What does the 2026/27 contract mean for GP practices?

This week the Government revealed changes to the GP contract for 2026/27 following a consultation with a group of stakeholders, rather than a negotiation with the BMA. The Pulse team looks at what it will all mean for practices

As contract details started to emerge – with a letter from NHS England to GP practices setting out the changes on Tuesday – GP leaders said that this contract ‘tinkers around the edges’ of what is actually needed to stabilise practices.

The letter promised new investment, but continued to emphasise the need to improve access, with new specific requirements around ‘clinically urgent patients’; it introduced new QOF points, but demanded even more data on appointments is provided to NHS England; it moved advice and guidance funding into core, but also effectively mandated A&G ‘where clinically appropriate’.

The Government removed the BMA as the sole negotiating partner for the GP contract in England last year, so this contract was released without approval from the union, and yesterday its GP committee voted in favour of rejecting it. But ministers have been clear that the imposed changes are final – so what will it all mean in practice?

£485m funding uplift

The contract letter promised a £485m uplift for 2026/27 – representing a 3.6% cash increase or 1.4% real terms growth. NHS England said that this includes a ‘pay assumption’ of 2.5% in 2026/27 which will be revisited in light of the pay review bodies’ recommendations, as well as additional funding to support QOF changes and funding to ‘cover costs nationally of other cost growth pressures’.

But accountants and experts warn that the cash uplift is ‘unlikely’ to leave practices with a significant funding increase for the next financial year, despite the Government’s commitment to move more care into the community and out of hospitals.

‘The 2.5% pay assumption looks low, compared with a rise in the national minimum wage of 4.1% and the Agenda for Change staff pay increase of 3.3%, and consumer price inflation remains at 3% for other costs,’ says Andy Pow, adviser to the Association of Independent Specialist Medical Accountants (AISMA). As in previous years a further uplift may arise once the DDRB publishes its review, but Mr Pow added that overall the changes are ‘unlikely’ to provide general practice with any substantial uplift in funding to develop services, or to resolve any of the uncertainty in general practice coming out of the 10-year plan.

‘From where I’m sitting, the extra £485m of largely conditional funding won’t touch the sides,’ says medical accountant Katie Collin. ‘All in all, [the changes] really concern me, and I doubt it will have done much to quell GPs’ anxieties, either.’

Nuffield Trust director of research and policy Dr Becks Fisher says that the 3.6% funding increase set out means GP funding next year will rise more slowly than the DHSC day-to-day budget as a whole, which is growing by more than 4%. ‘One of the likely reasons will be the trade deal with the USA to drive up medicine costs, with another being money held back in case other parts of the NHS overspend,’ Dr Fisher adds. ‘The announcement means that next year, unless there are additional in-year funding boosts, money will not be shifting towards GPs and their practices, despite the commitment to offer patients more of their care outside hospital.’

PCN Capacity and Access Payment scrapped to fund practice-level GP reimbursement scheme

A £292m ‘practice-level reimbursement scheme’ will be made available to practices to recruit new GPs or increase sessions for GPs already working at the practice ‘to support clinical same-day urgent access’. The money will be ‘repurposed’ directly from PCN Capacity and Access Payments, which included incentives for PCNs to identify patients who would most benefit from continuity of care. However, practices that have high patient-to-GP ratios (more than 3,000) and would like to access the scheme, would first need to engage with their local ICB to explain the ratio.   

While the scheme may appear as a good thing at a headline level by expanding the number of reimbursed GP roles, Mr Pow warns that reallocating this money may pose problems for PCNs who are currently using the CAP payment at scale.  ‘The reality is that practices are already using this funding at practice level in an unrestricted way, and ringfencing the money is going to cause problems for practices,’ he says.  

Ms Collin points out payments in these schemes are usually made in arrears, causing major cash flow issues for practices. ‘In these cases, the CAP has always been absolutely crucial, and removing that safety net now could be disastrous’, she adds.  

According to NHS England, the GPC executive proposed a practice-level GP employment scheme, ‘potentially targeted by list size, recruitment challenges and demand’ in its consultation with the Government over the contract. Dr Manu Agrawal, South Staffordshire LMC chair and clinical director of Cannock North PCN, is critical of the change, and says it could have serious financial implications for practices and PCNs. ‘This a direct loss from the bottom line of PCNs and practices, the £292m would be around a £50,000 loss for an average practice and a £200,000 loss for an average PCN,’ he tells Pulse. ‘A lot of PCNs might have been using this funding to top up the ARRS salary scheme within their PCNs so that would put them in massively difficult position of where does that funding come from.’

