A breach of your GMS or PMS contract occurs whenever your practice fails to meet an obligation set out in the contract, whether that is a missed CQC action, an out-of-date recruitment or safeguarding policy, or a gap in clinical governance arrangements. What happens next depends on whether the breach is capable of remedy, and how your integrated care board (ICB) chooses to respond under Schedule 3 of the National Health Service (General Medical Services Contracts) Regulations 2015 (or the equivalent Schedule 2 of the PMS Agreements Regulations 2015 for PMS practices).
Most breaches do not end in termination. But the process that gets triggered the moment a remedial or breach notice lands on your desk has strict timescales attached to it, and getting the response wrong, or simply not responding quickly enough, is what turns a manageable compliance issue into a genuine threat to the contract. This post sets out what counts as a breach, what commissioners can do about it, and what your practice should do the moment a notice arrives. For the background on how GMS and PMS contracts work generally, see our post on NHS GP contracts explained.
What Counts as a Breach
A breach is any failure to comply with a term of your contract. In practice, the breaches that generate remedial or breach notices tend to fall into a fairly narrow set of categories:
- Failures identified by the Care Quality Commission during inspection, particularly where a practice is placed in special measures or issued with a notice of proposal to cancel registration.
- Clinical governance gaps, such as an ineffective infection control protocol, safeguarding policy, or significant event review process.
- Recruitment or workforce issues, including employing or continuing to engage staff who do not meet the conditions required under the contract.
- Failures to provide essential services within core hours, or to meet specific access requirements, including the same-day triage and online consultation requirements that apply across GMS, PMS and APMS contracts from 2026/27.
- Financial irregularities that put the ICB at risk of material loss.
Not every shortfall is a breach in the contractual sense. The regulations distinguish clearly between breaches that are capable of remedy (most of them) and breaches that are not, because they relate to a specific event that has already happened and cannot be undone, for example a day on which no clinician was available in the practice. That distinction determines which type of notice you receive.
Remedial Notices vs Breach Notices
| Feature | Remedial notice | Breach notice |
|---|---|---|
| When used | Where the breach is capable of remedy | Where the breach is not capable of remedy (a one-off event) |
| What it requires | Specific steps to remedy the breach within a set notice period | An instruction not to repeat the breach, and a statement of steps to avoid repetition |
| Minimum notice period | At least 28 days, unless a shorter period is necessary to protect patient safety or prevent material financial loss to the commissioner | No fixed remedy period, since there is nothing to remedy |
| Governing provision | Schedule 3, paragraph 70(1) to (4) GMS Regulations 2015 / Schedule 2, PMS Regulations 2015 | Schedule 3, paragraph 70(5) GMS Regulations 2015 / Schedule 2, PMS Regulations 2015 |
| Consequence of repetition | Further remedial notice, or termination if the cumulative effect would prejudice service efficiency | Further breach notice, or termination on the same cumulative effect test |
In our experience, remedial notices are by far the more common of the two. Breach notices are comparatively rare, because most contractual failures relate to an ongoing state of affairs (a missing policy, an unresolved staffing gap) rather than a single, closed event.
What Happens if a Breach Is Not Remedied
If your practice fails to take the required steps within the notice period, the ICB may issue a further notice terminating the contract with effect from a date it specifies, under paragraph 70(4) of Schedule 3. Separately, paragraph 70(6) allows termination where, following a breach notice or remedial notice, the practice either repeats the breach in question or otherwise breaches the contract in a way that results in a further remedial or breach notice.
Termination on this repeated-breach ground is not automatic. The ICB may only exercise it where it is satisfied that the cumulative effect of the breaches is such that allowing the contract to continue would prejudice the efficiency of the services provided, a test set out at paragraph 70(7). NHS Resolution’s published determinations show this test being applied in practice: in one 2020 case, a practice that had received three successive remedial notices, and had spent time in CQC special measures, was found to have been lawfully terminated because the pattern of repeated, unremedied breaches met the prejudice test, even though some earlier breaches had technically been addressed. In other words, a practice’s argument that “we fixed it eventually” will not necessarily prevent termination where the pattern of repeated notices itself demonstrates a wider problem.
Short of Termination: Contract Sanctions
Where a commissioner is entitled to terminate a contract but chooses not to, it can instead impose a contract sanction, provided it is satisfied the sanction is appropriate and proportionate. The available sanctions are:
- Termination of specified reciprocal obligations under the contract.
- Suspension of specified reciprocal obligations for a period of up to six months.
- Withholding or deducting monies otherwise payable under the contract.
Sanctions cannot be used to affect the delivery of, or payment for, essential services, and unless patient safety or financial risk requires urgency, the commissioner must give at least 28 days’ written notice of the sanction, setting out what is being imposed, from what date, and its effect. In our experience, sanctions are used more often than outright termination, precisely because they allow an ICB to apply pressure on a practice without disrupting patient care in the local area, which termination inevitably risks doing.
Your Options When a Notice Arrives
The steps that matter most are the ones taken in the first few days after a notice is received.
- Read the notice carefully and note the date. The clock on any remedial period runs from the date the notice is given, not from when your practice gets round to acting on it.
- Take specialist advice immediately. Both the regulations and the practical experience of Local Medical Committees are consistent on this point: practices that engage legal and LMC support early tend to get better outcomes than those that try to resolve matters informally first and only seek advice once a further notice arrives.
- Respond to the substance of the notice, not just its existence. A generic assurance that the practice will “look into it” is not the same as evidencing the specific remedial steps the notice requires.
- Keep a clear record. If a dispute later arises over whether the breach was remedied in time, contemporaneous evidence, dated correspondence, updated policies, minutes of governance meetings, carries real weight.
- Know your right to invoke the NHS dispute resolution procedure. Where a commissioner gives notice of termination under paragraphs 66, 67, 68, 70(4), 70(6) or 71, it must specify a termination date at least 28 days after the notice, unless urgency applies. If your practice invokes the NHS dispute resolution procedure before that period ends, the contract does not terminate until the dispute is finally determined, or until you stop pursuing it, whichever comes first.
We also regularly see commissioners refer breach matters on to the CQC, the NHS practitioner performance team, or the GMC, depending on the nature of the underlying issue. A GMS or PMS breach rarely exists in isolation from a practice’s wider regulatory position, so any response strategy needs to consider all of the bodies that might become involved, not just the ICB.
How This Connects to Termination
Breach and remedial notices are the mechanism that sits immediately upstream of contract termination. If your practice is already facing termination, whether through the breach process described above or through one of the other grounds in Schedule 3 (such as a partner no longer meeting the conditions to hold the contract, or a change in partnership structure), our post on automatic contract termination sets out those provisions in detail. If the dispute has moved beyond the notice stage and into a formal disagreement with your commissioner, our post on NHS contract disputes covers how practices can respond and what the dispute resolution process involves.
What This Means for Your Practice
A remedial or breach notice is not, in itself, a crisis, but it is a formal legal process with strict time limits, and the way your practice responds in the first 28 days will usually determine how it ends. We advise GP partnerships across London and the South East on responding to remedial and breach notices, negotiating with ICBs, and, where necessary, running the NHS dispute resolution procedure through our dispute resolution team. If your practice has received a notice and you would like advice on how to respond, get in touch with our healthcare team or call us on +44 207 566 1188. You can also reach us by email at info@gurvelegal.com.
