GP Contract Changes – Impact Discussed

This following guide tells you what to expect from your general practice (GP) and how you can help them, so you get the best from the National Health Service (NHS). More details can be found through the link: 

NHS England » You and your general practice – English

Excerpt from Practice Index – September 4, 2025 

When the latest variation to the GP contract landed last week, Practice Managers were left wondering how they’d cope. The requirement that practices, from October, must keep their doors, telephones and online consultation tools open throughout core hours has caused alarm, with many warning of yet more strain on already stretched systems.

NHS England has insisted the change is nothing new. The February announcement on the 2025/26 contract already required practices to keep their online consultation tools open during core hours for appointment requests, medication queries and admin requests. But the variation notice went further, spelling out that practices must ensure patients can contact them by attending in person, phoning or using online consultations at all times between 8:00am and 6:30pm.

For many, this isn’t just tidying up wording. GP leaders believe it removes the scope for practices to shape services around local needs and limited budgets. As one LMC leader put it, the change shifts the contract away from focusing on what patients need and towards simply meeting what patients want. It takes away the ability of practices to decide how best to organise services for their population within the funds available.

The practical implications are worrying. Practices that close briefly for training or use subcontractors for cover at the edges of the day, may now find themselves in breach of contract. Managers say it will affect everything from staff rotas to professional development. One Practice Manager explained that their team had been pressured in the past to keep the front door open until lunchtime, even though that meant staff couldn’t reach a mandatory training session held miles away. Meanwhile, they’d seen neighbouring practices shut up shop mid-morning without challenge. “The enforcement of opening times is inconsistent and often unfair,” they said. “This just adds more confusion.”

Another Practice Manager commented that enforcement already varies between ICBs. “We all know practices in the same area that operate differently, depending on what’s tolerated locally. I can’t see that changing, but the new wording piles on the pressure and raises patient expectations.”

Concerns are also being raised about how the change fits with existing regulations. The GMS regulations state that essential services must be provided at times appropriate to meet the reasonable needs of patients. By requiring practices to be accessible at all times during core hours, the contract wording appears to contradict that. Managers fear this inconsistency will leave them exposed to criticism however they choose to organise services.

At the same time, NHS England has published a new patient charter which practices must display online from October. It states that patients should expect to be able to visit, call or use online consultations between 8:00am and 6:30pm every weekday. Practice Managers are worried that this will lock patients into the idea of constant access without any acknowledgement of staff shortages or the reality of managing workload safely.

A Practice Manager from a rural practice in Cumbria said the change ignores local realities. They explained that their practice flexes services to match the rhythms of the community, with higher demand during the tourist season but long stretches where walk-in access isn’t needed. “For us, keeping the doors open all day just doesn’t make sense,” they said. “Our patients need flexibility – like being able to phone if they’ve had an accident on the farm late at night – not a rigid mandate dreamed up by civil servants who don’t understand how we actually work.”

One Practice Manager was equally blunt: “It feels like we’re being set up to fail. Patients are being told they can turn up, call or submit online requests at any point, but we don’t have the staff to deal with that. Something will give – and its usually staff morale.”

Another said their immediate priority would be to review staffing at the shoulders of the day, but even that was proving difficult. “We’re already short-staffed, so extending cover is near impossible. We’ll have to look at whether we can pool resources with other local practices, but that takes time to arrange.”

Others are adopting a wait-and-see approach. “Until the BMA issues guidance, we don’t know what’s enforceable,” one Practice Manager pointed out. “In the meantime, I’ll be documenting every rota change and every extra cost so we can evidence the impact.”

Practical steps are emerging, though most are survival tactics rather than solutions. Some practices are talking to their ICBs early to flag the risks, while others are mapping patient demand across the day to see where the pinch points really lie. “If we can show the data, we might be able to argue for more flexible arrangements,” a Practice Manager explained.

What’s clear is that this “variation” is not seen as a small technical edit. For Practice Managers, it represents a significant operational challenge that will make an already pressured job even harder. October looks set to bring yet another round of difficult decisions about how to balance contractual compliance with safe and sustainable patient care.

306 Medical Centre – Our Perspective and approach.

At 306 Medical Centre we are adopting a pragmatic approach whilst we wait for these changes to embed and have a clearer understanding of any impact if any, this may have on our current service provision.

We are open on weekdays from 8am-6.30pm, when our doors are open and our phones are answered. We currently provide online access using online triage tool, webform to contact us, both available on our website and email access too, during these core times.

We have no plans to make any changes at this stage as we feel the changes required may not necessarily impact on our access as we have had these arrangements in place for some time now and meet the requirements as they were implemented some years ago, as part of our patient focused approach.

The only change we may consider making is reviewing our online access, as we are aware most practices only facilitate online access using the online triage tool, whilst we give our patients choice with email access and a webform online to contact us. We may consider this if we are monitored for online access, if our email and webform data is not taken into consideration and we are unfairly penalised. However, we strive to ensure our patients have a good experience with us so any decision will be carefully considered to ensure the quality of our patient access is maintained and works effectively for all our patients.

We hope that our patients can help us to help them by being understanding and using our services responsibly.