2025 in review: What does the 10-year plan mean for general practice?

As 2025 comes to an end, Maya Dhillon looks at the big issues in general practice this year – including how the Government’s 10-year plan threatens the GP partnership model with the rise of ‘neighbourhood health’

The Government’s 10-Year Plan for Health dropped in July of this year. Built off the back of Lord Ara Darzi’s investigation into the ‘state of the NHS’ – commissioned by health secretary Wes Streeting one week into his term – the plan was touted as being ‘GP-centric’ ahead of its release.

Perhaps it was naïve to think that this might translate to increased funding or protection of the traditional GP model. Because, of course, what it actually meant was: general practice will continue to prop up the wider NHS, but also coupled with an incremental erosion of autonomy and control over how they deliver care. 

At a glance of the 168-page document, there were some ideas GPs could welcome. The plan renewed its promise to reduce ‘red tape’ and bureaucracy, promised rollout of AI transcription tools in surgeries to save clinician time and to create a ‘single patient record’ via the NHS App by 2028. And it also committed to a much-needed review of the Carr-Hill formula for GP funding, promising this would result in ‘working-class areas’ receiving their ‘fair share of resources’.

But for many, these pledges were quickly eclipsed by what followed: the introduction of two new contracts to offer an ‘alternative’ to the traditional GP partnership. The first would support the creation of ‘single neighbourhood providers’ – delivering enhanced services to people with similar needs across a local area of around 50,000 people, roughly similar to PCN scale. The second would create ‘multi-neighbourhood providers’, serving around 250,000 and focusing on services requiring coordination across several neighbourhoods.

Even though NHS England framed these contracts (which the plan said were due to be rolled out in early 2026) as complementary to GMS, their scale and design have raised questions about the future of general practice. ICBs could also offer these neighbourhood contracts to a wide range of neighbourhood providers – most controversially trusts. 

The ‘traditional GP partnership model’ was only mentioned one time in the entire 10-year plan, and the term ‘GMS’ did not appear anywhere in the plan.

Given that GPs were told they were the ‘cornerstone’ of neighbourhood health, this prompted a horde of vocal critics. The BMA, who had not been allowed to see the 10-year plan before its publication – warned that this could ‘seriously undermine’ the current GP practice model. The union went on to add that practices should not be pressured into new contracts given the lack of clarity over whether these contracts will sit alongside or instead of existing GMS contracts.

Throughout the latter half of 2025, so-called reassurance was offered from multiple directions. The health secretary insisted there was ‘no reason’ why GPs could not lead these new integrated neighbourhood organisations, while NHS England medical director Dr Claire Fuller suggested the idea of GP-trust alliances leading neighbourhood provider structures. However, these assurances sat uneasily alongside early implementation decisions, with one ICB solely appointing hospital trusts to lead neighbourhood teams in south east London – though it was unclear whether this meant the trust would hold the contracts.

It is also worth mentioning that trusts seemed to have a prominent place in the plan, as it was revealed that Integrated Health Organisations (IHOs) would hold the whole health budget ‘for a defined population’, with more contracts to be awarded when the model officially goes live in 2027. The Government recently revealed a list of eight ‘advanced foundation trusts‘ which will be among the first to take on the new IHO contracts.

Criticisms increased as the year went on. In September, doctor leaders voted in support of GPs re-entering a formal dispute with the Government over the risks to the independent contractor model and GMS contract presented by the 10-year plan – and this became a reality on 1 October. The same message was reinforced in November at the LMC conference; GP leaders voted to boycott neighbourhood plans that were not ‘demonstrably’ led by general practice.

Alongside this, concerns mounted that funding for enhanced services could be diverted into neighbourhood contracts, rebadging existing GP work without adequately resourcing core practice. Plans to develop up to 250 new neighbourhood health centres, backed by private finance, only strengthened the idea that structural reform was being prioritised over addressing the immediate and tangible issues general practice is facing: GP unemployment, funding and workload.

Six months on from the plan’s publication, many fundamental questions remain unanswered. There is little detail on how the two neighbourhood contracts will interact with existing GMS arrangements; how exactly GP practices fit into these plans; who will ultimately hold contracts for neighbourhood health centres; what does ‘neighbourhood health’ actually mean in practice; and how will all of this be funded?

The threat to the independent contractor model has left the GPs unsettled. It doesn’t feel too far away from comments made by Mr Streeting about the partnership model and wanting to tear up the ‘murky’ GP contract before he became health secretary. Against that backdrop, assurances that the partnership model is safe have struggled to land, particularly when accompanied by plans that seem to dilute its importance.

This all matters because these new neighbourhood contracts are not a distant prospect. They are intended to come into force in early 2026, leaving little time for meaningful engagement, co-design or reassurance before ICBs begin making decisions that could reshape local general practice for years to come. 

As the year ends, the direction of travel is clearer than the destination. The Government insists it wants a strong, sustainable GP sector at the heart of neighbourhood health. Whether that ambition can coexist with a model that risks sidelining partnerships – intentionally or otherwise – will become apparent very quickly.

Listen to our podcast episode analysing the 10-year health plan, featuring Professor Azeem Majeed, head of the department of Primary Care and Public Health at Imperial College London, and Dr Steve Taylor, GP spokesperson for the Doctors’ Association UK. Listen here.