GPC England chair could face vote of no confidence amid contract changes row
Exclusive England’s GP leaders may hold a vote of no confidence in their current elected chair, following concerns around changes to GMS regulations coming into force next month.
The BMA’s GP committee for England could hold a no confidence vote in chair Dr Katie Bramall at their meeting next week, Pulse has learnt.
It follows concerns raised by GP leaders around changes to the GMS regulations which will come into force next month, including a requirement for practices keep their premises, telephone lines and online consultation tools open throughout core hours from 1 October.
Announcing changes to the GP contract in February, NHS England told GP practices they would need to keep their online consultation tool open throughout core hours for appointment requests, medication queries and admin requests from October.
But a contract variation notice published last month appears to go further in stating that practices ‘must take steps to ensure that all of the following means of contacting’ the practice ‘are available for patients throughout core hours’, including:
- by attending the practice’s premises;
- by telephone;
- and through the practice’s online consultation tool
In a message sent to LMC officers last week, seen by Pulse, Dr Bramall acknowledged concerns that the changes had been ‘missed during the review of the draft regulation changes back in April 2025’.
She said that the amended regulations were received by the BMA from the Department of Health and Social Care in April but that they were not shared with the relevant policy group.
She also added the BMA has sought legal advice on the changes, after the contract wording ‘caused us all such alarm and consternation’.
Dr Bramall said: ‘We are waiting on a senior external KC to provide feedback, prior to sharing the legal guidance that the BMA staff have drafted for GPCE and LMCs.
‘Some LMC officers have expressed concern at the forthcoming changes to GMS/PMS regulations coming into effect from 1 October 2025, particularly the relevant section of the contract referring to ‘Contact with the practice’ by a patient; and have enquired whether the BMA had been made aware of the wording changes, or if they had been missed during the review of the draft regulation changes back in April 2025, and secondly why the draft regulatory amendments were not shared with the Contracts and Regulations (C&R) Policy Group listserver for scrutiny / review, as would normally be custom and practice.
‘We can confirm that the amended regulations were received from DHSC on 9 April 2025. Following an initial internal review, we can confirm that the amendments were not posted to the C&R policy group listserver.
‘This is an oversight which will be taken forward in terms of how to prevent any such further recurrence.’
The message added that the draft amendments were shared by BMA staff with the GPC executive but that there was ‘no comparative piece produced from a BMA perspective’, comparing the 2024/25 and 2025/26 wording or tracking amendments.
She said: ‘There was no feedback from any other elected member or staff member on the relevant listserver threads. The deputy chair leading on the contracts and regulations policy area shared comments to the listserver on 23 April 2025, the chair then reviewed and supported those comments following their submission on 28 April 2025.’
She also added that a ‘significant event audit is underway’ which will be reviewed on 18 September 2025 for the elected members of GPC England to discuss.
Following this message, 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, seen by Pulse, 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.
‘We feel that the lack of clear accountability and the poor communication has left us exposed and vulnerable, in a public forum.
‘We accept that mistakes can and do occur. However, our concern lies in the absence of acceptance, accountability, transparency, and a formal apology in response to this serious error.’
GPCE representation policy lead Dr Rachel Ali told Pulse that the vote of no confidence and the letter mean that those involved have ‘lost track of the purpose of the committee and the work we need to get done’.
‘We all need to get back to worrying about the people we represent and what is preventing us doing that well, not waste time and energy on internal politics,’ she said.
She added that Dr Bramall and GPC officers are ‘negotiating a critical national contract’ while ‘writing their own PowerPoints, booking their own trains, and being expected to do all of this on only a few days a week’.
She said: ‘The issue with information being missed on list servers is a perfect storm of the issues with inadequate staff support for GPCE that we’ve been highlighting and trying to fix for years. It only seems to get worse.
‘Of course something got missed. It was inevitable. We need to address the systemic issues and fix these, not create chaos around the edges and increase the risk of it happening again.’
A BMA spokesperson said: ‘The agenda for next week’s GPCE meeting is yet to be finalised, but agendas for BMA branch of practice committee meetings remain confidential.
