GP Contract Dispute: Could Doctors Legally Breach NHS Contracts?
The long-running tensions between GPs and the Government have escalated into a formal dispute — one that could soon test the boundaries of contract law within the NHS.
The British Medical Association’s (BMA) General Practitioners Committee (GPC) England has officially declared a dispute with Health Secretary Wes Streeting, citing fundamental disagreements over online consultation requirements, data access, and the Government’s 10-year plan for primary care.
While disputes between the medical profession and government departments are not new, this one stands out for its tone — and its legal implications. The BMA’s GP chair, Dr Katie Bramall, has openly stated that GPs may be encouraged to “breach their contracts” if the Government refuses to negotiate, a statement which immediately raises questions about contractual liability, public safety duties, and the lawful limits of industrial action.
The legal backdrop: NHS GP contracts as public-law instruments
Unlike ordinary commercial contracts, General Medical Services (GMS) contracts and Personal Medical Services (PMS) agreements are hybrid legal instruments — partly private contracts, but also heavily regulated by statutory frameworks.
This means that any deliberate breach, even if politically motivated, could have disciplinary, regulatory, and financial consequences beyond the normal civil law remedies.
Under the National Health Service Act 2006, NHS England can issue a breach notice or ultimately terminate a GP’s contract if obligations are not met. Practices that “switch off” online access systems — the act at the heart of the current dispute — could be deemed in violation of contractual terms related to patient access and safety.
However, the BMA argues that the contracts themselves have become unsafe due to unrealistic digital workload expectations. This introduces a nuanced legal debate: can a healthcare provider refuse to perform certain obligations if doing so would compromise patient safety or staff wellbeing?
The dispute: what triggered it?
On 1 October 2025, the BMA’s GPC England formally notified the Department of Health and NHS England of a collective dispute.
The union’s position is that recent contractual changes — particularly those mandating continuous online consultations and digital write access through GP Connect — expose practices to excessive risk and liability.
Dr Bramall told members that to resolve the dispute, the Government must:
- Provide written assurance that practices will not face breach notices when diverting urgent same-day patient requests to telephone or walk-ins.
- Collaborate with the BMA and GP IT Committee to ensure online tools include safeguards for triaging urgent cases.
- Address liability concerns linked to “write access” functions in patient data systems.
- Commit to a transparent roadmap for a new GMS contract and clear funding envelopes beyond 2027.
In other words, the BMA is challenging not just the letter of the contract, but its practical enforceability under real-world conditions.
“Nothing is off the table”
In an exclusive interview with Pulse Today, Dr Bramall stated that the BMA’s next steps could include:
- A judicial review of the 2024–2025 contractual changes.
- A ballot for industrial action, potentially including a coordinated breach of contract.
- Or, less drastically, collective non-compliance measures similar to those taken in 2024.
The BMA has already instructed a King’s Counsel (KC) to explore grounds for judicial review, arguing that NHS England’s imposition of online consultation requirements may have been “unreasonable” or procedurally flawed.
A successful judicial review could force the Government to revisit or suspend the disputed provisions, though such proceedings often take months — or years — to conclude.
Nevertheless, Dr Bramall emphasised that pursuing judicial review would not delay other escalation measures, confirming that “nothing is off the table”.
What does a “contract breach” mean in this context?
In legal terms, a breach of contract occurs when a party fails to perform its contractual obligations without lawful excuse.
However, within the NHS framework, intentional breaches as a form of protest would be unprecedented in scale. The BMA has suggested that GPs might temporarily disable online access systems or divert patient queries when capacity is exceeded.
While such acts could technically constitute a breach, the legal consequences would depend on:
- The terms of the individual practice’s GMS or PMS agreement, including any clauses concerning patient access and safety.
- The regulatory oversight of NHS England, which has discretion to issue warnings or breach notices.
- The context and proportionality of the action — for example, whether it was taken to prevent patient harm or under extreme workload conditions.
If tested in court, practices might argue “frustration of contract” or necessity, claiming that compliance was impossible without breaching patient safety obligations. However, such defences have limited precedent in healthcare contract law and would be risky without explicit legal guidance.
Industrial action and the law
Industrial action within the NHS is governed by strict legal frameworks under the Trade Union and Labour Relations (Consolidation) Act 1992 (TULRCA).
Before any strike or coordinated action, the BMA must hold a lawful ballot among members. Failure to comply with procedural requirements — such as notice periods or voter eligibility — could render the action unlawful, exposing both the union and participating doctors to civil claims or disciplinary proceedings.
