Waiting Lists, Politics, and the Real Issues Behind the GP Contract Overhaul

When the Government announced its latest overhaul of the GP contract, headlines focused on investment, modernisation, and improving access to primary care. But senior doctors are questioning whether the narrative obscures the real challenges facing general practice—and patients—across England.

Dr Katie Bramall-Stainer, chair of the General Practitioners Committee (GPC) England, recently joined Kamran Abbasi, editor in chief of the British Medical Journal, to discuss the new contract arrangements. In their conversation, she highlighted how political messaging around waiting list management can distract from fundamental issues affecting GP services.

“You can see why the default – ‘we’re taking you off the waiting list’ – is complete political maneuvering here,” Dr Bramall-Stainer explained. The comment points to a broader tension: whilst the Government frames its investment as a solution to access problems, GPs argue that the underlying financial and structural issues in general practice remain unresolved.

The dispute over GP contracts has been building for years. The previous five-year GP contract, agreed in 2019, set funding increases at approximately 2% annually—a level GPs argued did not keep pace with inflation or rising practice costs. When that contract expired in 2024, the Government initially offered just 1.9% uplift to baseline funding, whilst other NHS services received 6% increases. This sparked significant friction between the BMA and NHS England.

GPC England, under Dr Bramall-Stainer’s leadership, voted to hold a ballot of GP partners on collective action. The decision reflected wider frustration within the profession about pay erosion and the sustainability of general practice services. GPs argued they needed a new long-term contract framework that would genuinely revitalise the profession, not a series of short-term adjustments.

In response to the dispute, the Government announced a new GP contract for 2025/26 that includes significant investment. There will be £969 million of new funding, comprising £889 million in additional core contract funding and £80 million for electronic referral system advice and guidance between GPs and consultants. This represents 7.2% cash growth, or 4.8% in real terms, compared with the previous year.

The investment addresses several key areas. The Additional Roles Reimbursement Scheme (ARRS)—which helps practices employ additional staff such as practice nurses and clinical pharmacists—has been expanded to include GPs themselves for the first time, with minimum salary reimbursement increased in line with BMA pay ranges. The Quality and Outcomes Framework (QOF), a system of financial incentives tied to practice performance, has been reformed: 32 indicators worth 212 points have been permanently retired, and funding has been redirected towards nine cardiovascular disease indicators.

The contract also includes restoration of Statement of Financial Entitlements (SFE) payments for sickness and parental leave cover, with reimbursement rates returning to 2025/26 real-terms values compared to 2018/19 levels.

However, Dr Bramall-Stainer’s comments suggest that the way this investment is being presented—particularly around waiting list management—misses the point about what general practice actually needs. The Government has framed improved access and waiting list reduction as central to the contract. From October 2025, all GP practices in England must keep online booking open throughout working hours (8am to 6:30pm), with no appointment gaps.

Whilst improved access is important, GPs warn that access problems are not simply about booking systems or opening hours. General practice faces deeper challenges: staffing shortages, practice closures in some areas, unsustainable workloads, and the cumulative effect of years of underfunding relative to inflation and rising patient demand. A new booking system cannot resolve these structural issues.

The concern is that by focusing the political narrative on waiting lists and access technologies, policymakers can claim success whilst the underlying viability of general practice as a profession remains uncertain. This is why Dr Bramall-Stainer described the “waiting list” framing as “political maneuvering”—it projects an image of action on a headline issue without necessarily addressing why those waiting lists exist in the first place.

The BMA has stated that it will not accept another multi-year contract deal on the current financial trajectory. The organisation has called for a new long-term contract framework as part of the Government’s 10-year NHS plan. Without such a framework, GPs fear a pattern will repeat: short-term agreements, ongoing disputes, and continued professional burnout.

For patients, the implications are significant. If general practice continues to operate under financial and staffing constraints, improved access through online booking may simply distribute the same limited capacity across more channels. GPs warn that the profession needs genuine investment in workforce development, infrastructure, and sustainable working conditions.

Key Takeaways

• The Government’s new GP contract includes £969 million in additional investment for 2025/26, but senior GPs question whether political messaging about waiting lists addresses fundamental problems in general practice.
• The contract reforms the Quality and Outcomes Framework and expands the Additional Roles Reimbursement Scheme, but GPs argue these changes cannot resolve years of underfunding relative to inflation.
• The profession is calling for a long-term contract framework as part of a 10-year NHS plan, warning that short-term agreements perpetuate instability and professional burnout.

What This Means for Kent Residents

Kent residents relying on GP services through Kent and Medway NHS Trust and other local providers should understand that headline improvements in online booking access do not necessarily reflect deeper changes to GP capacity or availability. Whilst the investment announced is welcomed by the profession, GPs across Kent continue to work under significant pressure. If you are experiencing difficulties accessing your GP surgery, contacting NHS England’s primary care team or your local Integrated Care Board may help identify alternative services. For urgent health concerns, the NHS 111 service remains available, and patients can also explore community pharmacy services for minor ailments. Longer-term resolution of general practice challenges will depend on whether the Government commits to the multi-year funding framework that GPs have been requesting.