This site is intended for health professionals only

NHS England imposes GP contract with focus on access

NHS England imposes GP contract with focus on access

NHS England has imposed a contract on GPs to start next month, which includes more stipulations around access, but no extra funding.

The contract letter, which was sent to GPs today (Monday 6 May), was not agreed with the BMA GP Committee, who have said they are entering ‘serious discussions’ with the profession to decide on next steps, which could include industrial action.

Under the new contract, GP practices will have to offer patients an ‘assessment of need’ on first contact and will ‘no longer be able to request that patients contact the practice at a later time’.

The GPC’s main problem with the contract offer was the lack of funding beyond that already agreed in 2019, as part of the five-year deal, but the final imposition doesn’t include any uplift in practice funding.

NHS England has also said it will be consulting on the future of the QOF for 2024 onwards, but it has announced a number of changes to the framework this year.

Practices have also been told they will need to offer automatic access to future patient records through the NHS app.

The main changes in the contract include:

  • An update to the contract to ‘make clear that patients should be offered an assessment of need, or signposted to an appropriate service, at first contact with the practice’
  • The majority of the IIF – worth £246m – will be entirely focused on improving patient experience of contacting their practice and providing appointments within two weeks;
  • Changes to the childhood immunisations payment system, with lowered thresholds for the QOF targets;
  • The number of indicators in the IIF to be reduced from 36 to five (worth £59m), focusing on flu vaccinations, learning disability health checks, early cancer diagnosis as well as the two-week access indicator;
  • Changes to the additional roles reimbursement scheme, including adding advanced clinical practitioner nurses to the reimbursable roles, increasing the cap on advanced practitioners to three per PCN and removing the caps on mental health practitioners.

NHS director of primary care Dr Ursula Montgomery said: ‘GP teams have worked hard to deliver record numbers of appointments with half a million more delivered each week last year compared to pre-pandemic, and this new contract aims to build on this further with more access for patients. 

‘As well as providing same day care to more than two fifths of patients, GP teams will also step-up preventive action against heart attacks and strokes over the next year, with health professionals encouraged to prescribe statins alongside other preventative measures such as exercise to a much wider number of patients with heart disease, arterial disease and those who suffered a stroke or who have high levels of cholesterol.

‘This contract supports GP teams to provide what matters to patients, and later this Spring the NHS will publish the GP Recovery Plan on how access to care will be expanded even further.’

Acting GPC chair Dr Kieran Sharrock said: ‘This hasn’t been properly considered, ramping up GP workload, and without the support needed, will lead to more GPs leaving the profession. 

According to Dr Sharrock, the GPC had hoped to collaborate on contract negotiations, but has been repeatedly disappointed with the lack of support for struggling practices. 

Last month, the Committee rejected a version of the contract, calling it ‘insulting’, and Dr Sharrock said the recent meeting with the health secretary was merely a ‘tick-box exercise’.

Dr Sharrock added: ‘General practice can no longer be expected to take whatever is thrown at it, and the Committee’s recent rejection of the contract offer still stands. 

‘We will now look to enter serious discussions with our membership and the wider profession on what action we take next.’



Please note, only GPs are permitted to add comments to articles

Not on your Nelly 6 March, 2023 4:08 pm

I await the response of the BMA…….who am I kidding….

The Prime Minister 6 March, 2023 4:13 pm


Meaning of contract in English:
a legal document that states and explains a formal agreement between two different people or groups, or the agreement itself:


David Turner 6 March, 2023 4:29 pm

Just say no and mean it.
Sadly I suspect many GPs will just do what they are told by NHSE.

Darren Tymens 6 March, 2023 4:34 pm

‘NHS director of primary care Dr Ursula Montgomery said: ‘GP teams have worked hard to deliver record numbers of appointments with half a million more delivered each week last year compared to pre-pandemic, and this new contract aims to build on this further with more access for patients.’

Yes, we have overworked because we thought it was for the good of our patients, and you have refused to fund this extra work and you have continued to exploit us. You have normalised this exploitation and this contract imposition is just more of the same.

‘This contract supports GP teams to provide what matters to patients, and later this Spring the NHS will publish the GP Recovery Plan on how access to care will be expanded even further.’

How? With what? Are you cloning slave GPs? Are you going to allow anyone who can hold a pen to prescribe? Or will it just be more unfunded expectations heaped upon practices? We don’t actually need a recovery plan because we are already seeing patients at levels above pre-covid, unlike the rest of the system – so why exactly are you pretending we aren’t?

By comparison, you gave billions to hospitals and have let them continuously underperform without any sanctions.

When future historians write about the end of the NHS, Dr Ursula Montgomery and all her NHSE-employed GP apologists will have a chapter to themselves. Disgraceful.

Cameron Wilson 6 March, 2023 4:41 pm

Without a Plan B, this is the future. Am not interested in industrial action to get a few extra scraps, it’s obvious that the current system is finished, time for a radical change, and better one designed by ourselves! This micromanagement by the Quislings of the NHSE needs treating with the contempt it deserves!

Some" Bloke 6 March, 2023 5:06 pm

nice management style, Ursula. “GPs have worked hard”, so we are dictating that they work a bit harder for no extra pay. You couldn’t make this up, would be comical if not so in your face real and clearly going to undermine finance and morale for so many Practices. Idiots at the helm are turning this into another interesting year!

