2025/26 GP contract: what will it mean for England’s practices?

The BMA agreed to a deal on the 2025/26 GP contract last week – following months of intense negotiations. Eliza Parr and Anna Colivicchi look at what the changes – and funding increase – will really mean for practices

The next GP contract marks the first agreed – rather than imposed – deal in England in four years. It prompted the Government and NHS England to hail the negotiations a success, while the BMA said that this is ‘the first step on the road to recovery’ for general practice – but will it be enough to stabilise practices?

Where is the money going?

The deal has promised £889m additional core contract funding, including:

• £745m being invested into the global sum;
• £104m into GPs as part of the additional roles reimbursement scheme (ARRS);
• Vaccines and immunisation fee increases of £17.8m and Statement of Financial Entitlement (SFE) uplifts of £12m (although a part of the funding for this will be drawn from a portion of removed QOF indicators);
• An uplift to PCNs for ‘business pressures’ of £13m.

In addition to this, there will also be an investment £80m for use of advice and guidance (A&G) between GPs and consultants (for a total of £969m).

Some of this had already been trailed by the Government before Christmas, when it unveiled the very first details of the contract. This funding is on top of the £433m added to the core contract in the autumn last
year, and NHS England has also promised that a ‘further uplift’ may be made following the Government’s response to the Doctors’ and Dentists’ Pay Review Body (DDRB) outcomes for 2025/26.

After the announcement on Friday, the profession seemed cautiously optimistic about this deal, with GP leaders saying that it seemed promising, but that it will definitely not be enough to fix significant issues caused by decades of underfunding.

‘It isn’t perfect,’ said BMA GP committee member Dr Brian McGregor. ‘It will not ‘save GP’, it is not the end, but it is probably the end of the beginning. The intention was to get a deal that could stabilise practices, reverse some historic losses, and give hope.’

It is significant to note that there was no mention from the BMA or the Government around the financial impact of changes to National Insurance contributions (NICs) kicking in next month, which still represent a huge concern for practices. The BMA recently calculated that planned increases to NICs and the National Living Wage (NLW) in 2025/26 would cost GP practices between £180-200m nationally, and many GP leaders and politicians have been pushing for practices to be fully reimbursed for these extra costs.

GP leaders told Pulse this morning that the funding boost announced as part of the contract deal is indeed expected to cover the extra costs resulting from the NICs and NLW changes, and experts expressed concerns that this means that a huge chunk of the new funding will be lost to the tax changes.

According to the BMA, the new funding represents a 7.2% cash growth in contract funding, while NHS England subsequently said that it estimated 4.8% ‘real growth’ on overall 24/25 contract costs.

‘This uplift includes “business pressures” – a cunning new phrase for the NI uplifts and National Living Wage uplifts, also called “circular money” as it goes in and goes out straight back to the Treasury – so let’s be honest, it is roughly a £689m uplift,’ Dr McGregor added.

Doctors Association UK GP spokesperson Dr Steve Taylor said that the new funding ‘goes a small way’ to fix some of the ‘significant’ issues for GP practices, in that it prevents further declines in funding with a ‘small’ percentage increase. ‘Sadly much of the increase in funding will be lost to National Insurance, staff and on costs,’ he told Pulse. ‘Whilst there has been an acknowledgment of the need to invest in community services, a much larger investment will be needed to reverse the decline and build more capacity for the future.’

‘Actually the headline number of 7.2% I think is slightly misleading,’ said Wesleyan Financial Services’ head of medical Alec Collie. ‘Given a big chunk of it is going back to the Government on tax – but we have seen some interesting moves in terms of what the Government is trying to do, obviously an increase in money is a positive.’

Graham Crossley, NHS pensions expert at Quilter, told Pulse that while the full details are not yet known, there seems to be ‘a general consensus’ that this is ‘a good starting point’.

‘It’s important to note that the majority of the additional funding is being allocated to the global sum,’ he added. ‘While this approach ensures that some practices will benefit significantly, it also means that the distribution of funds may not be uniform across all practices. Consequently, some practices might experience more substantial financial relief than others.’

