General Practice in England

Health policy is devolved. The information in this briefing applies to England unless otherwise stated. General practitioners (GPs) refers to GPs in the NHS unless otherwise stated.

What do GPs do?

GPs are expert medical generalists. They are often the first point of contact for medical advice and treatment for their registered NHS patients. Most general practices in England are part of a primary care network, working together with other local health and social care providers to provide coordinated care and an extended range of services.

How many GPs are there in England?

At the end of February 2026, there were 39,086 full-time-equivalent (FTE) NHS GPs in England, according to data from NHS England. The FTE measure takes into account whether GPs work full-time or part-time.

In December 2025, FTE GPs (including those on training grades) were responsible for an average of 1,671 registered patients each.

GPs make up only a quarter of staff in general practice. A range of other staff groups also provide general practice healthcare and support services.

How are GPs funded?

GPs provide services to the NHS independently through a contract. This means general practices operate like businesses, and many GPs are responsible for running their own practices either alone or in partnership with other GPs.

General practices are funded by the NHS and have various income streams from the NHS. The government has said between 50% to 60% of a practice’s income comes from funding to deliver its core contractual arrangements (such as identifying and managing illnesses, providing health advice and referral to other services). Other NHS funding sources for general practices include:

• incentive schemes (such as the Quality and Outcomes Framework where practices get extra payments for managing chronic conditions or public health concerns),
• extra service provision,
• or funding from primary care networks.

GP partners are self-employed independent contractors, rather than NHS employees. Salaried GPs are mostly employed directly by GP practices. As businesses, general practices have the freedom to set the pay and terms and conditions of their workforces.

What changes were made to the GP contract in 2026/27?

Usually, the government negotiates annual contractual changes with the British Medical Association (BMA) general practitioners committee England (GPCE), the professional body representing GPs in England. This year the government consulted with a wider range of stakeholders, including National Voices (a coalition of health and care charities), and the Royal College of GPs.

The GP contract for 2026/27 was published in February 2026. It came into effect from 1 April 2026.

The government has increased the GP contract by £485 million, bringing the total contract value to £13.863 billion. It said this is a 3.6% cash growth, or 1.4% real-terms growth. This is a smaller increase (in both cash and real terms) than the £969 million increase in 2025/26.

Improving patient access to GP services

Changes in the 2026/27 contract include measures to improve patient access to GP services. For example, under the changes, general practices must provide patients with a same-day response for all urgent requests. Contract changes also focus on public health prevention, such as extra financial incentives for general practices to support increasing childhood vaccination rates and reducing obesity.

Advice and Guidance

‘Advice and Guidance’ is when a GP seeks specialist advice from secondary care before, or instead of, making a referral. It can help a GP to decide on treatment plans, how to interpret results or if it is appropriate to refer a patient. Under the 2026/27 GP contract changes, it is mandatory for GPs to use Advice and Guidance “where clinically appropriate” and following any locally agreed referral pathways.

There have been mixed stakeholder reactions to making Advice and Guidance mandatory for GP practices, with some stakeholders raising concerns that it could affect patient safety through delays or blocked referrals, or increase the workloads of GPs.

Opposition

GPs and GP registrar BMA members voted to oppose contractual changes, following a referendum on 26 March 2026.

The BMA GPCE is concerned that contractual changes will increase GPs’ workloads. It supports a pause in new requirements for GP practices to provide a same-day response for all urgent requests and to mandatorily use Advice and Guidance. It has said that it may escalate to collective action if these conditions are not met before 30 April 2026.

What are the concerns about the GP workforce?

There have been longstanding concerns about the recruitment and retention of GPs, and about overwork and low morale within the GP profession. Particularly in the past few years, there have been increasing reports about newly qualified GPs struggling to find jobs within GP practices.

In 2019, the government introduced the Additional Roles Reimbursement Scheme (ARRS) to increase capacity, alleviate GP workload and help solve the workforce shortage in primary care in England. The government added recently qualified GPs to the ARRS from October 2024 to aid with workforce numbers and address rising reports about newly qualified GPs struggling to find jobs. The 2026/27 GP contract expanded the ARRS further to include experienced GPs.

Alongside reports about GPs struggling to find jobs, there have been ongoing concerns about patients struggling to access GP services since the pandemic, which increased pressures and patient dissatisfaction about the difficulty of accessing services.

Improving access to general practice is one of the key priorities for the public. In the last year, various survey results have shown that although access to GP appointments continues to be a concern, there has been a small increase in people reporting they are finding it easy to access their GP service.

The government has introduced various measures in the last year to improve access, including mandatory requirements for patients to be able to request non-urgent appointments online within core hours. The 10 Year Health Plan, published in July 2025, also contains various measures for improving access to primary care, such as training more GPs and using technology to make it easier for patients to book appointments.

Who are GPs accountable to?

Responsibility for commissioning primary medical services has been delegated from NHS England to integrated care boards (ICBs) since they replaced clinical commissioning groups (CCGs) on 1 July 2022.

GP practices are accountable via their contractual arrangements to ICBs and to NHS England, which is in turn accountable to the government and to Parliament.

Who is responsible for GP infrastructure?

As independent businesses, GP partners are responsible for making decisions about what infrastructure their practices need. General practices can receive funding from NHS England and ICBs towards improving their infrastructure and estates.

The 2024 Autumn Budget announced £100 million to support 200 GP estate upgrades in 2025 and 2026 across England, as well as to improve the use of existing buildings. This is called “The Primary Care Utilisation and Modernisation Fund 2025 to 2026”.

What challenges are there for the future of general practice?

With a growing and ageing population and an increase in long-term chronic conditions, health demands are increasing and the work of general practice is becoming more complex.

In its vision for a neighbourhood health service that can better meet rising health demands, the government has recently outlined new joined-up ways of working. Under the 10 Year Health Plan, new and repurposed ‘neighbourhood health centres’ will bring together GPs and a range of other healthcare professionals under one roof, offering a range of services and staying open in evenings and on weekends. The government will also introduce two new alternative contracts for GPs. In the coming months, NHS England will consult on how the new contracts will collaborate with existing GP contracts.

There are questions about how these changes will affect GP practices and the existing partnership model. At the same time, there are continued questions about the sustainability of the GP partnership model, calls to reform GP funding and questions about what the future of general practice might look like.