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By Nita Kotecha, Senior Manager, Healthcare
Andy Burnham's arrival in Downing Street on 20 July 2026 matters for GP practices because he is the first Prime Minister in decades who has previously run the NHS, and he has already started acting on it. Within his first five weeks he appointed Yvette Cooper as Health Secretary with an explicit mandate to deliver social care reform, committed the government to the principle of "devolving by default" through his Rewiring the State framework published on 31 July, and accelerated the Casey Commission on social care from a 2028 deadline to mid-2027. For practices already navigating the NHS Modernisation Bill, the Single Patient Record, and a tight contract year, the direction of travel is now clear enough to plan against.
That does not mean the operational reality of running a surgery has changed overnight. The three-year spending review set in 2025 is already locked in, the Modernisation Bill is in committee, and the 2026/27 GP contract is imposed and running. Much of the architecture that will shape primary care for the next two to three years was in place before Burnham took office. But his first weeks have removed much of the ambiguity about where the emphasis is heading, and practices that are not paying attention to these signals risk being caught off guard.
What does Burnham actually believe about primary care?
The most important thing to understand about Burnham's healthcare thinking is that it was forged outside Westminster. As Mayor of Greater Manchester, he co-chaired the Greater Manchester Integrated Care Partnership and championed a model he called "whole person care": joining physical health, mental health, social care, housing, and employment support around the individual rather than treating each as a separate administrative silo. His Live Well programme in Greater Manchester connected social prescribing with primary care and job centre resources in ways that most of the country has not attempted.
In conversations with GP partners and practice managers across the Midlands, I find a common reaction to these kinds of ambitions: interest in the principle, deep scepticism about the delivery. Integration sounds good until you are the practice expected to deliver it with existing staff, existing funding, and a contract that was not designed for it. That scepticism is well earned. But Burnham has a track record that extends beyond policy papers. Greater Manchester's devolution deal, brokered in 2015, gave the region genuine control over health spending, and Burnham used it. That record is what makes this appointment different from the usual change of face at the top.
"Burnham is a former Health Secretary who spent a decade running an integrated care experiment. GP practices now have a Prime Minister who thinks he understands their world."
Devolution is no longer a hypothesis
Before Burnham became PM, health devolution was being tested cautiously. Two pilot deals had been announced for Greater Manchester and South Yorkshire, with ICB chairs serving jointly as the mayor's health commissioner. The King's Fund described the prospect of a Burnham premiership as potentially meaning "devolution on steroids". Five weeks in, that description is looking accurate.
On 31 July, Burnham published Rewiring the State, formally adopting the principle of "devolving by default". The framework commits the government to transferring powers to strategic authorities across England, with the aim of every area having a strategic authority by the end of 2028. A full white paper with implementation detail is due alongside the Budget on 28 October. The principle is significant: rather than local areas having to make the case for devolution, central government will now have to justify why it is retaining a power rather than devolving it.
For GP practices, this has practical consequences. In areas with metro mayors, local political priorities will increasingly shape how health funding is directed and how commissioning decisions are made. Practices that have treated ICB strategy documents as background reading may find those strategies carrying more weight than they expected, particularly if ICB chairs become directly accountable to elected mayors as well as to the Health Secretary. The English Devolution and Community Empowerment Act, passed in April 2026, already requires strategic authorities to have regard to improving health and reducing health inequalities. That is no longer a theoretical duty.
The question that remains unanswered is what this means for areas without a metro mayor. The government's plans to date leave open the possibility of different tiers of devolution depending on where people live. For practices in areas that are further behind on the devolution pathway, the risk is that they find themselves operating under a system that was designed for regions with different governance structures.
What should practices be watching on data?
The Single Patient Record is the element of the Modernisation Bill with the most direct operational impact on general practice, and it is also the most contentious. The SPR would require all GP practices, including private providers, to share patient data into a unified record accessible across care settings. The aim is to end the fragmentation that means a hospital consultant cannot see a patient's full primary care history, and vice versa. In principle, most clinicians support that objective.
The dispute is about who controls the data. Since the inception of the NHS, GPs have been the data controllers for their patients' records. The Modernisation Bill transfers that controllership to the Department of Health and Social Care. Under Yvette Cooper, now the Health Secretary who would hold those powers, the BMA's GP Committee has been clear in its opposition: it has called for GPs to remain the data controllers and raised concerns about patient confidentiality, indemnity cover, and the risk of unintended workload transfer if the SPR is implemented without meaningful input from primary care.
