The Government’s 10-year plan sets out how they see the future of general practice. But with a new GMS contract due in 2028, GPs in England are facing the biggest set of reforms since 2004. In this first instalment of a Pulse miniseries, Anna Colivicchi examines what the plan really means for the partnership model.
A new model for general practice?
In the months leading up to it, the Government’s 10-year plan for the NHS had been described by those in the know as ‘GP-centric’ – but the long-awaited 168-page document mentioned the partnership model precisely once. ‘Where the traditional GP partnership model is working well it should continue,’ the plan said, ‘but we will also create an alternative for GPs.’
This statement from the Government comes at a crucial time for the profession and for the partnership model, as the BMA is currently in negotiations with ministers over the biggest reform in two decades – a completely new GMS contract, to be implemented by 2028. The union wants this new contract to be agreed by the end of next year but we don’t know where discussions are at currently. How does the 10-year plan fit into these negotiations, and how will it influence the future of the partnership model?
‘We’ll put neighbourhood health centres in every community,’ health secretary Wes Streeting said in his speech unveiling the plan. ‘So you can see a GP, nurse, physio, care worker, therapist, get a test, scan, or treatment for minor injuries, all under one roof – the NHS will be organised around patients, rather than patients having to organise their lives around the NHS.’ According to the plan these ‘new health centres’ will ‘house neighbourhood teams’ and will ‘eventually’ be open ‘at least’ 12 hours a day, six days a week ‘within local communities’.
These statements have caused confusion, anger and anxiety among the profession in the aftermath of the announcement, generating more questions than answers. GPs are wondering: How do GP practices fit into these plans? Who will hold contracts for these centres? What does ‘neighbourhood health’ actually mean? How is it different from what practices already provide at the heart of their communities? And, crucially, how will all of this be funded, through GMS or otherwise?
‘There has been a lot of anger about a breach of trust and faith from the current Government,’ says YOR LMC medical secretary Dr Brian McGregor. This is related to the promise of a new GMS contract, of investment, of ‘bringing back the family doctor’ and of supporting the partnership model, all of which ‘are missing from this document’, he adds.
GPs say that general practice is already being delivered in health centres based in the community, with most of those health professionals already based in the same building. ‘This seems to ignore the fact that 6,000 GP practices are already providing neighbourhood care and could in theory with the right funding, upscale,’ the Doctors’ Association GP spokesperson Dr Steve Taylor tells Pulse.
New contracts – without GPs?
The plan does mention providing care at a larger scale within ‘neighbourhoods’ – it defined the ‘neighbourhood health service’ as a system ‘bringing care into local communities, convene professionals into patient-centred teams and end fragmentation’.
And as part of this, two new contracts were announced, which were described as an ‘alternative’ to GMS and will be rolled out next year, to ‘encourage and allow GPs to work over larger geographies and lead new neighbourhood providers’. These will create ‘single neighbourhood providers’ (covering a population of around 50,000 – similar in scale to current PCNs) and ‘multi-neighbourhood providers’ (serving around 250,000 people).
But GPs won’t be the only ones who can hold these contracts for neighbourhood services – ICBs will be given new powers to award them to other providers, including hospitals. This was something Mr Streeting had already hinted at before the plan was published, saying that he was ‘open’ to acute trusts providing primary care services.
‘The plan doesn’t really reference GP practices that much, and to me this is a bit of a worry,’ says Andy Pow, adviser to the Association of Independent Specialist Medical Accountants. ‘All the discussion is around either the single neighbourhood providers or multi neighbourhood providers, whatever they are. To me, they’re still a bit vague in terms of how they are being described.’
Berkshire, Buckinghamshire and Oxfordshire LMC chief executive Dr Matt Mayer says there is already a ‘neighbourhood health service’ and it’s called general practice. ‘It predates the NHS and, until relatively recently, the “family doctor” model has worked fine, providing ever increasing access that surpasses other nations,’ he tells Pulse.
Echoes of past reforms
This isn’t the first attempt to reshape general practice by moving away from small, independent surgeries.
In 2007, Labour health minister Lord Ara Darzi introduced the idea of polyclinics – large, centrally located health centres intended to house a range of services, including GPs, diagnostics, and community care, all under one roof. The aim was to improve access and integration, especially in urban areas. These polyclinics were not designed to replace GP practices entirely, but to operate alongside them – sometimes hosting relocated practices, sometimes offering walk-in services in parallel.
The policy was controversial from the start. Many GPs and patients objected to the idea of moving care away from established surgeries. Critics argued that polyclinics undermined continuity of care, favoured a ‘factory model’ of healthcare, and often lacked local consultation. The BMA opposed them, warning they could pave the way for more corporatised or non-GP-led provision.
Only a handful of polyclinics were actually opened, and most were quietly phased out or repurposed after the 2010 general election, when the incoming coalition government scrapped the wider rollout. The failure was seen by many as a vindication of small-practice, relationship-based care.