Pradeep Bahalkar 6 March, 2023 5:19 pm

Let us see whether our profession has spine to say ” NO, we will not accept this contract. Can not provide more access without more funding ” If you want to impose contract we will walk away just like dentist have walked away.
Lets see how do NHS England will manage that. Most important thing is to have unity amongst our profession. If we are united Government can’t do a damn thing. They cannot replace all GP surgeries overnight.
Big question is does our profession have unity and guts to stand up to NHS?

john mackay 6 March, 2023 5:23 pm

Perhaps we all just need to send a leaflet to each of our patients explaining what our charges will be after a certain date and explaining that the government have stopped paying for our work?

Matthew Woodhouse 6 March, 2023 5:45 pm

We have no appointments left, I have assessed your need and signpost you to ED.

Dermot Halpin 6 March, 2023 6:02 pm

I thought slavery was illegal.
This is not a contract.
It is a very dangerous document and completely ignores Health ans Safety Regulations and Labour Law.
It is harassment.
Will result in more burnout and litigation.
All above are anticipatable.

Just My Opinion 6 March, 2023 6:51 pm

Exactly Matthew Woodhouse, all to go to A&E in that case when there are no appointments left, rather than what happens now which is asking them to call later/another day if it can wait.
Oh wait, your self limiting problem got better and you didn’t need to call back after all?
They just don’t get how much we manage behind the scenes.
Now I am CONTRACTUALLY MANDATED to direct them to another service. Which of course is A&E, as pharmacies have no capacity and no one trusts 111. And I don’t want to get sued.

Reply moderated
Adam Crowther 6 March, 2023 8:12 pm

Maybe time to start considering the telephone call to patient services team member and associated triage as an appointment now 🤔

Douglas Callow 6 March, 2023 8:18 pm

undated resignation will stop this if the numbers are high enough

Valerie Jane Philip 7 March, 2023 6:20 am

‘Assessment of ‘need’ on first contact’
Who is the genius that has thought up this great idea?
Isn’t that what we have been doing since general practice was invented?
So nothing new here then!

Michael Mullineux 7 March, 2023 7:33 am

Infinite demand to be met by finite and dwindling capacity and resource whilst secondary care waiting lists for GE/Neuro/Ortho/Derm/Resp etc continue to rise beyond 18 months without any sanction.

Turn out The Lights 7 March, 2023 8:35 am

Dont sign it shred it up send the shreddings back to NHS contacts.

Nick Mann 7 March, 2023 9:01 am

Agree regarding undated resignations: GPs, Nurses, Ambulance Staff, Consultants, Junior Doctors… all together now.

Truth Finder 7 March, 2023 9:11 am

This is slavery. I cannot see anymore patients safely without being struck off. BMA, take us out of the NHS. The system is broken.

Bob Hodges 7 March, 2023 9:14 am

Presumably, because this ‘contract’ has not agree or accepted by our professional representatives, and it demonstrably NOT the product of some kind of national emergency as per the GMS 2 negotiations in 2003/4, then this is not legally binding.

Therefore, any practice/partnership wishing to hand back their contract need not wait the required notice period as the contract that your representatives accepted and that you accepted by working under this year up the end of March 2023 is no longer in existence.

Contracts are not unilateral instruments under the law.

It looks to me like you can hand back the keys on April 1st, or any time thereafter if you give notice promptly, if you want. Someone else’s problem! The ICB will have to take up the slack, which will mean TUPE for your staff in practice.

Turn out The Lights 7 March, 2023 9:50 am

Agreed Bob shouldnt the BMA legally challenge this clause.

Andrew Milne 7 March, 2023 10:20 am

a written or spoken agreement, especially one concerning employment, sales, or tenancy, that is intended to be enforceable by law:
“he has just signed a contract keeping him with the club” · “much of the produce is grown under contract”

neo 99 7 March, 2023 5:32 pm

@turnout the lights. The Bma agreed to this clause in 2004 new Gms! It’s been used a number of times since and never been challenged by the weka GPC.

neo 99 7 March, 2023 5:36 pm

industrial action, undated resignation without a worked out plan B are all pointless. What is needed is a ballot on undated resignation on 31st March 2024 and for the GPC to start preparing for plan B outside the the NHS as of that date. This is really the only option if you want to remain independent and in control. Otherwise you will have the next 5 year plan with recurrent impositions of contract and primary care subsumed and “integrated” (as Amanda Doyle has said) at the end of 5 years as a donkey 3rd rate non GP led service within the NHS with comparable poor pay. It’s crunch time. I’m pretty confidence however the professional does not have the stomach to walk away so we are headed for more of the same.

John Evans 8 March, 2023 4:49 am

We have to admit it. Blame lies with GPs.
Too many act in immediate self interest.
1. More comfortable partnerships less vulnerable to burden of PCT/Commissioning/ CQC = let small practices fail
2. Salaried Drs not wanting the risk / Partners wanting to protect profit = mergers and salaried service
3. Pre kids and mortgage = locum
4. Kids and mortgage = fearful and hang on regardless
5. Find job unworkable = get job away from front line on boards, appraisals or working for the enemy at NHS Primary Care Support, etc
6. Older and more freedom from kids / mortgage = part-time locum

Ground conditions are being laid for Corporate / US style systems. Patient dissatisfaction with GPs who are increasingly unable to match the unfunded promises will be used to support further imposed changes.

No chance of GPs of acting as a unified group and doing anything different.

Ali Hossein Esteki 9 March, 2023 12:05 am