Medicine and Science from The BMJ What should GP's make of the new NHS contract?
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Mar 12, 2026 Dr Katie Bramall, Chair of the BMA’s General Practitioners Committee and practising GP, speaks passionately about the new NHS GP contract. She highlights uncapped online consultations and shifting referral duties back to general practice. She warns this could fracture continuity of care, strain GP–consultant relationships, and jeopardise workforce recruitment and local leadership.
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Unlimited Online Consultations Create Unsustainable Demand
- The imposed contract forces unlimited uncapped online consultations and urgent requests onto GPs, increasing demand without safeguards.
- Katie Bramall warns this creates 24/7 digital triage work, undermining planned care, continuity, and safety in general practice.
Advice And Refer Risks Trapping GPs In A Doom Loop
- Contractualising advice and guidance plus 'advice and refer' removes GPs' effective right to refer and shifts decision-making to hospitals.
- Bramall calls this a 'doom loop' that traps GPs in firefighting and rationing care rather than prevention.
Digital Referrals Are Causing Repeated Poor Advice
- Siloed systems and clunky electronic referral services degrade referral quality and repeat advice between primary and secondary care.
- Bramall describes copy-paste templates and consultants unable to see prior guidance, worsening patient experience.