But NHS leaders’ ambition to upscale general practice was not lost. As revealed by Pulse in 2018, NHS England’s then-primary care director Dr Arvind Madan said GPs should welcome the closure of small practices that struggled to meet demand – prompting a fierce backlash from grassroots GPs.
This latest 10-year plan – while not using the word ‘polyclinic’ – echoes many of the same themes: larger providers, centralised services, integrated teams, and contracts potentially held by non-GP entities. For some, this raises fears that lessons from the polyclinic experiment are being ignored.
A threat to partnerships – and GP leaders?
It is also significant to note that the BMA has revealed it did not contribute to the plan, nor was it given the opportunity to see it before it was published. ‘We are working through the plan, having not been given the opportunity to see or contribute to it ahead of publication,’ says BMA GPC chair Dr Katie Bramall.
There are outstanding questions about who will be in charge of negotiating these contracts with the Government, whether it will be the BMA or whether they won’t be negotiated at all. GP leaders we have spoken to say that this is still unclear and the Department of Health and Social Care has failed to answer our questions about it.
GP leaders and experts have warned that the changes announced in the plan could signify the end of the GP partnership model as we know it. ‘What we can already see is that the plan points to potentially profound changes to general practice,’ says BMA GP committee chair Dr Katie Bramall. ‘Changes that, in some instances, could seriously undermine the current practice model and the continuity of care that patients rely on.’ And she is not the only one who thinks the plan could threaten the partnership model and put small practices at risk.
Dr Mayer thinks the plan is ‘clearly designed’ to bring about the end of the partnership model. ‘If it goes ahead, it will force the loss of individual GP surgeries and the death of the trusted “family doctor” model of care, which I’d point out is a clear broken manifesto promise by the Government,’ he says.
According to Dr McGregor, the document is ‘full of broken promises’, and ‘obfuscation’. ‘It sets out the agenda for the destruction of general practice as we know it, and will leave some stark choices for practices and partners in particular,’ he adds.
Dr Taylor also agrees that one of the biggest concerns with the plan is the ‘ongoing destruction of the partnership model’, which will ‘probably occur as a result not funding GP partnerships’.
‘There’s a lot of anxiety,’ Katie Collin, a partner at medical accountancy firm Ramsay Brown tells Pulse. ‘You get these big announcements and then there’s absolutely no detail behind them. So there’s a lot of anxiety about what these two new contracts are. They talked about alternatives to the partnership model, what does that mean? GP practices certainly don’t seem to be the focus, the plan talks a lot about GPs and primary care, but not actually partnerships.’
The BMA also recently warned that handing some ICB functions to neighbourhood teams, something that was suggested even before the plan, poses an ‘existential threat’ to GPs as independent contractors – the changes could involve ‘vertical integration’ of GP practices with acute or community trusts, or ‘horizontal integration’ with at scale providers, such as GP federations, potentially posing threats to the independent GP contractor model.
NHSE: No intention to scrap partnerships – but trusts could step in
Grassroots GPs fear this could happen too. During a webinar organised by NHS England last week, primary care director Dr Amanda Doyle was inundated with questions from GPs about the plan and about whether the Government was planning to replace GMS with these new contracts. Dr Doyle responded that ‘there is no intention’ as part of this to replace the partnership model. ‘There’s no aim to encourage or incentivise people to move away from the partnership model,’ she said. ‘Some of those partnerships may be bigger or may look slightly different, but we are not looking to move away to a sort of a not-independent contractor model, because of all the benefits we get from it.’ But she said that acute and community trusts will be invited to take over primary care services ‘where GPs are not stepping up’.
However, having trusts or other providers running neighbourhood services could jeopardise primary care as we know it, says Ms Collin. ‘The GMS contract in itself is modelled on the tangible value that partners bring to running their own business and knowing their patients and committing their lives to doing this,’ she says. ‘And you don’t get that in a corporate infrastructure. So it’s potentially jeopardising to primary care as we know it.’
Dr McGregor adds that there is a risk that the plan ‘will kill the concept of the family doctor’ that the Government has been aspiring to, ‘losing it in corporate structures and depersonalised offerings’.
While the plan is clear about the fact that GMS will be allowed to continue where it ‘works well’, it is also clear about the fact that small practices are ‘struggling’. ‘Having served us well for decades, the status quo of small, independent practices is struggling to deal with 21st century levels of population ageing and rising need,’ it says. But it seems to offer no clear ways to reverse this situation, only an ‘alternative’ in the form of new contracts.
‘It’s going to be smaller practices which will continue to be at risk,’ says Mr Pow. ‘I struggle to see how they fit into this model.’
Who will hold contracts in 2028?
