What will be some of the major hurdles and issues for practices in the next 12 months? Our experts have come up with the following critical agenda
1.Preparing for the new neighbourhood health service and working at scale
There are currently more questions than answers on how the 10-year health plan for England will play out. We know the remit for the first wave of neighbourhood health services is to provide additional support for people living in deprived areas with chronic conditions. This first wave will be backed by £10m, although it is not clear where the funding will come from.
There is also uncertainty around what services will form part of the new neighbourhood provider contracts, how those services will be delivered, who will deliver them, and how GP practices will be paid for their involvement.
While some may sit back and wait for clarity, practice managers preparing for working at scale now have a better chance of being on the front foot when more details start to emerge.
Here are five areas to consider:
Be in the conversation. Find out who’s who in your primary care system. Establish your place in it as a practice, at PCN and at federation level. Get involved with conversations about how the new neighbourhood NHS will work in your area.
Previous experience shows that GP practices involved in PMS contracts and fundholding initiatives were likely to be higher earning practices. Discussing neighbourhood plans with colleagues in the PCN and federation will lower the risk of activities being imposed and funding pots being raided. You will also have up-to-the-minute knowledge of any opportunities for taking on new, profitable income-generating services and what hasn’t worked before.
Look at service opportunities. Look at the services primary care could take on from the local hospital (known as the ‘left shift’). Work out if there is spare capacity in your practice and across the PCN for delivering better services for patients closer to home.
Take stock of what you are currently being paid for services such as minor surgery and phlebotomy compared with what hospitals are paid. When the time comes to take on new work from secondary care it should be profitable. Delivering services that cost more to provide than the income received doesn’t make good business sense.
Make sure the PCN is ready. Is your PCN ready to take on a neighbourhood provider contract? For example, are its boundaries aligned with the local council, community health and social care organisations you’re likely to be working with?
Does the PCN (and any limited company working alongside it) have the governance in place that allows it to take on new contracts and pension directions, make effective decision-making, and distribute funding? Is the network agreement is up to date, and have annual accounts have been prepared? The support of a specialist medical accountant can make a real difference here.
If you are not convinced the PCN has the necessary governance and leadership in place, this is your opportunity to step up and take the lead on sorting things out, with the support of the clinical director or a GP partner.
The same governance and leadership points apply to your local federation. Articles of association or any shareholder agreements and members’ agreements need to be checked and updated if necessary to make sure the organisation can take on a neighbourhood provider contract when the opportunity arises.
Shape services in your area. Working at scale brings the opportunity to shape services in your area. You can begin this now by working to understand the population needs across the PCN. Rather than being led by the ICB, take the initiative and share ideas, knowledge and experience with your network colleagues.
Combine and analyse the clinical system data across the network. This will help you to identify the key health issues in your patient population and start thinking about how services could be designed to meet their needs. You’ll then have a crucial understanding of what the neighbourhood provider contract in your area will need to deliver.
Understand the Fuller report. For a deeper understanding of the origins of the government’s vision for a neighbourhood health service, read the 2022 Fuller Stocktake’ by Dr Claire Fuller, national medical director at NHS England.
On page 3 you’ll find a summary of the three ‘offers’ behind the vision for integrating primary care and improving the access, experience and outcomes for patients.
While practices do not yet know what they will be asked to deliver and at what price in the new neighbourhood NHS, it is already clear that the practices benefiting the most in the long run will be the early birds who choose to get involved and take their place at the decision-making table.
Lizzy Lloyd is chair of the Association of Independent Specialist Medical Accountants (AISMA) and partner at Larking Gowen LLP
2. Unlocking the potential of AI
It may be that 2026 is the year that AI comes into the mainstream in general practice.
There are limitations of AI, of course, but there are benefits too. Anything that frees up valuable time and money needs to be considered, especially when finances are tighter than ever.
The practices that can work with the strengths of AI could unlock productivity gains, building on some of the significant expansion of technology within general practice in the last five years.
But there are many practices still trying to work out how AI can help them – without losing the human touch for patients. If you’re one of them, here are the key things to think about.
How can AI help?
Ambient scribes have become increasingly popular in 2025. This is where the AI ‘listens’ to consultations and provides a transcript – notes you can copy into the clinical record. It sometimes even codes relevant information as well. You can use the same technology for meetings, which saves time on administrative tasks such as drafting minutes and updating action logs.