The BMA’s approach appears cautious: Dr Bramall mentioned the possibility of an “indicative ballot” to test appetite for action before any formal vote.
If members approve escalation, options could range from symbolic protest to partial withdrawal of services, such as refusing certain administrative tasks or online consultation duties.
While the BMA insists that patient safety remains the priority, NHS England could argue that any refusal to meet contractual obligations constitutes misconduct, regardless of intent.
Judicial review: a parallel legal route
Alongside potential industrial action, the BMA is exploring judicial review — the mechanism by which courts assess whether a public body has acted lawfully.
For a claim to succeed, the BMA must show that NHS England or the Department of Health:
- Acted beyond their statutory powers (ultra vires);
- Failed to follow proper consultation processes;
- Or made decisions that were irrational or unreasonable (the Wednesbury test).
If the court finds procedural or substantive unfairness, it could quash the disputed policy or require reconsideration. However, judicial review does not award damages — it is about legality, not compensation.
From a legal standpoint, this strategy allows the BMA to challenge policy without requiring GPs to break the law, potentially providing leverage in negotiations.
The Government’s position
Health Secretary Wes Streeting has rejected the BMA’s claims, describing some GP leaders as “turning the NHS into a 20th-century museum”.
He insists the digital reforms are designed for “maximum convenience for patients”, arguing that online consultations and data access are essential to modernising primary care.
Primary Care Minister Stephen Kinnock told Pulse he was “mystified” by the dispute, stating that NHS reforms aim to simplify patient journeys, not to overburden clinicians.
The Government’s rhetoric, however, has been described by Dr Bramall as “tone-deaf” and “inflammatory”, deepening mistrust between policymakers and practitioners.
Contract law perspective: the tension between performance and protection
From a contract law standpoint, this conflict highlights a fundamental tension between the duty to perform contractual obligations and the right to withhold performance when those obligations become unsafe or unreasonable.
In most private contracts, parties can rely on doctrines such as:
- Impossibility or frustration, where unforeseen events make performance impossible;
- Repudiatory breach, allowing one party to terminate the contract due to serious non-performance by the other; or
- Good faith, an emerging principle requiring both sides to act honestly and fairly in enforcing contract terms.
However, NHS contracts are not purely commercial. They are statutory service agreements, where the public interest and patient safety are overriding considerations. Courts are likely to interpret GP obligations strictly, especially where patients’ access to care is affected.
That said, NHS England also owes duties under public law principles — including fairness, proportionality, and reasonableness — meaning its enforcement actions could themselves be subject to legal challenge if deemed excessive.
Could this set a precedent?
If the dispute escalates to court action, it could set a precedent for how public-sector professionals challenge statutory contracts.
Questions that may arise include:
- Can doctors lawfully “breach” their NHS contracts in protest if they believe compliance endangers patients?
- Do public-sector contracts allow a “right of conscience” or “professional judgment” defence?
- How far can trade unions shield members from liability during coordinated breaches?
These are largely untested questions — but their answers could reshape how collective bargaining functions within regulated professions.
What practices should know now
Until formal legal guidance or a new agreement is reached, GP practices should:
- Review their GMS or PMS contract terms, especially clauses on patient access, IT systems, and data handling.
- Keep written records of workload pressures or safety risks that could justify temporary service changes.
- Seek legal advice before disabling online access tools or deviating from NHS requirements.
- Monitor BMA updates for official ballots or legal findings from the judicial review process.
- Engage with Local Medical Committees (LMCs) for region-specific advice and representation.
If NHS England issues breach notices during this period, practices may challenge them under contract dispute resolution clauses or through public-law remedies such as judicial review.
Conclusion
The standoff between GPs and the Government represents more than a workplace dispute — it is a live test of how far professional autonomy extends under statutory contracts.
Should the BMA proceed with coordinated breaches or judicial review, the outcomes could redefine the legal boundaries of collective action within the NHS.
For now, both sides remain entrenched: the Government insists digital reforms are essential, while GPs argue that relentless compliance is unsafe and unsustainable.
Between them lies a complex legal question — one that could determine how much freedom public-sector professionals truly have when the law itself becomes part of the dispute.
Disclaimer: This article is for general information purposes only and does not constitute legal advice. For guidance on NHS contracts or professional disputes, contact our specialist solicitors at Parachute Law UK.
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