Leicester, Leicestershire and Rutland LMC chief executive Dr Grant Ingrams says that the move could mean the Government thinks PCNs are ‘a dead duck’. ‘At least the money is coming back to general practice in one way, shape or form, because the other fear was whether the Government would take PCN money as a block to fund neighbourhood health services – so at least it’s not that,’ he tells Pulse. ‘But it has taken away the flexibility for that money whilst at the same time returning money from the PCN level to the practice level. It is raiding money that practices would otherwise have earnt and then could have used for whatever they wanted.’

‘Experienced GPs’ included in the ARRS

PCNs can now hire ‘experienced’ GPs through the additional roles reimbursement scheme (ARRS), not just newly-qualified ones. The contract will remove restrictions on the use of ARRS funding to recruit GPs, while the maximum reimbursement PCNs can claim for ARRS GPs will increase, to account for more experienced GPs being eligible. 

According to specialist accountants, the ARRS expansion is ‘a great move on the surface’, but GPs would need to be ‘cautiously optimistic’ until figures are presented. ‘In the past, ARRS funding hasn’t even covered the sessional rate for newly-qualified GPs,’ says Ms Collin. ‘So I would not be surprised if the same is true for more experienced doctors. In short, this change doesn’t necessarily mean that PCNs will be able to go out and hire the staff they want and need.’ 

The BMA has previously advocated in favour of scrapping ARRS because of the two-year eligibility cut-off, the low market rates offered for ARRS GP sessions, and the lack of a focus on continuity of care. 

Dr Agrawal says that relaxing of ‘discriminatory’ eligibility rules is a ‘welcome’ reform, as is the lifting of the payment cap for ARRS GP sessions. However, he is sceptical about how the reimbursement increase will be funded. ‘We’ve not seen any increase in the funding this year, unless it comes out in more detail. If the ARRS budget is not going to increase, how are PCNs going to be able to pass on those increased salaries?’

A&G mandated ‘where clinically appropriate’

A&G requests will no longer be an enhanced service and will be absorbed into core practice funding, meaning GPs will no longer receive a £20 service fee for using it instead of referrals. At the same time, A&G is set to continue to expand, with NHS England confirming practices will be ‘required’ to use A&G ‘prior to or in place of a planned care referral where clinically appropriate’. NHS England did not clarify to Pulse which referrals would be deemed as ‘appropriate’ to now go through A&G instead, but said guidance ‘to follow’ may define what this looks like in practice. 

The scrapping of the £20 incentive may reflect the fact the Government’s target for increased A&G requests is likely to be missed. It was hoped the incentive would increase pre-referral advice requests from GPs up to four million total in 2025/26, diverting two million referrals from elective care. However, monthly NHS data on A&G indicates these targets will not be met by the end of next month.

Prior to the publication of the contract details this week, GPs had already been asked to use A&G for the top 10 specialties at provider level ‘which have the most potential for this model to be effective’, with the specialties to be agreed upon locally. It was hinted at an NHS England board meeting this month there would be ‘significant rollout’ of ‘broader adoption’ of A&G, though it was not clarified if A&G would be mandated for all specialties. 

RCGP chair Professor Professor Victoria Tzortziou Brown says GPs will ‘need to be cautious’ about the integration of A&G into the GP contract and the implementation of a single point of access for specialist referrals. ‘Our members have raised concerns over how its use varies across the country, how delays and potentially blocked referrals can jeopardise patient safety, and how it can push workload from secondary to primary care without clear resourcing, consistent clinical governance, or sufficient consideration of the downstream consequences for capacity and care quality’, she says.

And Dr Paul Evans, chair of Gateshead & South Tyneside LMC, tells Pulse that the change could worsen patient care and restrict GP decision-making. He says that the change represents the effective removal of a patient’s right to seek specialist opinion, and that will mean GPs will be left holding clinical risk. ‘The removal of the right of a GP to refer directly to a consultant peer will undoubtedly lead to definitive patient care being delayed,’ he says.

Weight-loss drug prescribing added to QOF

Two new obesity-related indicators will be added to QOF to ‘track’ the provision of obesity care, including offering ‘evidence-based advice’, referrals to weigh-management programmes and NHS-approved weight-loss drugs.