AI is also starting to be used as a triage tool. It’s only a matter of time before AI is used to generate appointments and to support practices in safely meeting the requirements of the October 2025 contractual changes around opening hours.
Some providers are starting to use AI to help with optimising and coding letters from secondary care, and even to run patient recall.
Lastly, practices are beginning to embrace AI receptionists, which can answer phones automatically and deal with patient queries 24/7 without human intervention. This includes filling out forms and signposting patients.
Non-AI options
There are other helpful products out there that rely on similar technologies but aren’t quite artificial intelligence.
For example, there is triage software and lab report filing technology. Both of these apply complex algorithms to a situation to determine the outcome but without any interpretation of those rules. This makes it easier to say for certain that the technology will always do what you expect and makes it feel safer.
How to implement AI safely
Safety is absolutely the most important concern when implementing AI. So, what do you need to consider? Information governance is the first. For any AI product you use, you should complete a Data Protection Impact Assessment (DPIA), which ensures you have considered the impact on users. The provider may be able to assist you with this.
You should ask to see the DCB0129 from the supplier and use it to draft a DCB0160, which demonstrates you have considered the safety of the product. Ironically, AI is a tremendous help in drafting these.
Clinical safety
You may also need to consider whether the product is providing medical advice and keep a record of the evidence. The second thing to consider is whether you need a clinical safety officer.
This is dependent on the product. For certain commonly used products, it may be sufficient to get assurance from your ICB or PCN that any clinical risks have been considered, and that hazard logs and risk management plans have been created.
However, if that expertise doesn’t exist locally, you may need your own clinical safety officer and the training for this is quite time consuming. This should be a key consideration for PCNs, GP Federations and ICBs in 2026.
This is a new field so additional requirements may present themselves as time goes on.
Pete Woodward is managing partner at Cheadle Medical Practice and Alvanley Family Practice, non-executive director at Viaduct Care CIC and consultant practice manager at Woodley Village Surgery
3.Implementing effective cybersecurity measures
If 2025 proved anything, it’s that one cyber incident can dominate an organisation’s year. After M&S experienced an attack at Easter, it had to pause most online orders for 46 days, then restore services in stages. The lessons on resilience translate directly to general practice.
Below are 10 practical steps you can take now. They are low‑cost, high‑impact, and tailored to general practice.
Prepare for WhatsApp and impersonation scams. We are seeing criminals pose as a GP partner on a new WhatsApp number, sending a message such as: ‘I’ve been mugged on holiday, please transfer funds.’ Make it your policy to never approve payments from chat apps and to call the alleged staff member on a known number. It is a good idea to agree a simple team ‘safe word’ for urgent requests.
As Ofcom explains, staff can forward suspicious texts to 7726 and report suspect emails to the National Cyber Security Centre (NCSC).
Kill payment‑diversion fraud at source. Adopt a two‑to‑pay rule – dual approval – for bank transfers and verify any email request to change bank details. Verification should be done via a second channel – for example, calling a known contact using the number from your supplier file. Do not use the phone number given in the original communication, this will likely route to the fraudster.
You can read more about payment‑diversion fraud and business email compromise at the National Cyber Security Centre (NCSC) and Action Fraud.
Lock down the accounts that matter most. Turn on multi‑factor authentication for email, finance, clinical systems, remote access and admin accounts. Move staff to a password manager and ensure that standard user accounts do not have admin rights over your computer. The NCSC small business guide gives a clear checklist.
Practise your cyber downtime. This refers to periods when IT systems, applications, or networks are unavailable or not functioning due to cyber incidents. In preparation, maintain a printed downtime pack – paper appointment and prescription templates, contact tree, and supplier numbers. Run a one‑hour tabletop cyber security exercise using the free NCSC Exercise in a Box.
Keep software patched automatically. Enable automatic updates on endpoints and browsers, and include third‑party apps such as PDF readers. Schedule a monthly ‘patch check’ at your practice meeting, to ensure all computers and software are patched up to date. The NCSC small business guide provides more information on this.
Tighten supplier risk without drowning in paperwork.Ask core suppliers, such as clinical systems, telephony and IT support, for Cyber Essentials or equivalent and an incident‑response contact route ( in other words how to get in touch if something goes wrong out-of-hours!). Cyber Essentials is a Government-backed certification scheme that helps keep organisation’s and customers’ data safe from cyber attacks. You can read an overview of Cyber Essentials here.