The plan is unclear on who will still hold a GMS contract once the two new contract are in place, and the Department of Health and Social Care has failed to answer Pulse’s questions about this. However, GP leaders have speculated that there could be three cohorts of GPs in 10 years, if this plan is fulfilled:
- a first cohort of salaried GPs in trusts who run neighbourhood services, offering a service where GPs ‘have no autonomy’;
- a second cohort in practices which ‘have had no choice but to coalesce into large providers’ and the individual practice identity ‘will be gone’;
- a small minority of ‘business-savvy practices’ outside the NHS
‘Individual salaried GPs possibly retain some shareholder rights if they’re lucky, but will have zero direct control over services,’ says Dr Mayer. The third cohort, a ‘small minority of business savvy practices’ who truly want to retain total autonomy and be independent would still exist, but they would be ‘outside the NHS’.
Can the 2028 contract protect partnerships?
The BMA has been clear that a new GMS contract is needed to ensure the survival of independent practices – so much so that the agreement to the current 2025/26 contract was conditional on the Government’s commitment to negotiate a new contract within this Parliament.
But it is important to remember that the union is in negotiations with a Labour Government that has threatened to retire the partnership model before – and then U-turned. Prior to Labour coming into power, health secretary Wes Streeting expressed doubt concerning the future of the GP partnership model, arguing the ‘murky’ GP contract should be ‘ripped up’. However, he has since said he wants to ‘engage’ GPs in the discussion.
The BMA’s GP committee shared its vision for the new GMS contract last year, and defended the partnership model, saying that the ‘often-repeated’ trope ‘no one wants to be a GP partner anymore’ is simply not true. And it demanded the Government shows it is committed to the partnership model through financial support, incentives and mitigation against legal risks.
GPs who want to become partners should be supported and incentivised, including through schemes such as the New to Partnership programme, which aimed at ‘growing the number of partners’ and ‘stabilising the partnership model’, but was closed last year. The BMA demanded this is reinstated as well as financial incentives such as ‘golden hellos’ for new partners in under-doctored areas.
The new contract should also provide ‘protection’ for partners ‘against legal and financial risks’ – the BMA wants the Government to recognise that the ‘numerous’ legal regulations that practices have to comply with and the financial liabilities they hold place a ‘significant burden on them’, which can act as a ‘disincentive’ to GPs becoming independent self-employed contract holders.
We expect the negotiations will explore how these requirements and risks can be limited and mitigated against, especially in relation to the complexities associated with information governance requirements and staffing and estates liabilities. ‘These increased protections will help return general practice to a family doctor led service, where many GPs set down roots in one community for their entire careers,’ the BMA adds.
What do grassroots GPs want?
GP partner numbers have fallen over the past decade, but according to the results of our most recent survey of 667 English GPs, 48% strongly disagree with a move to a salaried GP model as part of the new contract and believe the partnership model continues to be the best option. ‘The partnership model works, as evidenced by primary care being the only part of the NHS not being run in deficit,’ one GP tells Pulse.
The RCGP has raised concerns over the decline in partner numbers recently and, similarly to the BMA, called on the Government to take action to ‘break down barriers’ to GP partnership. It stressed that the model ‘has the potential’ to offer the flexibility many younger GPs are seeking, if ‘key pressures’ such as workload and liability are addressed. Last year, 55% of RCGP members said that reduced financial risk would make becoming a GP partner more attractive.
Grassroots GPs taking part in our survey indeed say that they were discouraged from taking on partnerships due to the legal and financial risks. ‘When I started out in general practice I applied only for salaried positions, applying for partnerships seemed too precarious a proposition and I know of GPs who have lost hugely financially due to previous partnerships,’ one GP says.
But we expect to find out more about what grassroots GPs exactly want from the new contract, as the BMA revealed it will survey GPs this summer on their priorities.
What happens next?
While there are many questions the Government still needs to answer, the 10-year plan ultimately concludes that ‘truly revitalised’ general practice will depend on ‘more fundamental reform’ – we still don’t know exactly what this reform will look like in terms of the partnership model, but the plan has now defined the Government’s direction of travel.
This week the Government announced the first phase of the rollout of ‘neighbourhood health programmes’, with 42 areas to be chosen to pioneer the new model from September. This announcement – like the plan itself – lacked detail but we know that the most deprived areas with the lowest healthy life expectancy, such as ‘working-class’ and coastal towns, will be prioritised for this. ICBs and local authority chief executives – crucially, not GPs or PCNs – were asked to submit applications to take part, by outlining examples of ‘joined-up working and innovation’, and 42 areas will then be chosen so we will have to wait to know more.
We know the BMA has set a ‘target date’ to agree the new GMS contract ‘between July and December 2026’ and the outcome is expected to be put out to the profession via a referendum.
The GPC said it will meet ‘in the coming weeks’ to consider the ‘many questions’ they intend to put to the Government.
Primary care minister Stephen Kinnock recently told the audience at Pulse Live that although partnership is ‘not always the model that works best’, the Government is ‘not in the business of trying to micromanage what works best at a local level’.
Time will tell if that promise holds – and whether the 2028 contract will make or break the GP partnership model.
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