‘The chair of GPC England is on record as being concerned about some of the changes in the regulations due to come in on 1 October and their impact upon practices. She and the officer team continue to discuss these and consider next steps. Guidance is currently being drafted for practices on how to be able to maintain safe working beyond 1 October to prepare for any eventuality, and we hope to have this ready for the profession in the coming days.
‘Leaks and selective briefing to the media is not helpful and a distraction while the BMA and GPCE team are working hard on incredibly tight time frames, and focusing on the task at hand to ensure that the profession is protected and represented.’
Dr Bramall became chair of GPC England in 2023. Her election followed a controversial vote of no confidence in its former chair, Dr Farah Jameel.
Note: This article was updated to reflect that the agenda for next week’s GPCE meeting has yet to be finalised.
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READERS' COMMENTS [24]
Please note, only GPs are permitted to add comments to articles
While I’m a big believer in online access and my practice already meets the October 1st requirements, I recognise that this requires a degree of scale. This was a very strong card to play and giving it up at the first opportunity for the promise of a negotiation down the line always seemed like a naive approach. I can understand why small partnerships in particular would feel let down by the leadership. We will all be doing extra work for the promise of jam tomorrow – but it won’t come soon enough for many small practices.
The next contract negotiation will be of critical importance. We need accountable and transparent leadership coalescing behind the partnership model in all its forms.
This sounds petty and a huge overreaction. Bramall is an excellent leader for BMA. Who do they think can do better? Who called the VoNC?
who is their plan B?
Pretty pathetic over reaction to a non-issue on the part of a few people at GPC.
It’s a highly charged situation in general practice and GPs and leaders at all levels will have their own ideas about how things should be done. If frustrations are mounting, as they are over the whole online access requirement — as someone who already does it, I can assure you it does increase workload and impacts continuity — this sort of thing tends to happen. It happened to Farah two years ago. The concern is, if this vote passes there is a risk the GPCE chair post ends up becoming a poisoned chalice — like the Man Utd job of medical leadership. No one benefits from that.
Extreme caution is required with Mr Streeting. He clearly fancies the top job. His approach to the problems of the NHS by reorganisation nobody asked for, a plan with no implementation or funding, and general practice becoming busier than ever means he’s out to prove a point to further his political career. I don’t envy his job, but this move to reform is looking increasingly likely to lack any credibility, and GPs need to be aware and not be sold a pup.
Anyone who thinks someone would be better than KBS doesn’t deserve to be on GPCE. Don’t let us become the Tory party who eats their own and self destructs.
Katie seems to be a fantastic leader and goes above and beyond but I don’t understand why the contract variation has just been accepted without a murmur of descent from our leaders T the BMA and GPC
I don’t often attend unless absolutely necessary to listen to the pointless, ineffective leaders of the RCGP , ICBs or NHSE but fortunately went to listen to KBS who attended a local LMC meeting and worth every second. She leads with commitment and has a vision. If there is an error or judgement in relation to this contractual change due on 1/10/25 , which may or not be the case, it needs to be resolved by collective action and unity in not complying with this reckless, dangerous and destructive government NHS Primary care change, not by removing KBS but with KBS leading any action that could be taken as in my opinion her record demonstrates solid action and progress in an unforgiving role.
Just wondering why we didn’t refuse this contract variation, as unilateral contract impositions have become the norm, utilising the abuse of power by the Health secretary, ever since it was snuck into the 2004 changes.
We should be taking industrial action by refusing to even consider this change until the new contract negations become clarified, and we understand the direction of travel.
No free lunches for the DOH – any change needs to be funded.
With friends like these….
Do they issue body armour to doctors elected to office in the GPC, or do they take the back stabbing at risk?
Dr Bramall has been the most effective leader of GPCE in years, she is incredibly hard working and an excellent communicator, she has managed to get the ear of, and change the mind of, the SoS. If she is voted out it would be the political equivalent of auto-amputating both feet with a shotgun.
There is no need for this vote. She is trying her best.
on-line appointment booking was not feasable in 2013, but we were required by the health board to keep the doors open continuously from 0800 to 1830 back then, and were penalised for having one doctor stay behind till 1300 to man the desk, whilst the others went to arrive by 1300 at the half-day mandatory location training sessions, held about an hour’s drive away!
