These attempts to improve access – the ARRS, extended hours, Pharmacy First and Modern General Practice – are all embedded in the healthcare system now, even if we haven’t yet seen formal evaluations of them all yet. But they were all introduced under the Conservatives.
The Labour Party entered government in July 2024 with three priorities for the NHS: moving care from hospitals to the community; moving from analogue to digital; and moving from sickness to prevention. It laid out how it would do this through the 10 Year Plan, published in July 2025. Although it is yet to enact these plans, it is worthwhile considering what the government is planning for GP access, and what the initial response has been from the profession.
GP access is front and centre of the plan. ‘Many cannot get a GP or dental appointment’ was the first bullet point of the executive summary. There were five mentions of the ‘8am scramble’. It said that ‘GP access has become so poor that A&E has become some people’s de-facto primary care, particularly in more disadvantaged areas, where there are far fewer GPs per head.’ And it vowed to ‘restore GP access’.
The solutions it was offering around GP access included:
- The introduction of two new contacts, which will see GPs working across larger geographies;
- Using the ‘My NHS App’ to allow patients to find the most appropriate service and incorporate AI-powered online advice;
- Increase the proportion of staff trained for community and primary care roles;
- Cut bureaucracy to free up GP time.
There wasn’t much detail on any of these. On the recruitment aspect, it said it was going to publish a 10 Year Workforce Plan later in 2025, which will supersede NHS England’s 2023 plan.
Around bureaucracy, the 10 year plan said it will ‘support providers to roll out technology to cut unnecessary administrative and clerical work’. It highlighted the use of ambient voice technology’, or AI scribes, that is says saves 90 seconds for every consultation. Anecdotally, GPs have said they have found these tools to be very useful. But, in a case in point of how the NHS sometimes works, many practices have ditched the technology after NHS England guidance seemed to restrict its use.
Neighbourhood health service
The major proposed change to general practice came in the form of neighbourhood health centres. The 10 Year Plan said in full: ‘Truly revitalised general practice will depend on more fundamental reform. Having served us well for decades, the status quo of small, independent practices is struggling to deal with 21st century levels of population ageing and rising need.
‘Without economies of scale, many dedicated GPs are finding it difficult to cope with rising workloads. Far too often, that means work is causing chronic stress and mental illness among hardworking professionals. Many GPs are voting with their feet: 74% of fully qualified GPs were partners in 2015, compared to just 55% today. Where the traditional GP partnership model is working well it should continue, but we will also create an alternative for GPs. We will encourage GPs to work over larger geographies by leading new neighbourhood providers. These providers will convene teams of skilled professionals, to provide truly personalised care for groups of people with similar needs.’
To achieve this, it proposed the introduction of two new contracts, to be rolled out in 2026. The first will provide enhanced care for a single ‘neighbourhood’, covering around 50,000 people – a similar size to PCNs. The second contract will create ‘multi-neighbourhood providers’, covering around 250,000 people. These larger providers will ‘deliver care that requires working across several different neighbourhoods (eg, end of life care). They will involve shared back-office functions, oversee digital transformation and estate strategy, and provide data analytics and a quality improvement function. They will also be able to take over individual practices who struggle with either performance or finances.
These could signal significant change in the profession. But there is, as yet, little information around crucial aspects. First, whether either contract will replace GMS contracts in the areas they are implemented, or whether the constituent member practices of these neighbourhood centres will retain the nationally agreed contract. Second, there is ambiguity over who will negotiate the contracts, whether they will be entirely locally agreed or whether the national BMA GP Committee will be involved.
To further complicate matters, the NHS 10-year plan introduced the concept of a ‘year of care’ payment, which is a capitated budget that covers all of a patient’s primary care, community health services, mental health, specialist outpatient care, emergency department attendances and admissions care in a year. This would seemingly invite non-GP providers to take on all general practice services.
The Government has said that any of the contracts or models being discussed will be open to GPs. However, South West London ICB has already appointed five hospital trusts to run neighbourhood centres, with the sixth and final area – Greenwich – yet to confirm by time of publication. Meanwhile, LMCs in Staffordshire have advised local GPs ‘not to apply for it – until we have complete confidence that our GMS contracts will be protected’.
On terms of access, there is little evidence provided by the Government around how this will benefit access. The 10 Year Plan refers to helping retention by giving GPs the chance to work in larger organisations, and suggests there will be more opportunities to develop special interests.
But GP and medical profession leaders aren’t convinced. The BMA held an extraordinary special representatives meeting (SRM) to ‘debate the risk of the 10-year plan to the medical profession at large’. While not unprecedented, such SRMs are rare. In the meeting, delegates debated a number of motions that emphasised the threat to continuity of care, with one led by delegates from Manchester [CHECK] saying: ‘Trusts are wholly inappropriate organisations to absorb either the commissioning or operational responsibilities for general practice or neighbourhood health, lacking experience, knowledge, and evidence’ Such a move ‘risks greater system financial deficit, contract instability, and a loss of continuity of care’. Another motion from the Birmingham Division called for the meeting to ‘recognise the importance of independent contractor status of GPs for clinical autonomy, continuity of care, patient advocacy, GP recruitment and sustainable primary care’.
My NHS GP Tool
The other major area for improving GP access in the 10 year plan is through the NHS App and AI. It promises that: ‘By 2028, patients will be able to see who is involved in their care, communicate with professionals directly, draft and view their care plans, book and hold appointments and leave feedback. We will support patients to manage and direct their care digitally through the NHS App. For many people, this will mean they can access all they need from their neighbourhood team. This will include both booking and holding appointments with health professionals through their phone.’iv
It will also provide advice for non-urgent care through ‘AI-algorithms to take a patient’s descriptions of their worries or symptoms, ask the right follow-up questions and provide personalised guidance’. It will advise on self-care, including ‘well-evidenced consumer healthcare products’.
The BMA’s SRM had two distinct camps in terms of the benefits of using AI to improve access, especially through self care. On the one side, there was a motion from the Birmingham Division, which called for the meeting to ‘support the responsible use in the NHS of digital technologies, artificial intelligence and research-led innovation’ and said the BMA should ‘actively engage with and advocate for these developments in all appropriate areas of healthcare and primary care in particular’.
On the other side was a motion from the Buckinghamshire Division, which expressed ‘grave concerns about the Government’s ill thought out, extensive digital and technological aspirations in The 10 Year Plan’. It said that ‘where AI algorithms which have no concurrent clinical input such as My NHS GP’, the Government must ensure it accepted responsibility for ‘underwriting all penalties related to missed diagnoses, misleading advice etc’. It also said ‘that a future NHS reliant on digital and AI programmes for access will worsen the existing digital inequity divide’.
You can find all the data and the methodology in the full report. Click here to download the full report.