Katy Drew, primary care development manager at specialist medical accountants Sandison Easson, pointed out that practices should also be aware that there are other funding streams that have not received any uplifts, including the PCN participation payments, weight management and learning disability checks.

QOF changes

NHS England will remove 32 QOF indicators and invest their funding into global sum, childhood vaccinations, locum reimbursement rates and cardiovascular prevention.  

These 32 QOF indicators which were income protected in 2024/25 will be ‘permanently retired’, equating to 212 QOF points worth around £298m in 2025/26.

Of the 212 points, 71 points – worth around £100m – will be ‘removed outright’ and will be invested into global sum and into increases in both the Item of Service Fee for routine childhood vaccinations (from £10.06 to £12.06) and the locum reimbursement rates in the Statement of Financial Entitlements (SFE).

‘This is a win, you no longer need to chase the targets, and will get the money regardless,’ said Dr McGregor. ‘This is not an increase in funding but does allow a review of workload.’  

The remaining 141 QOF points (about £198m) will be ‘targeted towards cardiovascular disease (CVD) prevention’ to support the Government’s ambition to reduce premature mortality from heart disease or stroke by 25% within a decade.

Dr McGregor added: ‘A long debate took place over the impact of deprivation and the challenge of setting these higher targets, this scheme chosen was specifically done so as having the least predicted impact with deprivation.’

Commitment to a wholesale new contract

GPC chair Dr Katie Bramall-Stainer said that the Government must now recognise the ‘imperative’ to deliver a wholesale new GMS contract within the current Parliament for ‘meaningful’ reform and ‘vital’ investment.

‘Only then can we keep the front door of our NHS open, provide timely patient care, and alleviate pressure across our entire health service,’ she added.

The GPC has given the Government until 19 March to put this commitment into writing, before a special conference where LMCs will discuss the contract deal.

Experts have pointed to this as one of the main promising features of this deal. The BMA has been campaigning for this for a long time and included it in its list of demands to bring collective action to an end.

According to Dr McGregor, a complete new contract will takes two and a half years to negotiate. ‘It will involve a line by line re-write of 700 pages of the full GMS contract, a review of the Carr-Hill factor,’ he added. ‘But it will make our contract fit for 2025, not 2004, and bring about the potential for millions of investment and secure the future of the profession.’

Vaccinations and immunisations

The Item of Service (IoS) fee for routine childhood immunisations that are part of essential services will increase by £2 to £12.06 in 2025/26. There will be an evaluation during 2025/26 of the effect that these changes have on activity, uptake and inequalities in uptake.

The 2025/26 SFE will list all the vaccinations and immunisations which are in scope of the increase in the Item of Service fee, and around £17.8m of the funding generated through the retired QOF indicators will be used to cover the estimated costs of this increase.

The new contract also includes changes to the routine childhood and adult schedules in 2025/26, including an additional dose of Hib-containing multivalent (6-in-1) vaccine and the second dose of MMR vaccine brought forwards.

There will also be a change to the adult shingles programme, reflecting new evidence on the effectiveness of the vaccination for a broader severely Immunosuppressed (SIS) cohort and a potential introduction of a varicella vaccine, subject to ‘final ministerial agreement’.

ARRS – GPs and nurses added

Whether and how GPs should be recruited via the additional roles reimbursement scheme (ARRS) has been a hot topic of debate among the profession over the last year. In one of his early announcements as health secretary in August, Wes Streeting expanded the scheme to newly-qualified GPs with the aim of tackling rising GP unemployment. 

But despite many campaigning for GPs to be added to the ARRS, Mr Streeting’s £82m funding boost didn’t go down as well as he might have expected. Critics pointed to the short eligibility window (only GPs who qualified within the last two years), the ‘ringfencing’ of the £82m from the rest of the ARRS money, the small pot of funding per PCN meaning many couldn’t afford anything close to a full-time GP, and the potential negative impact on a GP’s early career if they are forced to work across lots of practices. The BMA was also pretty scathing about the salary range for ARRS GPs, calling it ‘derisory’ and ‘uncompetitive’. 

