How the Government froze the BMA out of GP contract negotiations

The health secretary overhauled decades of customs this week with his decision to remove exclusive negotiating rights from the BMA’s GP Committee. Jaimie Kaffash analyses how we got here, and the wider implications

This has been one of the most tumultuous weeks in the history of the BMA’s GP Committee and its relations with ministers. Pulse exclusively reported on Tuesday that NHS England and the government had unilaterally decided to remove the GPC’s status as the sole negotiating body for the GP contract and is instead moving to a ‘consultation’ method, where the Department of Health would hold meetings with a number of stakeholders, including the RCGP and patient groups. The following day, the exclusive was confirmed by health secretary Wes Streeting.

There are several strands to this story. Pulse has spoken to dozens of sources close to the negotiations, all of whom have asked to remain anonymous, to understand the source of the row, what has happened since and the wider implications for practices.

Contract announcement – February and March

It all seemed to start so well. The first contract negotiations undertaken with Dr Katie Bramall as chair of GPC England, and with Wes Streeting as health secretary, led to GPC agreeing to the contract in March, amid a number of impositions in recent years.

The headlines were fairly positive for GPs. There was a £800m funding uplift, a removal of ringfenced funding for the additional roles reimbursement scheme and the permanent addition of (newly-qualified) GPs and practice nurses to the scheme.

But there was a line that was causing GPs some concern: that, from 1 October 2025, practices will need to keep online consultation tools open from 8am to 6:30pm for ‘non-urgent appointment requests, medication queries and admin requests’.

NHS England intimated that these requirements were a red line – or, as its director of primary care Dr Amanda Doyle put it, ‘something ministers were absolutely set on’ during the contract negotiations. This is hardly surprising. As the Pulse and Cogora (Pulse’s publishers) white paper on GP access argued, access is always the main priority for ministers when it comes to general practice.

GPs warned that this could lead to safety concerns and burnout, especially if patients were including urgent issues on online forms. At the time, NHS England’s official line was that the changes would be ‘subject to necessary safeguards in place to avoid urgent clinical requests being erroneously submitted online’.

In a webinar just after the contract announcement, Dr Doyle attempted to allay concerns that this would lead to burnout by saying that queries would not necessarily need to be addressed on the day they were received. The BMA suggested that these changes would lead to a ‘temporary spike’ in demand, and not sustained increase. Throughout this, the BMA maintained the line that the changes were dependent on safeguards being developed with online consultation suppliers.

Contract regulations consultation – April

However, the problems started when DHSC sent the contract regulations – which determined exactly what practices were meant to do – to the BMA on 9 April, with a deadline for amendments of 25 April. And it is this period that sowed the seeds for the current crisis.

The regulations clarified that online consultations would need to be switched on from 1 October, regardless of whether the software companies were able to introduce safeguards. Under the regulations, it was practices’ responsibility to ensure safeguards were in place. It also stated that this level of access – ie, continuous throughout routine hours – extended to telephone access and the surgery doors remaining open.

But the GPC executive raised no objections to these regulations. The BMA secretariat provided a verbal report to the GPC on Thursday 27 November laying out the problems with the process. It found that any substantive amendments to regulations would normally be highlighted by NHS England, but were not in this instance. Crucially, there is no obligation for them to do so.

However, on receiving the amendments, the GPC support staff would normally provide the executive team with a tracked document showing the changes. But capacity issues meant this was not done. The changes were also not shared in the email group of the contracts and regulations subcommittee.  Finally, the GPC has final sign off for the regulations – and Dr Katie Bramall signed them off.

GPC members have told Pulse that they never had sight of these changes, and never had a chance to raise concerns.

Practices receive regulations – August

In August, GP practices received the contract, with the new regulations in situ, and they start to raise the alarm. Many practices warned they could not safely carry out these requirements without cutting appointments. The ‘safeguards’ promised by NHS England extended to practices being able to specify that the online consults tool was not for urgent conditions, but did not include the removal of free text boxes where urgent queries may be buried, or any kind of safe working limitations on the number of consults.

Pulse reported that – despite the disclaimers around inputting urgent queries – GPs were coming across red flags in the free text boxes. They managed this through limiting online access. Without the ability to do so from October, they were needing to reorganise their workloads to ensure due attention was being paid to the online requests. It seemed as though the worst fears of GPs were coming to pass.

BMA enters dispute with the Government – September and October

Over the next two months, as practices were growing more worried about the changes, the GPC was threatening the Government with going into dispute. In September, GPC chair Dr Katie Bramall said: ‘GPC England’s agreement to these changes to GP practice contracts was voted on in March in good faith, on condition of securing the “necessary safeguards” in advance of 1 October. At the time of writing, we do not believe those safeguards are in place.’

