Landmark court ruling on GP Contractual Dispute Resolution – what GPs need to know

A recent Court of Appeal decision has provided crucial clarity for GP practices regarding their contractual status and legal rights in disputes with the NHS. The ruling, which overturned a High Court decision, confirms that General Medical Services (GMS) contract holders operating as ‘non-health service bodies’ have the right to seek judicial review of NHS adjudicator decisions. This landmark case highlights the importance of understanding contractual designations and the legal pathways available to GPs who wish to contest NHS decisions.

What happened in the case?

The case involved Dr Sashi Shashikanth, a West London GP, who was served with contract termination notices by his Clinical Commissioning Group (CCG) for refusing to join a Primary Care Network (PCN) and declining to share patient contact details. The dispute centred on two key issues:

• Health Service body status
  Dr Shashikanth’s practice had elected to operate as a ‘non-health service body’. This would have given rights to have the dispute heard in a court of law but, for reasons which are not clear, Dr Shashikanth and his advisers elected to have their dispute heard by NHS Resolution. Under previous rulings, this decision was thought to limit access to judicial review and would have meant that the ruling of NHS Resolution was final and binding on all parties.
• Breach of contract allegations
  The CCG claimed that Dr Shashikanth had breached his GMS contract by failing to cooperate with the PCN, despite PCN participation being described as voluntary.

Initially, the High Court ruled against Dr Shashikanth, stating that his ‘non-health service body’ status precluded him from seeking judicial review. However, the Court of Appeal reversed this decision, confirming that GMS contract holders – whether operating as health service bodies or non-health service bodies – retain the right to judicial review for decisions made by NHS Resolution. Fortunately for Dr Shashikanth, this decision also quashed the original determination and remitted the matter back to NHS Resolution for reconsideration.

Key implications for GPs

This ruling is a significant development for GP practices, offering clarity on several important legal points:

1. Judicial review rights confirmed
   GMS contract holders operating as ‘non-health service bodies’ now have access to judicial review of NHS Resolution decisions in a similar way to those operating as health service bodies. This provides an additional layer of legal protection, ensuring that decisions made through NHS dispute resolution mechanisms can be challenged if they are unlawful. However, it would be a mistake to regard this as equivalent to a right of legal appeal, as judicial review is only a very narrowly defined process to assess the lawfulness of decisions made by public bodies.
2. Contractual designations matter
   Choosing to operate as an ‘health service body’ or a ‘non-health service body’ has far-reaching implications for how practices resolve disputes. Practices electing ‘non-health service body’ status gain access to the civil courts, including normal rights of appeal, in addition to the right to opt disputes into the NHS Resolution process. Health service bodies are limited to NHS dispute resolution mechanisms and have no right to opt disputes into the court process.
3. Clearer legal options
   This case highlights the critical distinction between judicial reviews (which only examine the lawfulness of decisions by public bodies) and appeals (which evaluate the merits of decisions). Appeals are only available through the court system (and thus only to non-NHS bodies) and are a much more effective way of seeking to correct erroneous judgements. Practices must understand these options when navigating disputes.

Practical advice for GP practices

The key takeaways from this case are clear: 

1. Opting for ‘non-health service body’ status offers significant advantages over ‘health service body’ status, including broader legal recourse through the courts. If desired, non-health service body disputes can anyway be referred into NHS Resolution, and would now have the same rights to judicial review as disputes arising from NHS bodies. Practices should be aware that they can change their Health Service body designation at any time and we would strongly recommend that you make understand your current status if you are not already aware of it.
2. Once GPs have understood their contractual designations they should tread very carefully when initiating a dispute resolution process to ensure they select the most pathway from the outset. Assuming you have retained the option, using the court system may well be preferable to using NHS Resolution, though specialist legal advice should always be sought on this point.

How DR Solicitors can help

At DR Solicitors, we specialise exclusively in supporting primary care professionals, including GPs, dentists, and consultants. With our unparalleled expertise in NHS regulations and contracts, we help practices navigate complex legal landscapes while avoiding regulatory pitfalls.

• Specialist advice: We work only with primary care providers, ensuring you receive tailored advice from experts who understand the challenges of your sector.
• Regulatory awareness: Our advice accounts for the NHS regulations that permeate all aspects of your business, helping you avoid breaches or missed opportunities.
• Holistic approach: We identify interconnections that generalist solicitors might miss, such as how contractual decisions impact NHS pensions or compliance with GMS contracts.

Many of our clients come to us after encountering issues caused by non-specialist advice. Whether you need support with GMS contract disputes, PCN disputes, or partnership disputes, DR Solicitors is here to help you navigate these complexities with confidence.