GPs in England overwhelmingly rejected new contract changes that would expand patient access, as NHS England reported record levels of GP activity driven in part by a surge in online consultations. 

In a ballot organised by the British Medical Association (BMA), 98.9% opposed the proposals, which the union said would increase workload in already understaffed practices by driving additional demand.

GP leaders have argued that easier digital access can increase demand beyond what practices can safely manage, intensifying workload pressures.

The contract changes would mandate unlimited same-day urgent appointments and unlimited online consultation requests, and would introduce rules affecting hospitals’ acceptance of GP referrals to specialists, according to the BMA.

The BMA’s GP committee (GPC) for England said the new contract would stretch GP services more than ever before, unless the government changes course.

GPC England chair Dr Katie Bramall said the ballot was “an unequivocal rejection from GPs across England.” The referendum had a turnout of 55.1%, with 16,586 of 16,764 votes (98.9%) for "reject" and 178 (1.1%) for "accept."

“The government cannot ignore the strength of feeling from a profession that is already at breaking point,” Bramall said.

However, a Department of Health and Social Care spokesperson said the vote was “not representative” of GPs across the country who “want to make general practice fit for the future.”

Online Access Drives Record Demand

At the same time, NHS England (NHSE) reported record GP activity, including 8.6 million online consultation submissions in February, up 85% year on year.

Dr Amanda Doyle, NHSE national director for primary care and community services, said this reflected practices now offering patients online contact options, helping reduce the so-called “8 AM scramble” to book appointments by phone.

The ballot followed rejection of the new deal by GPC England at a meeting last month, after the BMA criticised the government for broadening negotiations beyond GPC England to include a wider group of stakeholders.

Instead, the government had sought input from Healthwatch England, the Institute of General Practice Management, the National Association of Primary Care, National Voices, the NHS Confederation, and the Royal College of General Practitioners.

Call for Renewed Negotiations

The BMA said the deal would increase workload in already understaffed practices and called on the government to return to negotiations to agree on a new contract.

Bramall said mandating unlimited access without the staff, time, or infrastructure needed to deliver it was “not a plan but a fast track to collapse GP services.” She warned it could push some GPs to leave the profession or consider private provision.

The BMA said the contract, due to be imposed from 1 April, would require practices to do “more with less,” including responding to consultation requests even when working at full capacity.

It also pointed to a longer-term decline in GP partners, with more than 6000 leaving since 2015, adding to pressure on services.

Wider Dispute Over Pay and Conditions

The union also criticised a proposed 3.5% pay award for doctors recommended by the doctors’ and dentists’ pay review body (DDRB), which the government has since accepted.

Resident doctors in England have announced 6 days of further strike action, continuing a separate dispute over pay and jobs.

Health Secretary Wes Streeting said this was "deeply disappointing" following months of talks and urged the BMA to reconsider its position.

Dr Sheena Meredith is an established medical writer, editor, and consultant in healthcare communications, with extensive experience writing for medical professionals and the general public. She is qualified in medicine and in law and medical ethics.