ in partnership roles within practices and modelled on the Welsh approach. With the GP partner workforce continuing to shrink, the committee said that the trend has been attributed in part to financial uncertainties. They proposed the following key features:

• The scheme would be open to qualified GPs who join a partnership or remain in a partnership role within NHS GP practices in England.
• Eligible GPs would receive: an annual payment of £1,150 per clinical session (for up to a maximum of 8 sessions per week), increasing to £1,316 per session for those with over 16 years’ experience (up to a maximum of 8 sessions per week).

The current Welsh scheme offers a an annual payment of £1,150 per clinical session (for up to a maximum of 8 sessions per week) to every GP partner in who opts to participate in the scheme, along with a senior premium, under which GP partners with 16 years or more service will receive an additional £211 per clinical session (up to the maximum of 8 sessions per week).

NHS England said that this proposal ‘will be considered as something to explore under future GMS reform work’.

New funded approach to GP premises

NHS England said it would consider issues around GP premises costs as part of the GMS reform, after the GPC sought a commitment to ‘joint working’ with the Government to develop a ‘new, funded approach’ to GP premises. The GPC had asked for a ‘dedicated funding package’ alongside a reimbursement programme to cover practice property costs.

It argued that the last major capital investment in GP premises, delivered through the Estates and Technology Transformation Fund (ETTF), occurred over five years ago – and since then, many practices have been unable to upgrade facilities to meet modern standards, so an ‘urgent’ investment package is now required.

NHSE said it would consider this issue as part of GMS reform. ‘While we recognise the importance of premises in supporting sustainable general practice, we are not able to commit to a new funded approach at this stage,’ NHS England said. ‘The issues raised are better considered as part of longer‑term GMS reform.’

Safeguarding DES

GPCE proposed replacing the current patchwork of local enhanced services with a ‘comprehensive, nationally agreed and fully funded service’, including coverage for medical reports requested by probation services and fostering agencies.

It said that some local authorities and ICBs have argued that fees to GPs for contributing to the safeguarding process should not be paid. ‘They argue that newer regulations and guidance states that safeguarding is implicit in the role of GPs,’ the committee said. ‘While GPC England agrees that safeguarding is implicit, it remains the case that the regulations, which are agreed on an annual basis, and the NHS Act have not changed, and that a fee can be sought.’

According to the GPC, a new safeguarding DES would have the effect of:

• establishing consistency over safeguarding matters in every practice
• reduce regional variation
• improve system-wide efficiency
• improve outcomes for vulnerable patients

NHS England acknowledged that issues raised by GPCE ‘reflect wider concerns about fragmentation’, funding responsibility and workload associated with safeguarding‑related activity. ‘While this proposal cannot be taken forward in the 2026/27 contract, it raises important questions about consistency and resourcing that are more appropriately considered as part of the broader programme of GMS reform,’ it added.

Rejected proposals

NHS England also provided responses to other BMA proposals which were rejected, including their reasoning behind not considering these asks further.

Online access safeguards

NHS England rejected proposals related to further safeguards around online access. The GPC is currently in dispute with the Government over the online access changes which came into force in October last year, and had called for ‘urgent’ national safeguards to support safe online access, including:

• engagement with online consultation providers
• a national OPEL style framework for general practice pressures
• patient-facing guidance on appropriate use of services, and flexibilities for practices facing exceptional demand.

But NHSE responded to this demand saying that work is already under way with online consultation providers to ‘improve functionality and safety’ and that there are already a number of ‘effective’ local OPEL frameworks and tools in place. While ICBs are expected to monitor demand, capacity and pressures, NHSE said it would consider whether there is scope to explore ‘a more consistent national approach’, but this will be outside of the GP contract.

The Government had put forward a proposal for an ‘access incentive scheme’ – seemingly mandating an ‘ambition’ for 90% of patients to be seen on the same day – but, following the consultation, decided not to go through with it.

Uplift of £50 per patient per year

The GPC had called for a significant increase to the global sum payment per weighted patient, proposing an uplift of £50 per patient per year in 2026/27.

However, the contract changes promised a £485m uplift for 2026/27 – representing a 3.6% cash increase or 1.4% real terms growth. NHS England said that this includes a ‘pay assumption’ of 2.5% in 2026/27 which will be revisited in light of the pay review bodies’ recommendations, as well as additional funding to support QOF changes and funding to ‘cover costs nationally of other cost growth pressures’. called for the Government to go back to the negotiating table and negotiate ‘directly’ with the BMA the terms of a new contract – this time, the wholesale new GMS contract that the union has been calling for, rather than further changes to the 2026/27 contract. It admitted that this does not meet the scale of increase proposed by GPCE, but it reflects the ‘available funding settlement’.

Early career GP fellowships, ‘new to partnership’ scheme and targeted enhanced recruitment

The GPC had proposed:

• a one‑year early career GP fellowship to support recruitment and retention in hard‑to‑recruit areas
• reinstatement of the ‘new to partnership’ scheme
• reintroducing Targeted Enhanced Recruitment Scheme (TERS) to support recruitment in under‑served areas.

But NHS England did not commit to any of these. It said that the ‘new to partnership’ scheme was ‘time‑limited’ and was extended beyond the planned two years in recognition of pandemic impacts, but that DHSC and NHSE have ‘no current plans’ to reintroduce it.

Funding for TERS ended in 2025 following improvements in GP specialty training fill rates and limited evidence of long‑term retention effects once training was completed, and it is not being reintroduced.

What’s next?

The GPC wants the Government to come to the table and negotiate ‘directly’ with them a new wholesale GMS contract. We don’t know when these talks will start, but we understand the GPC wants them to start as soon as possible to avoid escalation of their dispute.

Meanwhile, this month the GPC will ask GP members to vote on the 2026/27 contract changes, in a referendum running from 4 March to 25 March – they will be asked if they accept the Government’s changes or if they want them to ‘return to direct negotiations’ with BMA leaders to ‘develop a new practice contract’. The results of this referendum are expected to be used as leverage in future negotiations, according to the GPC.

Read all of our coverage of the 2026/27 contract here.