Lack of guidance sparks GP confusion around contract changes implementation

GPs have expressed confusion around imposed contract changes which came into force last week, as NHS England guidance on many new requirements is still outstanding.

The BMA’s GP committee said that ‘many practices are querying what contract changes need to be put in place’, amid a lack of guidance from NHS England and potential GP collective action taking place from April 30.

From 1 April, practices have been contractually required to use A&G across specialities ‘prior to or in place of a planned care referral where clinically appropriate’, but the BMA is currently getting legal advice on this amid fears that the requirement could remove GPs’ right to refer, and NHS England has promised to publish new guidance for GPs around the requirement.

The contract also introduced a new requirement for GPs to ‘deal with’ all urgent patient requests on the ‘same day’, and while NHS England has explained how it will measure this, new guidance on this also remains outstanding.

These changes were rejected by the GPC and by 98.9% of GPs in a referendum last month. Following the vote, the health secretary urged the GPC not to take collective action, but the committee later announced that GPs could take action from 30 April unless the Government ‘pauses’ its plans around mandated A&G and put in safeguards regarding same-day access.

But regardless of the lack of guidance, rejection from the profession and potential collective action, the GPC said that practices should ‘review and prepare for the implementation of the contract’.

It added that ICBs must give practices at least 14 days’ notice before contract variations take effect.

In a message to GPs, GPC deputy chair Dr Samira Anane said: ‘We are aware that with 1 April passing, many practices and colleagues are querying what changes need to be put in place.

‘Therefore, we would recommend that practices review and prepare for the implementation of the 2026/27 contract. Under paragraph 57 of Schedule 3 of the GMS regulations, and under paragraph 52 of Schedule 2 of the PMS agreement, practices must have at least 14 days’ notice before variations take effect.

‘GPCE is developing guidance and “focus on” documents to support practices in understanding and managing the imposed contract changes. As a reminder, QOF changes are now in place.’

The Doctors’ Association GP spokesperson Dr Steve Taylor told Pulse that it is ‘vital’ that NHSE publishes ‘clear’ guidance on the requirements as soon as possible.

He said: ‘NHS England has implemented a number of changes without any significant guidance, this includes Advice and Guidance, which is ironic, and other aspects of the new imposed contract.

‘It’s an appalling contract with minimal additional funding and a massive increase in work for practices. It’s no wonder 99% of GPs rejected it.’

The RCGP said that the lack of A&G guidance means it is not fully clear how a single point of access would work in practice across the country, and that one approach may not be suitable in all areas. 

It added that GPs have already reported risks of delays with tests being required before any referral, ‘lost messages’ and staff without appropriate senior clinical oversight handling requests

It said: ‘Our members have raised concerns over how its use varies across the country, how delays and potentially blocked referrals can jeopardise patient safety, and how it can push workload from secondary to primary care without clear resourcing, consistent clinical governance, or sufficient consideration of the downstream consequences for GP capacity and the quality-of-care patients receive. 

‘An SPoA approach must not delay or limit appropriate referrals or impose ways of working that are not safe or suitable for patients or for general practice. 

‘A shift to this approach is likely to require further discussion and piloting before it is implemented, and therefore may not be feasible for full national implementation in 26/27 without further evaluation.’

Tower Hamlets GP Dr Selva Selvarajah told Pulse that there has been confusion on where the guidance is supposed to come from and whether it has been created with GP input.

He said: ‘Is it the ICB’s job to send out guidance? I haven’t seen any. Is it national or local guidelines? Has there been any work with the local LMCs and the hospital representatives to look at the 10 specialities and ensure safe rollout? I’m not sure there has been consistently across the country.

‘While I support the principle of A&G, guidelines need to make sure GPs are well supported, including additional resources, and that technology is enabled for speedier communication.’

Pulse has contacted NHS England for comment.

NHSE has published guidance on the contractual changes to QOF which set out that GP practices will be eligible for up to 18 QOF points under new indicators for taking part in obesity management.