Given this was badged an ‘emergency measure’ for 2024/25, many were principally worried by the policy’s short-termism, with contracts for newly-qualified GPs potentially lasting only six months from October to April 2025. In a bid to allay this concern, the health secretary reassured GPs in October that funding for the roles will continue into the next financial year.

Now, NHS England has laid out further details of next year’s scheme: 

• Funding will continue for GPs hired during 2024/25, equating to a total of £186m for the whole year;
• The ringfence around GP ARRS money will be removed, meaning there is no cap on the number of doctors PCNs can recruit;
• The salary element of the maximum reimbursable amount will increase by £9,305 from £73,113 for 2024/25 to £82,418;
• The eligibility criteria for ARRS GPs will remain the same – they must be within two years of CCT and must not have already held a substantive post in general practice;
• Practice nurses will be added to the scheme, but they must not have held a post within the PCN or its member practices within the last 12 months. 

This is an overall increase to the level of investment in the current financial year – £82m for six months – in order to accommodate increases to GP salaries. But given this money will no longer be ringfenced, PCNs can decide to spend more of their total ARRS budget on GPs (or, of course, vice versa).

The BMA has said these changes represent an ‘enhancement’ to the ARRS scheme, and highlighted its win in securing salary ranges which are in line with the union’s own recommended salary range. GP leaders said the removal of the ringfence also means individual practices can ‘decide which roles to hire using their additional budgets, rather than having this dictated centrally’. 

But the BMA has also been clear that ARRS funding would be better off at practice level, and LMCs recently demanded that the GPCE ‘negotiates that all ARRS funding is returned to the core contract’.

Dr Paul Evans, GPCE member and chairman of Gateshead and South Tyneside LMC, tells Pulse that ‘in an ideal world’ all ARRS funding would be returned to core with practices ‘able to work together where it’s mutually beneficial’. The BMA’s position on this, he says, ‘has not changed’. 

‘This is a step in the right direction by removing some of the restrictions on ARRS and by prioritizing core funding – but we’re not quite where we’d want to be on this yet,’ Dr Evans says. 

Katie Collin, a partner at specialist medical accountancy firm Ramsay Brown LLP, says that this ‘simplification of the scheme’ could ‘help practices take on the staff they need’. 

But she warns that there will ‘undoubtedly be practices that have maxed out their ARRS allocation already’ meaning they ‘cannot make the most’ of recruiting GPs using the total ARRS budget.

‘While it could make a difference for practices who have treated their ARRS budget with caution, like other elements of this contract, while certainly a good start, this update is no magic wand,’ Ms Collin says. 

GPCE member Dr McGregor told GPs within the YORLMC area today that the removal of the ringfence could mean more practices can afford a newly-qualified GPs, but this could come at the expense of other staff members. 

His LMC newsletter said: ‘Every practice could have a GP if you free up funds by other staff leaving/redundancies. (Make sure you follow employment law!).’

On practice nurses being added to the scheme, Dr McGregor worried that they ‘could use this to set practices against one another’ and ‘game job offers going forward’.

The Government hasn’t given any indication that the ARRS will be scrapped beyond 2025/26, however the BMA revealed on Friday that a ‘joint review on the future’ of the scheme will be held over the next year. Whether the BMA can convince Mr Streeting that the money is better off in practice core budgets remains to be seen. 

New advice and guidance (A&G) enhanced service

Last week’s contract deal contained very few fresh details about this new incentive, given it featured heavily in the Government’s elective reform plan last month. The plan had announced a £20 payment for practices for each A&G request, as part of an £80m funding pot. At the time, the BMA responded positively, suggesting that its advice for GPs to stop A&G could be ‘dropped’ from its collective action menu if the payment was ‘successfully negotiated’ into the 2025/26 contract. 

