Prof Andy Brooks
Clinical Chair
NAPC
How did you feel at the end of last week? Results still to file, letters to read, prescriptions still to authorise, and a number of important conversations that would have been great to have about how to improve what we do every day in general practice. As a GP, I know how that feels and that context matters, because any conversation about the future GP contract has to start from the reality of general practice as it is now.
Most practices I know are not short of ambition. We care deeply about continuity, prevention, neighbourhood working and population health. What we are short of is headroom. Demand is relentless, complexity is rising, workforce gaps persist, and even small additional requirements can tip a stretched system into firefighting mode.
So, when we talk about the proposed direction of the GP contract, the first question we should be asking is ‘how will it help?’
A moment to reset the relationship
What’s striking in the current policy discussion is that this contract could be more than a list of tweaks and targets. It could signal a more grown-up relationship between national bodies and general practice — one that recognises professional judgement, trusts local leadership, and is honest about capacity.
From a GP perspective, there’s real value in the stated intention to simplify expectations, clarify what really matters, and reduce unnecessary friction. That matters not just for morale, but because clarity is what allows practices to plan, invest and innovate rather than constantly react.
But realism is key. Any new requirements — even well-intended ones — need careful pacing and prioritisation. Without that, they risk becoming the proverbial straw that breaks the camel’s back, rather than the foundation for reform.
Neighbourhood care: accountability needs support
The shift towards neighbourhood-based models of care feels directionally right. As GPs with our professional colleagues, we are well placed to provide clinical leadership across neighbourhoods — holding continuity, understanding population need, and coordinating care for patients whose lives don’t fit neatly into organisational silos.
But accountability cannot be one-way. If general practice is expected to lead, that leadership has to be matched with capacity, capability and clear resourcing. Investment in clinical leadership time isn’t a “nice to have”; it’s essential infrastructure.
Continuity and relational care become more important, not less, as patient cohorts grow more complex. Workforce rules therefore need to support flexible, skills-based teams that reflect local need — not rigid role definitions that lock us into yesterday’s models.
Workforce flexibility that actually helps
There has been welcome intent around greater workforce flexibility, particularly through changes to ARRS. From the consulting room, the issue is whether we can shape teams around the needs of the people and populations we actually serve.
A shift from job titles to a population needs → skills → roles mindset would be a genuine step forward. That could enable practices to invest in digital support, behavioural health, community health and wellbeing, and analytical capacity — all of which matter if we are serious about prevention and proactive care.
The risk is that baselines and rules accidentally freeze innovation. If we want general practice to evolve, the contract needs to make space for that evolution rather than constrain it.
Access, continuity and what patients actually value
Access matters — no GP disputes that. But access divorced from continuity and coordination risks becoming transactional and, frankly, unsafe for our most complex patients.
In daily practice, the patients who benefit most are those who are known: by a clinician, by a team, by a system that understands their history and context. Team-based continuity, proactive neighbourhood approaches, and measures that focus on outcomes and experience — rather than raw activity — are far more likely to improve care in a meaningful way.
Reducing the drip-drip of transactional burden
One of the quiet truths of modern general practice is that workload doesn’t come from one big thing. It comes from the accumulation of dozens of “small” tasks — extra data flows, additional reporting, minor administrative requirements — each individually defensible, collectively overwhelming.
A genuine commitment to reducing low-value transactional burden would be transformative. Freeing up time and cognitive space is how we improve quality, safety and patient experience — not by layering on ever more micro-requirements.
A more mature approach to quality and prevention
There is an opportunity to move quality frameworks away from narrow, transactional targets towards population-level outcomes, person-centred care and high-quality decision making.
From the consulting room, good care is about judgement, shared decisions and understanding what matters to the patient — not just ticking boxes. A stronger focus on prevention, patient agency and relational care is more likely to deliver sustainable system benefits than an endless expansion of indicators.
Supporting change, not just demanding it
Transformation doesn’t happen by mandate alone. Practices will need ongoing, practical support — for workflow redesign, digital enablement, organisational development and neighbourhood working.
Crucially, that support needs to recognise different starting points. One-off initiatives won’t cut it. Continuous, accessible support is what enables real improvement in a pressured system.
Collaboration has to be reciprocal
Neighbourhood working lives or dies on relationships. Time spent building trust, aligning across organisations and agreeing how work is shared is real work — and it needs to be recognised. This is true whether with commissioners or providers.
Collaboration that feels like compliance erodes goodwill. Collaboration based on reciprocity, clarity and appropriate resourcing builds the foundations for better care.
Looking ahead with cautious optimism
As a practising GP, I’m realistic about the pressures we’re under. But I’m also optimistic about what general practice could be if national policy creates the right conditions.
The direction of travel — towards neighbourhood care, person-centred outcomes, workforce flexibility and reduced transactional burden — is promising. Whether it succeeds will depend on pacing, prioritisation and trust.
If the GP contract can genuinely support professionalism, continuity and local leadership — rather than simply adding more weight to already heavy shoulders — then it could mark the start of a more sustainable and hopeful chapter for general practice.
And that’s something both GPs and patients desperately need.
At NAPC we are continuing to develop our thinking about the future for general practice. If you would like to be part of this then please join NAPC and share your thoughts.
