Medical school teaches you to diagnose heart failure. It does not teach you to negotiate the terms under which you diagnose heart failure. This gap costs GPs tens of thousands of pounds over a career — and more importantly, it costs them the working conditions that determine whether they stay in the profession.
Everything in a GP contract is negotiable. The fact that a practice hands you a document doesn't mean you have to sign it unchanged. Here's what to focus on.
Salaried GP contracts
The BMA publishes a model salaried GP contract. Most practices deviate from it — sometimes reasonably, sometimes significantly to the GP's disadvantage. These are the clauses that matter most:
Session definition and number. A standard session is 4 hours 10 minutes. Confirm the number of clinical sessions and admin sessions. The BMA model recommends at least 1 admin session per 3 clinical sessions. If the contract offers 6 clinical sessions and zero admin, you're working unpaid evenings doing referrals and results. Negotiate protected admin time — this is the single most impactful clause for your quality of life.
Pay per session. The BMA recommended minimum is currently ~£11,800/session. Many practices offer this as a ceiling, not a floor. If you bring relevant experience, postgraduate qualifications, or skills the practice needs (minor surgery, dermatology, mental health), negotiate above the minimum. A differential of even £500/session compounds to £4,000–£5,000/year across 8–9 sessions.
Study leave and CPD. The BMA model provides for paid study leave and a study budget. Check how many days per year, whether it's paid at your normal session rate, and whether there's a separate budget for course fees. Practices that offer zero study leave are telling you something about their culture.
Maternity, paternity, and sick leave. These vary dramatically. The BMA model includes enhanced maternity provisions, but many practices revert to statutory minimum. If you're planning a family, this clause is worth thousands of pounds and should be negotiated before you sign, not when you're pregnant.
Notice period. Standard is 3 months. Some practices push for 6 months. A longer notice period benefits the practice (continuity) but constrains you (can't leave quickly if things go wrong). Three months is reasonable and standard.
Restrictive covenants. Some contracts include non-compete clauses preventing you from working at nearby practices for a period after leaving. These are often unenforceable but create uncertainty. Push to have them removed or limited to a very short duration and narrow radius.
Superannuation. Confirm the practice will pension your earnings through the NHS Pension Scheme. This should be standard but verify it explicitly.
Locum GP terms
Locum negotiation is simpler because it's a market rate — but many locums undervalue themselves.
Set your rate based on your costs, not the practice's offer. Calculate your minimum viable rate: indemnity pro-rated per session, pension contribution (if you self-fund), accountancy costs, travel, equipment, and the opportunity cost of not working elsewhere. For most locums in 2026, this puts the floor at £750–£800/session before it's financially worth turning up.
Negotiate cancellation terms. Practices cancel locum bookings. It happens. Your booking confirmation should include a cancellation fee — typically 50% of the session rate if cancelled within 48 hours, 100% if cancelled within 24 hours. Without this, you bear all the risk of last-minute cancellations.
Clarify the scope of work. Will you be expected to do home visits? Triage? Duty doctor? Each of these expands your workload beyond standard consulting sessions. If the practice expects duty doctor coverage, the rate should reflect it.
Agency vs direct booking. Direct bookings pay more because there's no agency margin. Build relationships with practices that book you directly and prioritise those bookings. Agencies are useful for filling gaps but should not be your primary income source long-term.
Partnership agreements
Partnership negotiation is the highest-stakes contract negotiation most GPs will ever face. Get a solicitor — ideally one who specialises in medical partnerships.
Profit share. Understand the profit-sharing model: is it equal shares, seniority-weighted, or productivity-based? Equal shares are simplest but may not reflect differences in workload or seniority. Ensure the model is documented and that you understand exactly how your share is calculated.
Buy-in terms. If there's a property buy-in, understand: the valuation method (independent or partner-determined), the payment timeline, and what happens to your share when you leave. Is it returned at current market value or at a predetermined formula?
Decision-making. How are decisions made — unanimous, majority vote, or managing partner discretion? What requires partner vote (hiring, firing, service changes, financial commitments above a threshold)? Ensure you have a voice proportionate to your stake.
Exit provisions. What's the notice period? Is there a restrictive covenant? How is your capital (property share, retained profits) returned? What happens if you're expelled versus resigning? These clauses matter more than anything else in the agreement because they determine your options when things go wrong.
Mutual obligations. What minimum sessions are required? What happens during sick leave or maternity? Can you be required to increase sessions unilaterally? Ensure obligations are symmetrical — if the practice can require you to do more, you should be compensated for more.
The negotiation itself
Ask for what you want explicitly. Most GP negotiations fail not because the practice refuses but because the GP never asks. Practices expect some negotiation — a candidate who signs without discussion is a candidate who'll accept every subsequent imposition without pushback.
Get everything in writing. Verbal assurances are worthless when the person who made them leaves the practice. Every agreed term should be in the contract document.
Be willing to walk away. The strongest negotiating position is genuine alternatives. If you have another offer or can sustain yourself through locum work, you can negotiate from strength rather than desperation.
Don't negotiate against yourself. State your position and wait. Silence is uncomfortable but powerful. The practice will either agree, counteroffer, or explain why they can't — all of which give you information.
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