Negotiations appear to have proven fruitful, with the contact deal cementing this £20 payment as part of a new national enhanced service from April. GP practices will access the payment via an Item of Service (IoS) fee for ‘pre-referral requests’, with funding capped per ICBs. The BMA sought to emphasise on Friday that local commissioners will receive funding ‘according to activity delivered so they are not incentivised to withhold it from general practice’.

More details of the ‘eligibility criteria’ and logistics will no doubt be revealed in the full enhanced service specification, which is not yet published. But there’s one important question which NHS England has so far declined to answer: what happens if A&G activity outsrips the funding available? 

The £80m is intended to fuel an expansion of advice and guidance, with NHS England setting a target to reach 4 million advice requests from GPs in 2025/26, up from 2.4 in 2023/24. According to these figures, it looks like there’s enough money to go round. But if the £20 incentive turns out to be more effective than planned, it’s unclear whether GP A&G activity may go unpaid. 

This new enhanced service does however send a clear signal that the Government is willing to shift money out of hospitals and into general practice. NHS England’s elective reform plan in January said the funding would be found by ‘splitting the existing elective tariff’. Dr McGregor says this is the ‘first time ever’ that resource has been transferred from the secondary care budget. But NHS England has also declined to clarify how much hospital trusts receive on their end to process A&G, so it’s not possible to judge proportionality between primary and secondary care. 

Dr McGregor also points out that there is wide variability when it comes to the workload associated with A&G: ‘This is a payment for something we already do, and there is a world of difference between “what antihypertensive should I try next” to being asked to carry out multiple imaging and drug titrations/monitoring’.

He advised his LMC constituents that a GP’s right to refer remains and that ‘any complex advice can be sent back stating it obviously needs more complex input that a GP can facilitate’. 

As with ARRS, it seems the Government has also committed to reviewing this new A&G enhanced service through 2025/26. The BMA said on Friday that the impact on GPs will be reviewed in the spring, and also that local systems will be required to review the availability of secondary care advice channels. 

Continuity of care incentive

Labour politicians have long hinted at plans to incentivise GP practices to improve continuity of care, as part of the party’s manifesto pledge to ‘bring back the family doctor’. Back in 2023, as shadow health secretary, Mr Streeting said he wanted to introduce financial incentives which would mean practices offering poorer continuity of care receive less money. Later, Labour pledged to remove ‘burdensome’ bureaucracy in return for continuity of care’.

After almost two years of trailing this policy, the now-Labour Government has finally revealed details of the new incentive. One domain of the Capacity and Access Improvement Payment (CAIP) will now be repurposed to ‘incentivise PCNs to use the intelligence gained from population health risk stratification tools to stratify those patients’. Using this data, practices will need to identify those that would ‘benefit most from continuity of care’.

This incentive will be worth £29.2m, equating to a third of the total CAIP funding pot (£87.6m), the rest of which will continue to focus on improving patient access at GP practices. The funding represents only a small portion of the total contract investment next year, and the push for continuity of care is unlikely to be controversial given the mountain of evidence that it is good for patients and GPs alike.

But more information is needed on the requirements for accessing this funding, with only high level details revealed so far. NHS England has promised more guidance in the full 2025/26 Network DES. 

And this kind of risk stratification exercise may not be well-suited to all practices. GPCE member for Cheshire and Mid Mersey Dr Ivan Camphor tells Pulse that while continuity of care is ‘the basic, fundamental thing that holds general practice together’, his small practice in the Wirral is unlikely to be able to reap benefits from the CAIP.

‘Whilst the risk stratification is great for a huge practice, I’m not really sure whether we have the resources or the time and energy to do that. I’ve been seeing my patients for the last 32 years so they know who to see, when to see me and what our specialties are. They make choices by choosing who to see, and that’s how it is.’

New digital tool requirements

From October, practices will need to keep the online consultation tool open from 8am to 6:30pm for ‘non-urgent appointment requests, medication queries and admin requests’.

‘This turned out to be both ours and their red lines,’ said Dr McGregor. ‘They asked for 24/7 including urgent care, we settled at during opening hours, non-urgent and admin, and not until 1 October to work together to sign off as safe before it is introduced.