For NHS data assurance, keep your Data Security and Protection (DSP) toolkit up to date and expect appropriate assurance from suppliers handling NHS data.
Segregate payments and approvals.Separate requester, checker and payer roles in your finance system. For urgent out‑of‑hours payments, use a pre‑agreed process that still requires a call‑back on a known number.
Make reporting easy and instant.If you suspect a live cyber-attack, Action Fraud runs a 24/7 line for organisations on 0300 123 2040. For other incidents or near misses, log them as part of your DSP toolkit evidence and brief the team – near misses are free rehearsals.
Train little and often.Use the NCSC’s free 30‑minute Top Tips for Staff e‑learning at induction and annually. Rotate quick 10‑minute refreshers on safe file-sharing and how to spot phishing.
Mind your social media footprint.Criminals do reconnaissance so remind teams to avoid posting real‑time holiday details or internal operational updates that could fuel tailored scams. Review public information on your website and socials that could help an attacker craft convincing messages. The NCSC’s phishing collection covers what and how to report.
Finally, the goal isn’t perfect security; it’s resilience. Your aim is to stop the common scams quickly and stay safe and stay open when something does go wrong.
Daniel Vincent is CEO of Enhanced Primary Care Ltd
4. Working collaboratively with community pharmacy
With an ever-increasing workload and the pressure on enhancing access for patients it is now more important than ever for practice managers to collaborate with community pharmacy. We must stop seeing them as our competitors and start to appreciate they are our colleagues who also deliver NHS services to patients.
I have always forged good relationships with community pharmacists and it has worked well for our practice and patients. For example, we have engaged with our local pharmacy who now also provide a full medicines management service for our practice. This has freed up GP, nursing and healthcare assistant time and increased our capacity as well as increased access and reduced waiting times for patients.
It can go beyond that though. Practices can take steps to maximise the use of NHS services delivered outside the practice that our patients can benefit from, such as Pharmacy First.
It is practice managers that can be the ones to reach out and establish relationships. We can be the conduit for positive conversations and enable new work processes to evolve.
Do you speak to your community pharmacists regularly? I can pick up the phone anytime and speak to ours. The staff can also contact them and we have established a mutually agreeable system so that feedback flows and we are able to communicate freely with each other.
How can practice managers forge such collaborative working? I know the biggest hurdle we have is lack of time of or the head space to plan how we can do this. But by starting with small areas of work and building on them we can start to reap the rewards.
This was our approach when it came to the Pharmacy First scheme. The result has been that frontline staff have been trained to ensure patients are effectively signposted, appropriately referred (including self-referrals) and are engaging positively with the service.
We started by raising awareness of the service with patients via various methods including our patient participation group champions, social media and our website. We also encouraged practice staff to spend time shadowing pharmacy staff and vice versa. This gave both teams the chance to gain insight of each other’s perspective.
We agreed to start the service focusing on uncomplicated urinary tract infections (UTIs) in women aged 16-64 and then slowly expanded it to include the other six conditions, once the confidence of our team increased.
By creating simple and easy standard operating procedures (SOPs) for staff, easy-to-read information materials for patients and auditing activity we were able to signpost a significant number of patients to the pharmacy for treatment and care.
Initially, there were more than the expected number of ‘bounce backs’. However, by auditing and reviewing these and through discussions with the community pharmacy team and our staff , we could assess what was happening and agree a plan to resolve the issues. We found that we were not getting enough information from the patient so we refined our processes, which led to significant improvements.
Our practice –Lambert Medical Centre in Thirsk – now has the highest number of referrals to Pharmacy First in our PCN, all of which are appropriate. Some patients are referred back to the practice if they cannot be dealt with by the community pharmacy, but these are very few and appropriate. This is not viewed as a failure in our systems but a positive as we are safety netting and getting it right.
We look forward to working with our pharmacies more and increasing the services we can signpost our patients to once we introduce prescribing-based services.
Tracy Dell is a practice business manager and locum working in North and West Yorkshire
5.Staying up to date with employment law changes
The Employment Rights Bill, which received Royal Assent (and became law) in December, has been the subject of a lot of scaremongering headlines. I’d like to take a more positive look at the changes as they are likely to impact GP practices. For example, it’s not just another cost burden, it can be viewed as an opportunity to invest in good work and improved performance and productivity.
Of course, there’s still a lot to sort out and the Government has agreed a phased implementation of the changes to allow time for engagement and consultation and give organisations time to prepare and update their policies and practices. That has been widely welcomed.