The Department of Health and Social Care said that the new indicators, backed by £25m of ring-fenced funding, will mean adults living with obesity are ‘more consistently identified and supported’ by GPs across England, through improved recording of BMI and ‘appropriate’ support to manage their weight. Tirzepatide prescribing was rolled out in primary care through a phased approach in June last year, but there have been issues as ICBs were late in putting provision in place. After the rollout started, GPs said they were facing a major increase in workload as patients were seeking to access the drugs, but because some ICBs were slow to set up prescribing pathways GPs found themselves explaining to eligible patients that the treatment was not yet available locally.

Integrating weight-loss drugs into a national incentive scheme such as QOF assumes a uniform level of access to weight-management services across England, while the provision remains fragmented, according to GP leaders.

‘Introducing QOF targets before local weight-management pathways are fully commissioned risks penalising practices operating in areas where the supporting infrastructure is weakest,’ Professor Azeem Majeed, head of primary care and public health at Imperial College London, tells Pulse. He also points out that weight-loss medications such as GLP-1 agonists also require careful initiation, dose titration, ongoing monitoring, and integration with behavioural and lifestyle interventions to ensure safe and effective use in clinical practice. ‘Any new QOF indicators must be matched by adequate and equitable supply of weight-loss medications, clear commissioning of Tier 2 and Tier 3 services, and appropriate investment in multidisciplinary teams across all ICBs,’ he adds.  

NHS England said that during the consultation on these changes there were concerns around disadvantaging practices lacking access to wrap-around services, but stressed that they are going to provide ‘clear guidance’ on implementation.

‘Improvement incentives’ for progress on vaccination rates

The QOF will also be updated to introduce additional improvement thresholds for the three childhood vaccination indicators (VI001, VI002 and VI003) for 2026/27 and the Statement of Financial Entitlements (SFE) will be updated to reflect this change. These are meant to ‘reward’ practices that may not meet the existing achievement thresholds but demonstrate ‘meaningful and sustained improvement’ in vaccination update.

NHS England said that feedback on these changes was ‘broadly supportive’, and that their approach reflects a consistent message from stakeholders to ‘better support practices in high-need areas’. But according to the BMA, these proposals ‘will not go far enough’ to support practices serving deprived communities with vaccine‑hesitant populations, and the RCGP said these changes in particular could have ‘potentially significant resource implications’. The BMA had previously raised concerns about inadequate funding for practices to continue carrying out vaccination programmes.

Same-day access for ‘clinically urgent’ patients

An explicit requirement will be introduced for requests ‘identified as clinically urgent’ by the GP practice to ‘receive a same-day response’. However, the wording used by NHS England has already caused some confusion, as the letter said a new requirement will be introduced so that ‘clinically urgent’ patients will be ‘dealt with on the same day’. At present it remains unclear what counts as ‘dealt with’ but NHS England is expected to produce more guidance on this.

On this requirement, the GPC said that the contract is setting more ‘unrealistic expectations’ of ‘unlimited’ same-day urgent care. ‘We expect the Government to frame this GP contract as a major win for patient access, but hard-working family doctors will be deeply concerned about setting up even more unrealistic expectations of unlimited same‑day urgent care provision alongside potential barriers being put in place around specialist referrals, all while trying to keep practices open and prevent even more surgery closures,’ said GPC chair Dr Katie Bramall.

Dr Steve Taylor, the Doctors Association GP spokesperson, says there could also be issues around defining an urgent request given that practices will triage and assess requests and their urgency. ‘This is too vague and sounds restrictive,’ he tells Pulse. ‘Without clarity, it is open to interpretation and therefore confusion, both for patients and practice teams.’ 

NHS England also made a change to response time for ‘non-urgent’ requests – while these were previously required to receive a response within the same core hours in which they were received, this has now been changed to ‘by the end of the next working day’ (rather than within the same core-hours period).

While more guidance remains outstanding, the Government has told the BMA in a closing letter following the contract consultation that it will expect ICBs to reach a threshold of 90% requests dealt with on the day, and it goes on to indicate that those practices which fail will be contractually mandated to participate in a performance improvement process with their ICB.

No capping of online requests and providing additional data

Online consultation systems must ‘not cap the number of requests that can be submitted’ during core hours, according to the changes. This will not be a surprise to GPs, who have had to deal with online access tools remaining open for the duration of core hours regardless of capacity since October. The BMA is currently in dispute with the Government over this requirement and has pushed for it to be paused due to concerns for patient safety – but while NHS England said that they ‘heard feedback’ about safety and capacity for practices related to unlimited requests coming in during core hours, they have not reconsidered it, adding that ‘this is not a new requirement’ and it is needed to ‘enable equitable patient access to digital routes’.