‘We have warned, repeatedly, that this will not solve the 8am scramble, merely make it electronic, and will lead to waiting lists as requests for routine appointments for trivial reasons increase. It will involve changes to the online forms currently used.’

Dr Camphor tells Pulse he is particularly ‘passionate’ about this issue, suggesting it goes against GPs’ efforts to implement safe working.

‘We were working on safe working guidance, and saying we need to see “x” amount of patients and no more. And suddenly we’ve now got a scenario where we have to open our appointment system at eight o’clock so patients can book in left, right and centre.’

He also says patients may struggle to know which type of appointment and professional to book in with, without triaging from receptionists.

‘How will they know which one or who to book with? Because there are the receptions that triage them, that help them with whether they need a nurse, the first contact physio, or a doctor, or an HCA. But patients will now have access and they’ll be able to book appointments. So I’m not really sure how this is going to work.’

And by 1 October, GPs will be required to allow ‘read-only access’ to patients’ care records (via GP Connect Access Record HTML and Structured) to other NHS providers and in some cases to private providers, following ‘explicit permission’ from the patient. Practices will also be required to allow community pharmacy to send consultation summaries into the GP practice workflow, using GP Connect Update Record.

‘They really want Pharmacy first to work,’ said Dr McGregor. ‘Currently it isn’t doing well and seem to think electronic reporting into patient records will help.’

Violent patients’ rights

Aside from funding, NHS England has also made moves to clarify contract regulations around patient registrations. 

For violent patients, the process for removal ‘will be made clearer’ in the regulations. NHSE emphasised the importance of protecting ‘the right of practices’ to immediately remove violent patients, while also ‘ensuring patient choice is retained’ for those who have not been immediately removed from their previous practice.

Changes to the contract regulations will also:

• Reinforce the importance of practices processing the immediate removal alongside reporting the incident to the policy within the period set out in the regulations;
• Clarify that police reports made after this period should not necessarily affect patient choice of alternative provider and should not necessarily mean that a patient requires allocation through the Special Allocation Scheme.

Out-of-area patient registration approvals

There will be a contractual requirement that GP contractors ‘work collaboratively’ with commissioners to implement out of area registration, according to NHS England’s letter setting out the changes last week. ‘This will provide safeguards when practice lists are expanding rapidly with the registration of out of area patients,’ it added.

In these instances, contractors will need to seek approval of their plans to ‘enable commissioner oversight’ of the safety and effectiveness of the arrangements.

ICBs will consult with LMCs before granting the approval. NHS England told Pulse that more information and guidance on this will be published soon. 

Patient charter and patient safety requirements

GPs will be required to publish a ‘patient charter’ setting out the standard of care they are contracted to provide – this will be publicly available and will have to be posted on practices websites. The Department of Health and Social Care confirmed to Pulse that this charter will set out ‘in black and white’ what patients can expect from their GPs and practices and will also set out what to do if patient expectations ‘aren’t met’ and what is expected of patients.

The contract changes also include a new requirement to record patient safety events at the practice ‘about the services delivered’. This is to contribute to the national NHS-wide data source to ‘support learning, improvement and learning culture’, the commissioner said. It will also enable the practice to record patient safety events occurring in other health care settings (for instance if a GP practice wished to record an unsafe discharge from hospital).

What next?

The next big development will be whether the Government provides a commitment, in writing, to negotiate an entirely new GP contract in the coming years. Mr Streeting has just over two weeks to make a decision on this ahead of the special LMC conference on 19 March.

The BMA has also previously committed to giving delegates at this conference a vote on the 2025/26 contract deal, with the final decision being taken at a GPCE meeting the following day. 

There is also plenty of guidance yet to be published which will help GPs navigate the contract changes. The BMA promised on Friday to provide ‘detailed information about the contract changes and how they will affect’ GPs in the coming days. And from NHS England, GPs await further guidance and detailed specifications on the many policy changes set out above.