Whether an error or skulduggery in the BMA, a distracted, divided and squabbling GPCE perfectly serves the Govt at this moment in the negotiations, when they’re plotting a (?8am to 8pm) salaried corporate GP service.
They have signed something to say we have unlimited access via online/phone/walk-in 8-630, every day, and dealing with things within 24h.
We are fucked
Patients can contact the Practice during the hours we are open? Oh noes – how did we ever manage for the past 30+ years???
That’s sort of our job guys….
…however, judicious use of SWG can make it into a thing of beauty.
https://www.bma.org.uk/advice-and-support/gp-practices/managing-workload/safe-working-in-general-practice
“The practice is currently experiencing unmanageable demand for urgent care. Taking account of our practice team’s safety and the availability of other options for patient care we are not able to manage any more patients today. We are sorry for this inconvenience, which is beyond our control. If you have an urgent medical problem that you believe cannot wait, then you should seek help from other NHS agencies including NHS24 on 111 or through accident and emergency.”
You shouldn’t be letting GPCE fanny around squabbling, with the DOH no doubt utterly tumescent at the infighting.
Snuff this ridiculous VoNC, give KBS the backing she needs and deserves, and instead be sorting out a contract that rewards Practices for employing more GP partners, rather than the slow spreading cancer of corporate GP goliaths run by increasingly hands-off Partners and not-doctors aplenty, while fully qualified GP colleagues can’t get a f*cking job.
Wouldn’t you rather be making the same money looking after say 5-10,000 patients with 5-10 GPs than having to effectively become mini-Health Boards with the ever present risk of losing that which makes us the very best of the NHS – Continuity of Care?
Observations from a Scot who is somewhat terrified we import the worst of what England has had to suffer over the past 15 years.
silly
I was not happy about how Dr Jameel was removed, we were not given the full facts on this. Yet again our leadership are under attack with KBS being asked for removal. This is unfair and indicates a lack of transparency on behalf of GPC. I will be approaching my LMC for a full understanding of the facts behind the case. We cannot as a profession keep doing this to our leaders. It is government that have added this clause, GPC have not requested this. The vote of no confidence should be with the government, not with our elected officials that are doing their best to represent us. I want to understand the facts of this. Please GPC do not ask us to trust you on this.
Sorry finger strayed and I think I might have responded negatively to Nick Mann’s comment which I actually whole-heartedly support. I also think Bramall has been an excellent Chair. Do those who have called for a vote of no confidence have a plan to move forward?
I have every confidence in Dr Bramall and I hope she stays. She is a voice of reason that may hopefully be heeded by the politicians. I think if anyone can defend us against blundering politicians it is she.
Why has this article been changed from “the chair WILL face a vote of no confidence”, to the Chair ” COULD” FACE A VOTE OF NO CONFIDENCE. C’mon Pulse, did you not do your due diligence the first time or are being played like a fiddle by individual political inteersts. Please revert back to honest and proper journalism. Jaime, you and your team are better than this.
It is crucial at this time not to disrupt our GPCE MEMBERSHIP whilst it negotiates a long awaited new contract. Those working in the NHS will recognize the issues around doing complex work with inadequate support and that at times things are missed unintentionally. Recognizing this in time and taking action to clarify seem to be underway unready. We shoot ourselves in the foot if we lose Dr Bramall at this stage-cabinet reshuffle anyone?
I think it is clear that GPCE focus has been on patient safety throughout this and the principles they wanted in the contract has been clear.
Agree with Nick Mann.
From my own practice experience, working with a demographic with high numbers frailer elderly and commuters we are battling with providing all 3 methods of access at once to support our patient population. It will be difficult to adequately staff front desk, phones and manage e-consult all day with resources we have. Safely triaging e-consults has reduced clinician F2 F access and so made continuity more difficult. Yes practices should offer different ways of accessing service, but practices need to be free to choose most appropriate balance for their demographic.
It’s incredibly disappointing that members of the GPC chose to undermine Katie at such a critical time, including by leaking this letter. All they have achieved is weakening her negotiating position with Government, which harms all GPs.