But amid this, opposition to the GPC executive was growing within the committee. A group of past and present GPC policy leads wrote to Dr Bramall to ‘get clarity on several concerns’ around the approval of the changes. The letter requested that Dr Bramall acknowledges her ‘ultimate responsibility (as GPCE chair) for the error in ratifying the draft contract regulations’. It said: ‘While we acknowledge receiving a copy of the draft contract regulations in April 2025, we believe the ultimate responsibility for reviewing these regulations rests with the GPCE Chair, GPCE Officers and the Policy Lead for Contracts and Regulation.’

There were reports that there would be a vote of no confidence in Dr Bramall. When the agenda for the September meeting was released, there was no motion. However, Dr Bramall herself added a confidence vote to the agenda – and she emerged victorious.

The GPC was ramping up efforts to stop the Government from implementing the changes in October, but ministers were not for budging. As a result, on 1 October, the BMA entered formal dispute with the Government, the day that the changes were implemented.

Animosity grows between Government and GPC leadership – early November

The GPC leadership’s line continued to be that they had been given assurances by the Government in February that the parties would work together to ensure safeguards for practices. Dr Bramall gave the opening speech at the LMCs Conference in Manchester. In it, she referred to a ‘rogues’ gallery’ of ministers and NHS England officials who were ‘traitors’ to the profession – with pictures of them shown.

This led to the beginning of the end of the relationship. Pulse learned that NHS England and DHSC were cancelling planned meetings with the GPC leadership.

NHS England and ministers revealed letters from February that seemed to show that their side had been clear that online access requirements would ‘not be contingent on any specific software solution being found’. This was before the contract was approved by the GPC.

The GPC executive say that this was an ‘informal’ email, followed up by meetings where NHS negotiators reaffirmed their commitment to ensuring the necessary safeguards were in place. The problem, however, is that they have been unable to verify this, whereas NHS England and the Government have corroborated their argument – that these changes were not contingent on software safeguards – in writing.

Pulse understands that the LMCs conference speech angered NHS and government officials, who have been privately suggesting they will not negotiate with the GPC while Dr Bramall remains chair.

Removing negotiating rights from GPC – this week

All of which has led to the unprecedented actions we have seen this week. Pulse exclusively revealed on Tuesday that ministers were moving away from the BMA being sole negotiators of the contract to a ‘consultation’ model in which the BMA would be treated the same as stakeholders such as the RCGP and Healthwatch England – which itself is being transferred to the Department of Health and Social Care.

This came as a shock to everyone involved, including the BMA and the new stakeholders. Pulse also revealed that the reason for this was anger around the LMCs conference speech. This was originally dismissed by some, but the following day, health secretary Wes Streeting confirmed the story. He directly referred to the ‘rogues’ gallery’ speech by Dr Bramall at conference, stating it was ‘not just deeply unprofessional and unbecoming of a professional representative body, it was misleading’.

The bigger picture

So far, the announcement has been welcomed by most of the ‘stakeholders’ mentioned by the Government. However, crucially, the RCGP has reaffirmed the BMA’s role as negotiators of the contract.

The legality of the Government’s move has been called into question. The GP Committee of the BMA is the recognised negotiating body. But it is not entirely clear what obligations this places on the Government. There has to be at the very minimum discussions around the statement of financial entitlements, but again it is not clear what form this will take. As it stands, there are no formal meetings planned between the NHS/ministers and the BMA GP Committee. The BMA is calling for the Government to come back to the table, but it is highly unlikely Mr Streeting would agree to this. It is also unclear how many meetings there will be – the GPC executive suggested in a message to LMCs that it would be one, but Pulse understands it is likely to be more. However, it won’t be more meetings than other stakeholders will get.

But there is a bigger picture to this. Although there may be a personal aspect to this with regards to Dr Bramall, there is plenty of evidence that this row has offered the Government the opportunity to turbocharge its plans.

As the Pulse editor pointed out today, the DHSC had already shifted to referring to contract discussions as a ‘consultation’ rather than a ‘negotiation’.

But more importantly, there is a consistent theme from Mr Streeting towards sidelining the GMS contract. Before entering government, the then health secretary indicated he was not wedded to the partnership model. Though his tone did change somewhat, his actions do not suggest a commitment to the GMS and the partnership model.

The 10-year plan committed to new contracts for neighbourhood health centres. Yet, despite repeated questions from Pulse, the DHSC has not yet confirmed whether such contracts would be on top of the GMS contract – as is currently the case with the primary care network DES – or would supercede the contract. In the same manner, it is not clear who will be negotiating these contracts – though, with no reference to the BMA whatsoever in this discussion, it would be highly unlikely to be the trade union.

Also buried within the 10-year plan was the concept of ‘year of care’ payments, which would be capitation-based funding that would cover primary care in some cases – ie, would be a direct replacement of the GMS.

All of which is to say that, while the Government might say that it has the evidence on its side in the online access contract row, this might not be the full story. It might well be a convenient excuse to carry out its plans to overhaul the GP model. It won’t be long until we find out.

Please note – the original version of this article stated that the April regulations were signed off with ‘no amendments’. This was not the case, and we have amended the article accordingly