2025 in review: How did the BMA’s GP leaders fall out with Government?

Maya Dhillon asks: How did relations between the BMA and Government deteriorate to the point that GMS contract negotiation was completely overhauled?

When Labour came into power last year, it seemed like the Government was keen to reset its relationship with general practice. That optimism peaked this March, when contract negotiations ended with the GPC agreeing to the GP contract, rather than facing another imposition – the first negotiated deal for four years. There was much for GPs to welcome: almost £800m added to the global sum; removal of ringfenced ARRS funding for PCNs; permanent inclusion of GPs in ARRS; and a new £80m enhanced service to support advice and guidance.

But something caused mild alarm. As part of the deal – from 1 October – practices would be required to allow patients to submit non-urgent requests, medication queries and administrative issues via online consultation tools during core hours. According to the GPC, this has been a ‘red line’ for the Government, stressing ministers’ ever laser-focus on access.

GPs warned the requirement could drive unsafe demand and overwhelm practices. According to the BMA and NHS England, the implementation of the requirement was delayed so that ‘necessary safeguards’ could be put in place. The BMA further suggested that the policy would lead to only a ‘temporary spike’ in demand and that safeguards would be developed collaboratively with suppliers.

Alarm bells should have started ringing in April, when DHSC shared the detailed draft contract regulations with the GPC. However, no formal objections were raised at that stage. It later emerged that a procedural error meant the regulations were not seen by the relevant GPC subcommittee. GPCE chair Dr Katie Bramall signed them off, with some GPC members saying they had no opportunity to review the details.

By August, when practices received the regulations, concern escalated. GPs warned they could not meet the new requirements – to welcome patient requests in person, via telephone and online throughout core hours – safely without cutting appointment times.

As GPs grew more concerned about the impending changes, there was also disquiet growing within the GPC. Pulse heard murmurings of a vote of no confidence in Dr Bramall. Although no such motion appeared on the September agenda, Dr Bramall added a confidence vote in herself –  and won.

As October approached, several LMCs urged the BMA to enter a formal dispute. Despite the union’s last-ditch efforts to halt implementation, DHSC refused to back down (lest we forget Mr Streeting’s infamous ‘laggards’ comment). On 1 October, the changes took effect and the BMA formally entered a dispute with the Government.

As the changes took effect, the worst fears were realised – as Pulse reported cases of patients using online tools to report life-threatening symptoms, revealing the risks associated with free-text submissions.

Tension between the two sides continued to grow. GPC leadership maintained that the Government had given assurances that there would be technical safeguards implemented for practices; DHSC refuted this. At the LMCs conference in November, Dr Bramall paraded a ‘rogues gallery’ of ministers and NHSE officials who were ‘traitors’ to the profession, displaying their images behind her. 

Days later, DHSC and NHSE cancelled all meetings with GPC leadership and shared evidence with Pulse suggesting the GPC had been informed in writing, prior to contract agreement, that safeguards would ‘not be contingent on any specific software solution being found’. The GPC described the email as ‘informal’, saying verbal assurances followed, but no written evidence has been shown.

And then came the bombshell: Pulse exclusively revealed that the BMA was losing its position as the sole negotiator of the GP contract. Instead, there would be a consultation model where various stakeholders – including the BMA, but also the RCGP and patient groups – would have equal status in negotiations. Mr Streeting later confirmed that anger over the ‘rogues’ gallery’ speech had contributed to the decision.

So where does this leave general practice?

The BMA has since welcomed renewed engagement with the Government – but it is in the form of the new stakeholder consultation. This came after calls from the GPC to ‘reset’ the relationship after warnings that general practice risked drifting towards a dentistry-style model if relations continued to sour.

GPC leaders also indicated the stakeholder consultation may be a one-off exercise, but the Government told Pulse it could become permanent if deemed successful.

There is little consensus within the profession on what should happen next. A month ago, the England LMC conference passed motions calling for escalation of the dispute, including undated contract resignations and the possibility of full-day walkouts. Yet GPC leadership has so far chosen not to act on that mandate; Pulse has seen communications in which Dr Bramall suggested that LMCs are not yet ready for action, and that any escalation would be more effective in the spring (assuming that the contract is imposed from 1 April).

What remains unclear is how much leverage this consultation process will give the BMA. With promises of a wholesale new GMS contract, neighbourhood-based models and a 10-year health plan already on the table – much already developed without GPC input – there are real fears that GPs could be side-lined from their own future.

Listen to our newest podcast episode analysing the breakdown of BMA and Government relations over the changes to online access. Listen here.