Local GPs call on BMA to re-enter contract dispute over 1 October access changes

Exclusive Several local medical committees are asking the BMA’s GP Committee England to enter a contract dispute with the Government over new access requirements.

As of 1 October, GP practices must keep their phone lines, premises and online tools open during core hours, in a development that appeared to come as a surprise to GPC England.

Now the combined West Midlands LMCs; as well as Berkshire, Buckinghamshire and Oxfordshire LMCs, have all called for the GPC to launch a contract dispute over the changes unless they are amended.

They also urged the GPCE to provide guidance to practices to actively breach their contract on access from October, as LMCs cannot.

Practices told to keep phones, premises and online tools open

When the contract was agreed in February, GPs were told only online consultation tools were required to stay open in core hours, and only for appointment requests, medication queries and admin requests. However when the contract variation notice was published last month it went significantly further by also including in-person and telephone access.

GPs told Pulse the requirement was tying their hands to treat patients based on ‘want’ rather than having flexibility to treat them based on need.

The issue has also sparked a row among GP leaders, with members of the GPCE telling Pulse there was likely going to be a vote of no confidence in the chair next week. Although their meeting agenda has yet to be finalised, Pulse understands this is now not likely to take place.

Earlier this week, in a letter to LMC officers, GPCE chair Dr Katie Bramall acknowledged concerns that the changes had been ‘missed during the review of the draft regulation changes back in April 2025’ and she announced that a ‘significant event audit is underway’ which will be reviewed for discussion at the 18 September GPCE meeting.

LMCs demand safeguards or dispute

Following their annual general meeting, the liaison group of West Midlands LMCs has today written to Dr Bramall to urge a contract dispute with the Government unless the six demands that the GPCE made on the Government in July are met – including reallocating ARRS funding to practices and various reassurances regarding a new GMS contract, funding and the 10-year plan.

The letter said: ‘We understand that if any one of these asks is not agreed by the Government, their commitment to the addressing the crisis in our profession would be manifestly insufficient and we cannot avoid going into dispute with immediate effect.’

The letter also expressed ‘deep concern’ over the Government’s 10-year plan for the NHS; but said the ‘most important matter of deep concern’ was ‘the issue of the GPCE officers failing to scrutinise the contract changes sent to them in April 2025, which has left practices in an impossible situation’.

‘Practices will have to see unsafe volumes of patients or have no option to breach their contracts. This serious error falls to the GPC executive to explain, devise a plan to rectify the situation, and prevent a recurrence,’ the letter said.

It requests that the GPC ‘urgently consult with the Government, accepting the error, and re-negotiate access requirements with safeguards built in’.

‘Failing which, we would like a template letter from BMA for each practice stating that for safety reasons they will need to breach their contract as of 1 October 2025. Practices must be allowed to signpost patients to other local, urgent, and emergency services, without the threat of contract or performance management,’ the letter said.

It also demanded a ‘report’ on the ‘circumstances’ of the error made by the GPC executive and the steps GPCE and BMA are taking ‘to prevent this from happening again’.

South Staffordshire LMC chair Dr Manu Agrawal told Pulse: ‘We feel let down by the Government and by NHS England and that the promises that they have made have not been fulfilled. This obviously leaves the profession in a very perilous state and a dangerous state where practices, willingly or unwillingly, will end up breaching their contracts to maintain patient safety and safe working guidance. And what we want from the GPC is to take necessary steps, including dispute, to support the practices during this incredibly difficult time.’

Concerns over legality and patient safety raised

Meanwhile, Berkshire, Buckinghamshire and Oxfordshire LMCs have produced guidance for GP practices in their area on the new access requirement.

The LMCs’ guidance argued that the amendments to the GMS regulations have been made ‘prior to the agreed safeguards being in place’, meaning the contractual requirement already binds practices ‘regardless of whether any such safeguards are agreed or implemented’.

It called on the BMA’s GP committee to re-enter dispute ‘on the basis of the failure by Government to introduce necessary safeguards’.

The guidance, seen by Pulse, said: ‘It is the opinion of BBO LMCs officers that the 2025 amendment to the GMS/PMS regulations is questionable in its legality, and safety, as it contradicts and jeopardises not only the rest of the contract, but also other legal obligations to contractors such as but not limited to, health and safety, quality of care standards, and good medical practice.

‘However, the LMC cannot and will not advise practices to deliberately breach their contract, and any instruction to practices on the unenforceability of the contract must come from the BMA, as trade union.

‘We have made urgent requests to GPC leadership for such legal advice but are yet to receive a substantive response.’

BBO LMCs chief executive Dr Matt Mayer told Pulse that the contract change of online consultations being available throughout core hours ‘was sold to the profession on the condition that it would only be for routine administrative queries’, and would only be implemented if ‘necessary safeguards’ had been developed to ensure no urgent requests can be erroneously submitted.

Dr Mayer added: ‘GPCE must return to immediate dispute with the Government, on the basis of the failure by Government to introduce necessary safeguards.

‘GPCE and BMA must mobilise all legal and organisational resources at their disposal to challenge the safety and legality of the aforementioned amendment to the regulations.

‘The Government has entirely failed to implement the safeguards it promised, which were a condition of the acceptance of the 2025/26 contract, and therefore we urge GPCE to immediately re-enter dispute and resist this dangerous contract change.’

According to Dr Mayer, the contract changes as they stand will disadvantage patients as well as practices.

He said: ‘By making it impossible for practices to limit their workload, rather than “end the 8am scramble” this Government will see appointment numbers drop as GPs have to divert time sorting these requests; waiting lists for GP appointments will rise, and other services like 111 and A&E will be overwhelmed as practices will find it impossible to safely triage.’

BMA to review issue at 18 September meeting

A BMA spokesperson said: ‘The committee will be discussing whether the necessary safeguards have been met at its meeting on 18 September, as we communicated to Government in July.

‘We’re on record as being gravely concerned about some of the changes in the regulations due to come in from 1 October and their impact upon practices and patient safety. We continue to negotiate in good faith to secure what practices need and patients deserve.’

The BMA has also taken legal advice on the contract changes and Pulse has been told GPCE is preparing guidance for practices on the basis of this.

Dr Bramall told Pulse: ‘We absolutely take on board the concerns that we share with practices, LMCs, and other respected stakeholders such as the BMA and RCGP’s JGPITC (Joint GP IT Committee).

‘It is imperative that the necessary safeguards we agreed in good faith back in March, when we voted to accept this contract, are secured. We continue to work hard to this end and will continue to do so.

‘This week, we have been focused on getting out guidance for practices which shall be sent out this afternoon and which we hope will answer many questions.

‘The elected officers are accountable to GPC England, which will have the opportunity to have an informed debate and decide next steps at its meeting on Thursday 18 September.

‘As always, our duty is to keep practices safe, but also to act responsibly and make them fully aware, especially from a legal perspective – hence why we have sought advice not only from BMA legal teams, but also expert opinion from a senior KC.’

Pulse has contacted the Department of Health and Social Care for comment.

Last month, BBO LMCs called on the BMA to re-enter formal dispute with the Government over the 10-year plan. This is also due to be debated at a special BMA conference taking place this weekend.