In addition to this, practices will also be required to share ‘timely’ data on online consultations as part of the contract. This was justified by NHSE as a way to get ‘a clearer understanding of access’, but there have been concerns that this could lead to performance management. However, NHS England has put it in writing this time that the ‘intention is not to performance manage practices’ but highlighting ‘where improvement may be needed’.

Requirement to engage with ICB improvement measures and neighbourhoods

GPs must ‘engage’ with their ICB where ‘unwarranted variation’ in performance has been identified – though questions remain over what will be monitored and what ‘engagement’ means. The letter includes areas where ‘unwarranted variation’ will be monitored, such as ‘where practices are not meeting their requirement to see all clinically urgent patients on the same day or are at risk of contractual breach’. 

It also noted the need for ‘clarity’ on variation and ICBs’ role in engaging with practices and said it would publish guidance to ‘set out clear expectations for both practices and ICBs’. However, NHS England admitted that the measure had come up against resistance from GP representatives. 

‘If it is used as a stick for practices, then that is a real problem,’ says Dr Taylor. ‘But if there’s a carrot, with a way of fixing it and the resources to help it happen, that could be amazing and probably something that we would have called for. If it came with money and incentives, that would be a good thing.’  

PCNs will also be required to work with their ICB to ‘achieve greater alignment’ between the PCN-registered lists and neighbourhood areas. This will be done by amending the Network Contract DES to mandate collaboration on PCN footprints. NHS England stressed that this was not intended to lead to a ‘widespread reconfiguration’ of PCNs, but was only expected to apply in limited circumstances as a pragmatic safety net.

This comes during a stagnant period regarding guidance about the neighbourhood health contracts, first announced last summer as part of the 10-year plan. However, GP leaders have complained about a ‘vacuum’ of information on the new arrangement since. 

Earlier this week, NHS England and Government leaders told neighbourhood stakeholders – including GPs – to begin working in the new manner suggested by the 10-year plan, and ‘not to wait’ for published guidance. 

The lack of information on neighbourhoods in the 2026/27 GP contract coupled with the expectation to still ‘engage’ with neighbourhoods has raised a few eyebrows. Mr Pow said that the absence of any details on neighbourhood contracts will only increase uncertainty over ‘funding flows at both practice and PCN level’.

And Health Foundation senior policy fellow Dr Luisa Pettigrew added that the lack of clarity on neighbourhood providers has left practices ‘uncertain’ about their role in the services, and could stymie effective planning.

Continuity of care

NHS England will make it a core requirement for PCNs to identify and prioritise cohorts for continuity of care ‘using risk stratification tools’ as part of their core activities.

Before the 2024 general election, Labour politicians had long suggested that under their Government, they would financially incentivise GP practices to prioritise continuity of care in an effort to ‘bring back the family doctor’ – one of their manifesto pledges. In the 2025/26 contract, the then-new Labour Government repurposed one domain of the Capacity and Access Improvement Payment (CAIP) to incentivise PCNs to use the ‘intelligence gained from population health risk stratification tools to stratify those patients’. With this data, practices could then identify those that would benefit most from continuity of care. 

This year, that risk-stratification and identification has been embedded into the core contract, with the intention of making continuity a ‘core expectation within primary care’. NHS England noted that doing this will result in creating more ‘meaningful continuity models’ in subsequent contract reform. It is not clear how this will be done at this point in time.

What’s next?

The GPC has now rejected the contract changes, and called for the Government to go back to the negotiating table and negotiate ‘directly’ with the BMA the terms of a new contract – this time, the wholesale new GMS contract that the union has been calling for, rather than further changes to the 2026/27 contract.

But regardless of the imposition, next month the GPC will ask GP members to vote on the contract changes, in a referendum running from 4 March to 25 March – they will be asked if they accept the Government’s changes or if they want them to ‘return to direct negotiations’ with BMA leaders to ‘develop a new practice contract’. The results of this referendum are expected to be used as leverage in future negotiations, according to the GPC.

GPC chair Dr Bramall says that unless the Government returns to the negotiating table and ‘enter into serious one-to-one negotiations’ over a new contract, the profession ‘will be left with no alternative but to escalate to action’. ‘No more empty words, no more broken promises – it’s time for action,’ she says. The BMA has already hinted at what shape future GP collective action could take, including GPs uniting behind a new AI-powered OPEL-style framework that would enable closing of services. But timeline for possible action still remains uncertain, with some LMCs demanding escalation as soon as possible, following the breakdown in relationship between the GPC and the Government.

Read all of our coverage of the 2026/27 contract here.