GP reimbursement scheme could go unspent because it is too restrictive, experts warn
Much of the allocated £292m for a GP practice-level reimbursement scheme will go unspent because of overly restrictive rules for claiming the money, GP finance experts have warned.
This year’s imposed GP contract ‘repurposed’ £292m from PCNs to fund ‘a new practice-level GP reimbursement scheme’ to ‘enable practices to recruit new GPs’ or ‘increase the number of sessions from GPs already working in the practice’. Further details were released at the end of April which confirmed this applied to salaried GPs only and came into effect on 1 April.
Other restrictions include funding being capped at nine sessions, restrictions on eligibility for locum GPs, and the requirement for GPs with more than 3,500 patients to seek ICB approval before applying.
Specialist medical accountant Andy Pow said the recruitment scheme’s restrictions mean many practices ‘won’t be able to claim anything’.
Mr Pow told Pulse: ‘The reality is a lot of practices won’t be able to claim anything, so they [the Government] just won’t spend the £292m. They previously paid this money out under capacity and access to PCNs but they won’t necessarily pay it all out in terms of GP reimbursement schemes, so that’s going to save them money. From a practice perspective, it’s not very good.
‘I don’t think it has been deliberately designed that way, I just don’t think they have thought through the fact they have made it quite problematic for every practice to claim. It’s the reality of producing rules without really probably taking full advice on the implications of them.’
Katie Collin, a partner at specialist medical accountancy firm Ramsay Brown, agreed that the scheme’s restrictions were not a deliberate means of the Government retaining more of the £292m fund, but she said it could have been designed with NHS figures in mind.
She told Pulse: ‘It feels to me it’s a fund that’s about statistics at Government level – making the full-time GP statistics look better. Having locums in there wouldn’t count towards that statistic, and having partner time in there doesn’t either. It’s the number of sessions by salaried doctors, and “long-term locums”, which are essentially employees.’
Ms Collin said she anticipated that either a large proportion of the funding would go unused, or that the Government would ‘loosen’ the scheme’s restrictions halfway through the financial year, ‘which then doesn’t help anyone because we will have spent six months with these conditions’.
It comes as one GP practice has written to the BMA and NHS England to warn of the potential ‘cliff-edge’ effect for practices that ‘proactively’ hired GPs in anticipation of the scheme starting.
The Fareham Centre Practice in Hampshire said their application was rejected after they employed a new salaried GP because the GP had started three weeks before the period covered by the scheme.
GP Dr Kieran Gilmartin said the rejection went against the purpose of the scheme and risked penalising practices. He said his practice had applied for the scheme to cover the salaried GP, who started in early March, with the intention of funding the GP’s sessions once the scheme started in April.
In correspondence seen by Pulse, Hampshire and Isle of Wight ICB told the practice NHS England had rejected the application because ‘the GP was employed in the 12 months prior to the scheme starting (albeit in March)’.
Dr Gilmartin told Pulse: ‘The whole point of the scheme was it was about employing an additional GP, which is exactly what we’ve done.
‘We knew the scheme was being talked about [prior to April], and that it was going to happen. This is an extra six sessions of true additionality, and there’s no point delaying [the new GP starting in their role] because that wouldn’t be fair on them as an employee, and also it might risk losing them.
‘We employed them three weeks early, we knew we would be paying for that three weeks, so that was fine. When we saw the [SFE amendment] details and the way it was worded, we said, “they’re going to try and reject this, aren’t they?”’.
‘What is the point of us trying to do this and actually recruit when this sort of thing is happening on a regular basis?
‘It’s not even new funding, and this is what’s even more frustrating. This is funding that was already in the system for primary care, and all they have done is move it and made it really difficult.’
Dr Gilmartin told Pulse he has written to the ICB, the BMA GP committee, NHS England, Wessex LMCs and the practice’s local MP about the issue.
In his letter to the GPC, he warned of a potential ‘cliff-edge effect’ if the same rationale for his practice’s rejection was being applied nationally by NHS England.
Dr Gilmartin’s letter said: ‘Our practice acted early to recruit additional GP capacity and improve patient access. Had the same GP commenced employment only a few weeks later, the practice would have qualified for reimbursement. Instead, because we recruited before 1 April 2026, the practice receives no support despite delivering exactly the workforce expansion the scheme was intended to encourage.
‘This appears to create a situation whereby practices that proactively increased capacity before the formal commencement of the scheme may be financially disadvantaged compared with practices that delayed recruitment until after 1 April 2026.
‘My concern is therefore less about contractual interpretation and more about whether this outcome was intended when the scheme was designed and whether it represents an inequitable implementation of an otherwise welcome workforce initiative.’
Mr Pow said he ‘absolutely sympathised’ with Dr Gilmartin’s case.
He told Pulse: ‘The scheme rules didn’t appear until the back end of April, so you didn’t know what rules you were playing by that point in time. My concern is people are going to get knocked back for all kinds of reasons because it doesn’t fit the minutiae of the rules they produce’.
Hampshire and Isle of Wight ICB’s director of neighbourhood health James Roach told Pulse: ‘The decision regarding Fareham Centre Practice’s application was made in line with the national eligibility criteria set by NHS England for the GP reimbursement scheme.
‘We understand the practice’s concerns and appreciate the steps it has taken to recruit additional GP capacity. We have worked with the practice to seek clarification from NHS England and remain committed to our positive and constructive relationship with the practice.’
Meanwhile, former BMA GP committee chair Dr Katie Bramall told Pulse the decision was ‘unethical and illogical’.
Dr Bramall said: ‘While we have expressed cautious support for the GP reimbursement scheme, this decision appears unethical and illogical. Rejecting practices that are using initiative, getting in early to use the scheme in good faith to provide additional care is short-sighted, particularly at a time when practices and patients are crying out for help.
‘The support available already does not go far enough to address the wider crisis in general practice, nor does it guarantee fair remuneration or safe, sustainable working conditions for GPs or patients. However, this scheme would at least begin to help ease workforce pressures.
‘Common sense should prevail here. Practices should not be penalised for planning ahead in the interests of their patients. We hope this decision will be reversed so GPs can focus on what they do best – serving their communities.’
Last month, the Government corrected a published error in the amount GPs can claim under the reimbursement scheme for the increased participation of an existing salaried GP.
DHSC told Pulse no GP practices who had made claims had been affected by this error because the system via which practices claim reimbursement did not contain the incorrect amount.
NHS England declined to comment but said that ICBs follow national policy on whether to approve or reject practice claims.
