An NHS contract dispute, whether it concerns a breach notice, a remedial notice, or an outright termination notice, is governed by Part 8 of Schedule 3 to the National Health Service (General Medical Services Contracts) Regulations 2015, and by the NHS dispute resolution procedure administered by NHS Resolution. Practices have defined rights to challenge notices and defined time limits for doing so, but those time limits are often short, and missing one can significantly narrow your options.
This article sets out how the process actually works under a GMS contract, PMS contracts typically mirror the same structure, and what a practice should do at each stage, from a first breach notice through to a termination notice and any subsequent appeal.
The general shape of the dispute resolution process
Most disputes between a GP practice and NHS England (now largely operating through integrated care boards) are expected to go through local resolution first: both parties are required to make reasonable efforts to communicate and cooperate to resolve the issue directly before either side escalates. Where that fails, or where the dispute concerns a formal notice with its own statutory timetable, the matter can be referred to the NHS dispute resolution procedure, determined by NHS Resolution (the operating name of the NHS Litigation Authority), which is responsible for the prompt and fair resolution of disputes between primary care contractors and their commissioners, including disputes over GP premises rent, breach or remedial notices, and contract variation or termination.
Remedial notices and breach notices
Where a practice breaches its GMS contract in a way that is capable of being fixed, and the breach does not fall into one of the more serious categories set out below, the commissioner must give a remedial notice before taking any other action. Under paragraph 70 of Schedule 3 to the 2015 Regulations, a remedial notice must specify the details of the breach, the steps the practice must take to remedy it, and the period allowed, which must be at least 28 days unless a shorter period is genuinely necessary to protect patient safety or prevent material financial loss to the commissioner.
Where the breach is not capable of remedy, a breach notice can be issued instead, requiring the practice not to repeat it. If the practice repeats a breach that was the subject of an earlier notice, or commits a further breach resulting in another notice, the commissioner can move to terminate the contract, but only 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 single further minor breach after an earlier notice does not automatically justify termination; the cumulative impact test has to be met.
| Notice type | When it is used | Minimum notice period | Next step if unresolved |
|---|---|---|---|
| Remedial notice | Breach is capable of being fixed | 28 days (shorter only for patient safety or financial loss risk) | Further notice terminating the contract if steps not taken |
| Breach notice | Breach is not capable of remedy | No fixed minimum, but must specify the breach clearly | Termination if the breach is repeated or a further breach occurs |
| Termination notice | Cumulative breaches, serious risk to patients or finances, or a defined statutory ground | At least 28 days, unless patient safety or financial loss requires immediate effect | Practice may refer to the NHS dispute resolution procedure before the notice period ends |
Challenging a termination notice
Where the commissioner is entitled to terminate the contract, whether for cumulative breaches, for a change in partnership eligibility, or for one of the other statutory grounds, the notice must generally specify a termination date at least 28 days after the notice is given. If the practice invokes the NHS dispute resolution procedure before that notice period ends, and confirms this to the commissioner in writing, the contract does not terminate at the end of the original notice period. Instead, termination is suspended until there has been a final determination of the dispute, either through the NHS dispute resolution procedure or by a court, or until the practice stops pursuing the dispute. The commissioner can only override this suspension where it is satisfied that immediate termination is necessary to protect patient safety or prevent material financial loss, in which case it can confirm the contract will terminate regardless.
Common triggers specific to GP partnerships
Several of the statutory termination grounds are specific to practices operating in partnership rather than as a single contractor, and this is where NHS contract disputes most often intersect with a wider partnership dispute. The commissioner can terminate where the partnership no longer satisfies the eligibility conditions in the regulations, for example where there is no general medical practitioner left in the partnership, and separately, where a partnership dissolution is ordered by a court, tribunal or arbitrator. A further, distinct ground allows the commissioner to terminate where one or more partners have left during the life of the contract and, in the commissioner’s reasonable opinion, the resulting change in membership is likely to have a serious adverse impact on the ability to deliver services, though this requires the commissioner to specify its reasons in the termination notice itself.
It is important not to confuse these defined grounds with an assumption that any partnership change automatically ends the contract. Regulation 15 of the 2015 Regulations provides that a GMS contract held by a partnership is treated as made with the partnership “as it is from time to time constituted”, meaning ordinary changes in partners do not, by themselves, terminate the contract. This exact point was tested in Bhat v NHS Litigation Authority [2024] EWHC 375 (Admin), where the High Court found that NHS Litigation Authority had wrongly concluded that a partnership dissolution terminated a GMS contract. We examine that decision in full in our article on the Bhat case, and if your dispute has arisen alongside a change in your partnership, our guide to resolving a GP partnership dispute covers the partnership-law side of the same problem.
Working out whether you are actually in breach
Before any of the above becomes relevant, many disputes start with a practice being unsure whether it is in breach at all, or unsure whether a technical breach is serious enough to require proactive notification to the commissioner. We cover this earlier-stage question, and what triggers a mandatory notification obligation, in our article on whether you are in breach of your GMS or PMS contract. Some breaches also trigger automatic termination rather than a notice-based process, which we address separately in our article on automatic contract termination.
What This Means for Your Practice
If you receive a breach, remedial or termination notice, the notice period is your window to act, not a formality to be filed away. Check the notice against the specific paragraph of the regulations it relies on, confirm whether the cumulative effect test genuinely applies, and if you intend to dispute it, refer the matter to the NHS dispute resolution procedure before the notice period expires so that termination is properly suspended while the dispute is resolved.
If this affects your practice and you would like to talk it through, get in touch with our healthcare team or our dispute resolution specialists, call us on +44 207 566 1188, or email info@gurvelegal.com.
