England General practitioner Practice manager

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Retention of national core contract for general practice that provides a high-quality service for patients


A decade of underfunding has contributed to the destabilisation of practices, leading some to believe that there is a national strategy to encourage GPs into alternative contractual models. Some practices have had to take this step to guarantee future sustainability. This has led to doctors being unwilling to commit to becoming partners due to uncertainty, and has significantly impacted on the recruitment and retention of GPs. It also leaves practices reluctant to invest for the future, particularly in premises developments.



The national GMS contract underpins fair, consistent and high quality health service delivery for patients across England. The stability of a national contract and an independent contractor arrangement has resulted in general practice being rated higher than other organisations in the NHS and social care system.

The partnership model encourages doctors to commit to working with communities long-term, with business owners on the shop floor meeting patients every day and responding to their needs.

It’s a system that leads to continuity of care, with GPs fully understanding their patients’ needs and when necessary, acting as an advocate on their behalf in an increasingly complex system. Breaking this personal relationship between local communities and GPs risks a costlier service that loses the support of the public.



  • An ongoing commitment to the national GMS contract and the independent contractor status
  • The development of future working at scale models to be built on the foundation of registered lists and the GMS contract
  • The enabling of collaborative working across local healthcare systems that removes barriers between organisations and contributes to the creation of primary healthcare teams, rather than attempting to establish a single employing body
  • New regulations to enable practices to provide non-NHS services to their own patients
  • Use of the GMS contract rather than an APMS contract when new GP practices are established
  • A fully funded and integrated urgent care service that provides consistent and safe care to patients both in and out of hours
  • A commitment to support integrated service development for unscheduled care, and close engagement with OOH service leads
  • An established set of national terms and conditions for all doctors working in accountable care organisations and systems
  • A contract that provides time for GPs to continue to develop professionally and to use and enhance their skills in management, teaching and research


Outcome for patients

The retention of a national core contract for general practice will provide patients with a guaranteed high standard of care. It will also provide continuity and certainty that the needs of patients can be met regardless of postcode, provided by GPs that they know and trust.

Integrated urgent care services should work in partnership with local GP out of hours services to ensure patients benefit from the years of experience these services have in delivering high quality care, despite workforce and funding pressures.


Next: Premises, infrastructure, support


Saving general practice

With an insufficient workforce, a funding plan that is no longer sustainable, a growth in population and a sea-change in the level of complex cases being presented, urgent steps need to be taken to save general practice.

Key areas