So, what is likely to happen in 2026? And how can you prepare?
April 2026
Paternity Leave and pay – currently an eligible employee may take either one week or two consecutive weeks’ paternity leave. To be eligible, among other things, the employee must have 26 weeks’ continuous service. The Bill will make this a day one right.
Parental Leave – currently an eligible employee is entitled to unpaid parental leave of a maximum of 18 weeks to care for a child. To be eligible, among other things, an employee must have one year’s continuous service with their employer. The Bill will also make this a day one right.
Take a look at your policies for paternity leave and pay. These are changes that you could make now as a positive contribution to employee wellbeing. For example, the Joseph Rowntree Foundation makes the case for the real benefits that can be felt by families and the economy that arise from helping women work as a result of a more generous approach to paternity leave.
Statutory Sick Pay – the Bill will remove the Lower Earnings Limit and the waiting period – the first three consecutive days of sickness. This means that all workers will be entitled to Statutory Sick Pay at a rate of either 80% of weekly earnings, or the statutory rate, whichever is lower and that SSP will be payable from the first day of absence.
Now would be a good time to take another look at your policy for managing sickness absence. Evidence tells us that there are two things that make a real difference to managing sickness absence – return to work interviews and trigger points for taking action (such as the number of absences an employee has within a certain time period).
Do you have these in your policy? And what steps do you have in place to promote employee wellbeing?
Whistleblowing protections – the Bill will add sexual harassment to the list of qualifying disclosures. This means that employees will protected from being subjected to a detriment (being treated badly or unfairly) for making a disclosure around sexual harassment.
Trade union recognition – the Bill will simplify the trade union recognition process and the rules around balloting. Currently recognition must be supported by 40% of those entitled to vote. This will be replaced with a simple majority. The requirement to demonstrate that there is likely to be majority support for recognition at the application stage will also be scrapped. Trade unions are gearing up to take advantage of their new rights and at the very least practices should be aware of this and be preparing for it.
October 2026
Sexual harassment – the Bill will require employers to take all reasonable steps to prevent sexual harassment in the workplace. The Worker Protection (Amendment of Equality Act 2010) Act 2023, which took effect in October 2024, introduced an anticipatory duty on employers to take reasonable steps to prevent sexual harassment in the workplace. This means employers must be proactive and not wait for sexual harassment to happen before acting. The Employment Bill adds the word ‘all’ which points to a higher standard to met. Regulations to specify steps that are to be regarded as ‘reasonable’, are expected in 2027. The Bill will also introduce a duty to protect employees from harassment by third parties. A recent article set out the practical steps which you should take as an employer.
Sexual harassment has no place in modern workplaces. If this is completely new to you, take a look at the information available from the Equality and Human Rights Commission (EHRC) There is also material available from the NHS Employers.
Fire and rehire – this has previously been billed as a ban on the practice of dismissing and re-engaging employees who fail to agree to a change in their contract of employment. It’s turning out to be a lot less than that. As it now stands the Bill will mean that if employees are dismissed for failing to agree to a ‘restricted variation’ to their terms and conditions or so that they can be replaced by other workers doing the same job on different (less favourable terms), those dismissals will be treated as automatically unfair except if the employer can show financial difficulties that demonstrably made the need to change terms and conditions unavoidable. Restricted variations means: pay, pensions, working hours and duration and timing of shifts. So, anything else is not covered.
Fire and rehire was always fraught with practical difficulties. But more importantly changing terms and conditions is best done through consultation and agreement. When it is not, the price is likely to be paid in terms of employee engagement and productivity.
Employment tribunals – the time limit for bringing a tribunal claim will be extended from three to six months.
While this may see an increase in the number of claims to employment tribunals, those in favour argue that it will also result in increased access to justice and better prepared claims.
Trade union rights – The bill will require employers to inform workers of their right to join a trade union, introduce new rights and protections for trade union reps, extend protections against detriments for taking industrial action and give trade unions the right to request access to workplaces to achieve recognition and organize industrial action. Working with a trade union needn’t be something to fear. However, now would be a good time to look at levels of employee engagement and involvement that have anyway been shown to improve commitment, retention, productivity, innovation and team working.
There will a further implementation phase in 2027 – watch here for coverage and the changes in 2026.
George Lepine is an independent human resources consultant. Find out more about his work on policy, strategy, organisation development, leadership and team building here
