GP leaders reacted in anger last night after being served notice of GP contract changes, which they said they had not agreed.

The latest rift with NHS England increases the risk of GPs triggering protest action, which they are thought to have supported in a vote last year. The latest changes will require some practices to open on Saturdays between 9 to 5 – although this will be organised through primary care networks rather than practices and is expected to be in place by October. There will also be practices with evening opening up to 8pm.

The British Medical Association said it had been pressing for changes to reflect the extra pressures on practices triggered by the pandemic. These included funding for national insurance increases and a “funded” pandemic recovery plan to reflect the hopes of the NHS elective recovery plan. It revealed it had reached stalemate with NHS England a few weeks ago – but then obtained a meeting with Health Secretary Sajid Javid.

According to the NHS England letter to practices, the main changes to the contract include a requirement that at least 25% of appointments are available for on-line booking. NHS England says it is merely implementing the terms of a five year deal with the BMA agreed in 2018.

Its letter says: “As we look ahead, the needs of our populations and patients necessitates that the primary focus of general practice returns to addressing non-COVID needs. In particular this needs to be on long-term condition management and chronic disease control, ensuring timely access for patients with urgent care needs, and regaining momentum on the wider Long Term Plan prevention agenda.”

BMA GP committee chair Dr Farah Jameel said: “We are bitterly disappointed that NHS England has chosen to ignore the appeals from the profession and the needs of patients in today’s letter.

“Despite our best efforts to outline a number of positive and constructive solutions that would make a difference to practices’ ability to improve care for patients, NHS England has instead decided to follow a path laid out three years ago, long before the arrival of COVID-19, and roll over a contract that fails to address the current pressures faced by general practice. Failing to offer practices something as simple as reimbursement to cover additional costs for national insurance contributions means they are losing funding that should be going towards looking after patients. Therefore, a tax aimed at funding the NHS, has become a tax on the NHS itself. The result will be fewer members of staff to care for the growing needs of patients.

“Today’s letter attempts to sell the changes as stability. Whilst stability is important, the reality is that general practice needs an emergency rescue package. Without this emergency life support, patient care will suffer. The waiting lists currently seen across the NHS are now going to become more of a reality in general practice. We approached this year’s negotiations in good faith, recognising the need to uphold previous agreements but striving for improvements in patient care. Today’s letter, presented to us with only a few hours’ notice, defies everything we were aiming to achieve in building a constructive relationship and sits at odds with positive conversations with government.

“GPs and practices will see today’s changes as devaluing their goodwill and demolishing their spirit. The letter does nothing to capture the scale of changes needed nor safeguards patients, and further highlights the need for a new contract that delivers high quality safe care in the new world we live in.”