The newly released NHS England Patient Charter—You and Your General Practice—is now live on the NHS England website. It outlines what patients can expect from their GP practice, and what practices ask of patients in return. As part of the 2025/26 GP contract, it must be displayed on all practice websites by 1 October 2025.

Read the full charter on NHS England’s “You and Your General Practice” page

My View

When I joined the NHS in early 2003, the original Patient’s Charter was already receding into history. Introduced in 1991 as part of the Citizen’s Charter movement, it had aimed to define public service standards and articulate patient rights in aspirational terms. By the time I arrived, the tone had shifted. The NHS was no longer promising ideals—it was managing expectations.

I stepped into leadership during a time of reform, expansion, and growing complexity. Targets were tightening, digital systems were emerging, and the language of care was becoming more contractual.
That rhythm of change has never really stopped—and nor should it. Without change, we risk stagnation. But change must be purposeful. It should bring improvement, not simply more pressure.

The 2025 You and Your General Practice Charter feels like the culmination of this shift. It’s embedded in GP contracts, displayed in waiting rooms, and written in the language of mutual responsibility. Patients are asked to cancel appointments, use digital tools, and engage constructively. The tone is pragmatic, mutual—and, some might say, slightly weary.

🔍 What Changed?

In 2003, we were still balancing optimism with realism. Today, we’re managing scarcity—of time, staff, and trust. Digital access is now central. The NHS App is the new front door.

But I worry about those left behind: older patients, neurodiverse individuals, or those simply overwhelmed by technology. I also worry about the emotional toll this way of working places on patients already stressed by illness. The system asks a lot—and not always at the right moment.

What concerns me most is the imbalance in accountability. If practices fail to adhere to the charter, there are consequences: CQC inspections, ICB investigations, and more. But if patients disregard their responsibilities, it seems there is no equivalent red line. No formal mechanism to address repeated non-engagement or disruptive behaviour. That asymmetry creates tension—and it’s felt most acutely by frontline staff.

🛑 The Silencing of Healthwatch: A Quiet Retreat from Patient Advocacy

In June 2025, the government announced plans to dismantle Healthwatch—a move that, while framed as administrative reform, signals a deeper retreat from independent patient advocacy in my opinion. 

The Penny Dash Review recommended transferring Healthwatch England’s functions to the Department of Health and Social Care, with local Healthwatch bodies absorbed into Integrated Care Boards and local authorities.

Though legislation is still pending, the writing is on the wall. For many, this marks the end of a vital conduit for patient voice—one that operated at arm’s length from government and gave ordinary people a say in how health services were run. The closure feels emblematic of a broader trend to me: centralisation dressed as efficiency, and the quiet fading of watchdogs that once barked on behalf of the public.

🧭 A Mirror to Society

For me, this evolution reflects some broader societal shifts:

• From trust-based service to contractual obligation—a one-size-fits-all approach in a system full of nuance
• From empathy-led care to efficiency-driven systems—where time is rationed and compassion must be squeezed into minutes
• From quiet dignity to measured compliance—where the fear of non-compliance adds complexity and rarely accounts for individual needs

And yet, I still see heroism.

In receptionists who navigate impossible rotas and demanding patients with grace.
In those patients who wait patiently, understanding the strain.
In GPs who listen, even when the clock says they shouldn’t.

Why It Matters

The charters may change, but the heartbeat of care remains. It’s in the unsung gestures, the quiet resilience, the shared humanity. These are the moments that matter.

We must keep asking: What does dignity look like now?

And how do we protect it—not just in charters, but in practice?