I have spoken to a number of practice managers who are uncertain about what the SPR will mean for them in practical terms. The BMA recommended that from May 2026, practices take collective action focused on the sharing of GP patient data outside practices. Whether or not individual practices have followed that recommendation, the underlying tension is real. Practices hold patient data under a duty of care that has been central to the GP-patient relationship for decades. Transferring controllership to a government department changes that relationship in ways that have not been fully worked through.
Under Burnham, the SPR is unlikely to be abandoned. His commitment to integrated care depends on data flowing across boundaries. But his instinct for devolution raises an interesting possibility: regional bodies rather than central government could end up managing data access in practice, even if the legal controllership sits with the DHSC. Practices should be engaging with their Local Medical Committees and ICBs now on how SPR implementation is being planned locally, rather than waiting for the national framework to land.
Is the funding picture going to shift?
Not immediately, but the autumn will be telling. The 2025 spending review covers the period to 2027/28, and Burnham has inherited that fiscal framework. The 2026/27 GP contract, which delivered a 3.6% total uplift including a repurposed £292 million from the Capacity and Access Payment into a practice-level GP reimbursement scheme, is in place and unlikely to be revisited this financial year. Practices are already navigating its consequences, including the realities of National Living Wage increases, employer NIC rises, and the costs of delivering unlimited same-day urgent access.
The Budget on 28 October will be the first real signal of Burnham's fiscal priorities. John Healey, appointed Chancellor, will present the devolution white paper alongside it. Where Burnham's influence could be felt most is in how capital funding is allocated. The Strategic Defence Review is already competing for resources, and the King's Fund has flagged that NHS capital investment could be reallocated to help fund defence commitments. If that happens, it would affect estates, technology upgrades, and the neighbourhood health infrastructure that the Ten Year Health Plan depends on. Practices that are planning premises improvements or technology investments should be keeping a close eye on what the Budget says about capital.
Burnham's social care speech on 29 July also has indirect funding implications for primary care. He announced plans for a National Care Service integrated with the NHS workforce, with care workers given routes into formal NHS roles and pay aligned to NHS scales. If delivered, this would represent a significant reallocation of public spending. Whether it eases pressure on general practice through better discharge pathways and reduced A&E attendances, or simply redirects funding that might otherwise have reached primary care, depends entirely on the detail. The Casey Commission's accelerated report, now due mid-2027, will be the document that shapes those decisions.
More broadly, Burnham's commitment to prevention and social prescribing could redirect some funding flows over the medium term. If the Live Well model is scaled nationally, primary care networks may find themselves managing a broader set of community health resources. That could bring additional funding into primary care, but it could also bring additional expectations without a proportionate increase in core contract income. The pattern is familiar to anyone who has lived through the last five years of GP contract negotiations.
What should practices actually do right now?
The honest answer is that most of what matters to a GP practice today mattered before the change of Prime Minister. Patient demand has not changed. The contract obligations have not changed. The workforce pressures have not changed. A change of leader does not rewrite the operational reality of a busy surgery on a Tuesday morning.
But there are three things that are worth doing in the coming months. First, practices should be following the progress of the NHS Modernisation Bill closely, particularly the provisions on the Single Patient Record and devolution. The Bill is in committee and amendments are still possible. What emerges from the legislative process will define the structural environment for primary care for the rest of this decade.
Second, practices in areas with metro mayors or emerging strategic authorities should be engaging with their combined authority's health strategy now. Burnham's Rewiring the State framework makes it clear that devolution will accelerate, not slow down. Those strategies will become more significant than many practices currently realise. Being part of the conversation early is better than responding to it after the decisions have been made.
Third, and this applies regardless of who is in Downing Street, practices should be reviewing their financial position against the cumulative pressures of the 2026/27 contract, with one eye on the Budget on 28 October. The uplift sounds reasonable in headline terms. Whether it covers the actual cost of delivery depends entirely on the individual practice's staffing model, patient demographics, and estates costs. That calculation is specific to each surgery, and it is the one that determines whether the next twelve months are manageable or not.
If your practice is reviewing its financial position or wants to understand how the current policy landscape affects your planning, our healthcare team works with GP surgeries and primary care businesses across the Midlands and can help you work through the numbers.
This article has been prepared for information purposes only. Formal professional advice is strongly recommended before making decisions on the topics discussed in this release. No responsibility for any loss to any person acting, or not acting, as a result of this release can be accepted by us, or any person affiliated with us.
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