Calm before the storm? Unpacking the new GP contract

Last Friday, the government and the BMA announced a new contract for general practice in 2025/26. The government claims the deal will help deliver on promises to 'fix the front door of the NHS', while the BMA says the agreement is a 'crucial step' towards rebuilding general practice in England.

But what does the agreement really mean for patients and GPs?

What’s been agreed in the new GP contract?

At the top of the list is funding. The 2025/26 contract agreement provides an additional £969m to general practice in the coming financial year. This is the figure trailed by Wes Streeting just before Christmas, plus the £80m to support GP requests for specialist advice and guidance that was outlined in January’s elective reform plan. 

Several contract changes are aimed at boosting the general practice workforce. Since 2019, practices – through primary care networks (PCNs) – have been encouraged to employ 'additional' roles, such as pharmacists and paramedics, with costs refunded through the Additional Roles Reimbursement Scheme (ARRS). In August 2024 an ‘emergency measure’ temporarily expanded the ARRS to include up to 1,000 newly qualified GPs, in response to reports that newly qualified GPs were struggling to find employment. The 2025/26 contract makes that expansion permanent, lifts the cap (although remains limited to GPs within their first 2 years of qualification) and extends the ARRS to practice nurses as well. 

The Quality and Outcomes Framework (QOF) – a pay-for-performance scheme for practices – reduces indicator targets from 76 to 44 for 2025/26 onwards, billed by the government as ‘slashing red tape’ and ‘freeing up’ GPs to spend more time with patients. Most of the money that used to reward hitting these targets will be reinvested in childhood immunisations and cardiovascular disease targets, in a renewed push for these areas. 

Some existing funding will also be reallocated to incentivise practices to analyse their patient population and apply ‘risk stratification’ – using data to characterise patients based on need. This includes identifying the patients who would benefit most from continuity of care. 

Finally, there are two key commitments on how patients engage with practices. From October, practices will need to allow patients to request non-urgent appointments and submit enquiries online throughout core working hours. NHS England will also develop a new ‘patient charter’ setting out what patients should expect from their GP practice. All practices will have to host this on their website. 

Other contract changes for 2025/26 are set out on the NHS England website.

How significant is the agreement?

The agreement marks the first time in 4 years that the government and the BMA have reached a deal on the annual GP contract. Contract changes throughout that time have been imposed by the government, contributing to the decision last year for GPs to take collective action. The BMA has announced it is no longer in dispute with the government.

Most of the changes for 2025/26 focus on immediate issues. The addition of newly qualified GPs and practice nurses to the ARRS is intended to overcome misaligned incentives which were contributing to ARRS roles being prioritised for employment, as opposed to GPs and nurses who needed to be paid for from core practice funding.

Reductions in the number of QOF targets have been discussed for a while, including under the last government. Most of the retired targets are about maintaining registers (of patients with learning disabilities, for instance). A small number cover direct patient care – eg targets for physical health checks for people with severe mental illness. These changes may ease administrative burdens on practices, but come with trade-offs and their removal may have adverse impacts. As much of the money from the retired targets will go towards other cardiovascular disease prevention targets, the changes could be seen mainly as reprioritisation.

Online access requirements and the patient charter help advance the ‘modern general practice’ model, clarifying and embedding expectations on this from NHS England, but are likely to have capacity implications for practices. Incentives to undertake risk stratification (and systematically identify patients who would benefit most from continuity of care) support the vision for integrated primary care set out in the 2022 Fuller Stocktake. 

As a stopgap, the 2025/26 contract – including the additional funding – will be welcomed by many. However, it leaves many of the big questions facing general practice unanswered – including long-term funding, workforce sustainability and the future of PCNs. 

What comes next for general practice? 

Making it easier to get a GP appointment is now the public’s top priority for the NHS. The government’s ambitions include improving GP access, restoring continuity and delivering the three shifts for the NHS (from hospital to community, from analogue to digital, from sickness to prevention). Achieving these ambitions will need a more comprehensive vision for general practice, backed by concrete action and sustained investment. The government will also have to make general practice a more sustainable place to work. 

The upcoming 10-year plan for the NHS needs to provide this vision – articulating the role of general practice and PCNs in integrated neighbourhood teams, committing to resourcing general practice to meet growing need and improving the equity of GP services. This will lead to tricky questions for the government, including how new integrated services are contracted and how GPs are organised to deliver them. These decisions may test the recently smoothed relationship between the government and the BMA. 

The 2019 NHS Long Term Plan was backed by a substantial 5-year GP contract agreement. Implementing the new 10-year plan will also need a long-term approach. The BMA has also said their agreement on the 2025/26 GP contract is contingent on a government commitment for a ‘wholesale’ renegotiation of the GP contract within this parliament (along with agreement on some of the details for 2025/26). The challenge is now to develop a vision for the future of general practice and agree a new contract to make it a reality.