GPs in Northern Ireland Say Imposed Contract Has Left Them ‘Angry, Disappointed and Disrespected’

General practitioners in Northern Ireland have said they feel “angry, disappointed and disrespected” after the health minister imposed a new financial contract, triggering a work-to-rule that doctors warn is damaging patient care.

Under the action, GPs are restricting appointments to the recommended safe limit of 25 a day, ignoring non-essential paperwork and withdrawing non-contractual services, the British Medical Association in Northern Ireland (BMA NI) said. Dr Ciaran Mullan, deputy chair of BMA NI and a GP in Strabane, said the continued stalemate with the Department of Health had left clinicians with little option but to take those steps.

The dispute stems from a spring request by the BMA for a substantial uplift to the 2025/26 General Medical Services (GMS) contract. The union asked for an additional £80 million; the Department of Health provided £1 million and later said the minister was imposing the contract because the wider health budget could not meet the full demand in this financial year.

Health Minister Mike Nesbitt has defended his decision, saying he did not seek a confrontation but that the money requested by GPs was not available. The department acknowledged the situation was “regrettable” but pointed to pressures across the health service, including a projected funding gap earlier cited by the minister.

In a statement the Department of Health said the 2025/26 GMS contract included an additional £9.5 million investment, of which about £5 million is allocated to GP indemnity costs. The department said total investment in general practice in 2025/26 would be £414 million.

BMA NI and independent analysts say the dispute is taking place against a wider backdrop of sustained underinvestment and workforce strain. General practice accounted for about 5.4% of Northern Ireland’s health budget in 2023/24, roughly £388 million from an overall health budget of about £7.8 billion, figures provided by the department show. The BMA and other observers point out that the share of funding for primary care in Northern Ireland is lower than in other parts of the UK; in England, for example, primary care receives a larger proportion of the health budget.

BMA NI officials say the funding shortfall is compounded by a falling number of practices and recruitment challenges. Over the past seven years the number of registered patients per practice has risen from about 5,500 to around 6,586, the union said, reflecting practice closures and consolidation. The total number of patients registered with general practice in Northern Ireland is more than two million, a 4.5% rise in seven years.

Dr Mullan described the imposition of the contract as unprecedented and said the way the decision was announced in the Northern Ireland Assembly left many GPs feeling publicly chastised. “We are very unhappy and angry and feel disrespected, especially how it was delivered in the assembly — we’d spent a lot of time in our negotiations,” he said.

Ann Watt, director of the public policy think tank Pivotal, said the minister’s approach was “unprecedented” and warned it “could have a serious impact on patients.” Watt said continued dialogue would have been preferable to what she described as a stalemate.

Recruitment and retention are recurring themes in the dispute. Dr Kate Corrigan, who works on attracting and retaining GPs, said practices are finding it increasingly hard to fill vacancies. One practice cited by BMA NI had seven GPs but now operates with five because of recruitment difficulties, limiting capacity to see patients with complex needs.

The minister has sought to frame the contract decision alongside longer-term reform, announcing a neighbourhood-centred plan in July designed to place GPs at the heart of a reconfigured community health and social care model. Nesbitt said the plan could create opportunities to rework how money flows into community-based services if GPs, pharmacies and other local organisations take on more responsibilities.

The BMA said it had not been consulted about its potential role in the neighbourhood model and the department said the work to develop the approach had only just commenced and was at an early stage. The department added that GPs would have an important role in helping to develop and deliver the model.

With negotiations stalled, both sides said they remained uncertain about a path back to constructive talks. The BMA said mood music had not improved since the contract was imposed in May, while ministers pointed to the limits of the health budget for this financial year. Observers warned that a prolonged impasse could exacerbate access problems for patients already facing longer waits to see primary care clinicians.

The Department of Health said it continued to recognise the importance of general practice and that further engagement would be needed as authorities develop the neighbourhood model. GPs said they were waiting to see whether the department would return to the negotiating table or whether sustained industrial action would be required to press their case.

Healthcare leaders and policy analysts said the dispute underscores long-term pressures facing primary care in Northern Ireland: rising patient numbers, greater clinical complexity, recruitment and retention shortfalls, and a funding allocation that many say has not kept pace with demand. Until those structural issues are resolved, officials on both sides cautioned, tensions over contract terms and resources are likely to persist.

For now, patients and practices face the immediate consequences of reduced non-essential services and tighter appointment limits as the two sides await new movement on talks.