An Overview of the GP Contract 2026/27: Financial Entitlements and What Practices Are Contractually Required to Deliver
- May 4
- 8 min read
In a previous post, we shared the GP Contract letter for 2025/26. This post does the same for 2026/27, but goes a step further.
As well as covering what has changed this year, we wanted to give those of you who are not GP partners or Practice Managers a clearer understanding of what practices are contractually required to deliver and the income streams available to them.
GP Contract 2026/27 | Two Documents, One Contract
When the GP contract 2026/27 landed, it came in two parts.
The first is the contract changes letter from Dr Amanda Doyle, who is the National Director for Primary Care and Community Services. This is the policy document. It tells you what NHS England has decided and why.
The second is the Statement of Financial Entitlements Directions 2026, known as the SFE.
This is the legal document. It is issued by the Secretary of State under Section 87 of the NHS Act 2006, and it is what makes the contract binding.
The SFE sets out every payment type, the exact calculation method, the conditions that trigger payment, the due dates, and what happens if conditions are breached.
Let’s jump in!
What Practices Are Paid to Deliver
General practice funding is not a single payment. It is a layered system, and each layer covers a different activity.
The Global Sum is the foundation. This is the core monthly payment every GMS practice receives. It covers Essential Services and minor surgery, including staff costs. Essential Services is the baseline: day-to-day clinical care, management of chronic disease, general medical advice, and referral. Practices that opt out of minor surgery see a 0.6% deduction. Practices that opt out of out-of-hours see a 4.70% deduction.
The Quality and Outcomes Framework (QOF) sits on top of the Global Sum. This is the performance layer. Practices receive aspiration payments monthly based on expected achievement, and achievement payments at year-end based on actual performance. Practices that fall below 150 QOF points face a deduction from their Global Sum.
Directed Enhanced Services (DES) are nationally specified services paid over and above the core contract. The main ones are the Network Participation Payment, paid at £0.147 per weighted patient for PCN membership, and the Learning Disabilities Health Check Scheme, which pays per completed health check.
Item of Service (IoS) fees apply to vaccinations that sit outside the Global Sum. The current rates are £12.06 per dose for Table 1 vaccines and £10.06 for Tables 2 and 3. This covers childhood and adult routine schedules, RSV, and other programmes.
Specific-purpose payments are triggered by particular circumstances. They cover locum costs for maternity, paternity, neonatal, adoption, or shared parental leave, sickness cover, prolonged study leave, the GP Retention Scheme, and the Flexible Careers Scheme.
Dispensing payments apply to practices authorised to dispense. This includes reimbursement for drugs and appliances, a dispensing fee, and the option to join the Dispensary Services Quality Scheme for an additional quality payment.
The tables below set out the key payment rates for 2026/27, drawn directly from the SFE.
Core GMS Practice Payments
Payment | Rate | Basis | Frequency |
Global Sum | £130.07 per weighted patient | Contractor Weighted Population | Monthly |
London Adjustment | £2.18 per patient | Patients within the Greater London Authority | Monthly |
QOF point value | £227.95 per point | Adjusted by CPI and APDF (see note) | Annual |
QOF Aspiration Payments | 80% of expected achievement | Based on prior year performance | Monthly |
Vaccination IoS fee (Table 1) | £12.06 per dose | Per eligible dose administered | Monthly claim |
Vaccination IoS fee (Tables 2 & 3) | £10.06 per dose | Per eligible dose administered | Monthly claim |
LD Health Check | £140.00 per health check | Patients aged 14+ on register | Monthly claim |
GP Retention Scheme | £76.92 per session | Up to 4 sessions per week | Monthly |
Network Participation Payment | £0.147 per weighted patient |
| Monthly |
PCN-Level Payments
Payment | Rate |
Core PCN Funding | £3.059 per patient |
Enhanced Access Payment | £8.903 per adjusted patient |
Care Home Premium | £133.158 per bed per year |
Capacity and Access Support Payment (CASP) | N/A |
Local Capacity and Access Improvement Payment (CAIP) | N/A |
Investment and Impact Fund (IIF) | Max £198 per point (58 points) |
Additional Roles Reimbursement Sum (ARRS) | £27.668 per weighted population patient |
Check out our PCN financial entitlements calculator to find out what your PCN will be receiving this year here.
A note on QOF: the £227.95 point value is the national rate, but what a practice actually receives per point varies. Two adjustments are applied. The Contractor Population Index (CPI) reflects the practice's list size relative to the national average of 10,295. The Adjusted Practice Disease Factor (APDF) adjusts for disease prevalence, so practices with sicker populations are not penalised. The maximum number of points available in 2026/27 is 582. Practices must achieve at least 150 points or face a deduction from their Global Sum.
What Has Changed in 2026/27
On 1 May 2026, NHS England published implementing the 2026/27 GP contract changes to PMS and APMS contracts (PRN02354i). This applies at practice level, confirming that the same uplifts flowing through GMS apply equally to PMS and APMS contracts.
For practices, the net uplift is £6.73 per weighted patient across all three contract types, equating to a 5.5% GMS contract uplift. The practice Global Sum rises from £123.34 to £130.07 per weighted patient. The practice OOH deduction for 2026/27 is 4.70%, equating to £6.11 per weighted patient.
Also at the practice level, the new GP reimbursement scheme includes a funding entitlement of up to £4.57 per practice adjusted population.
On 30 April 2026, NHS England published a variation to the Network Contract DES (PRN02483), taking effect from 1 May 2026. This applies at PCN level. The variation introduces Local Variation Arrangements, allowing ICBs to request local variations to sections 7, 8 and 10.1 to 10.5 of the Network Contract DES specification. For more on how these sit alongside the proposed Single Neighbourhood Provider contract, see Local Variation Arrangements and the Single Neighbourhood Provider.
Also at PCN level, the variation introduces further ARRS flexibilities. From 1 May 2026, GPs and Band 5 and Band 6 practice nurses who were funded through the 2025/26 PCN Capacity and Access Payment, or through the PCN Test Sites Programme, can transition into the PCN’s ARRS, subject to funding availability. This is in addition to the removal of the recently-qualified GP restriction confirmed in the original contract.
The wider GP contract financial picture
The headline figure is £485 million of additional investment in the 2026/27 GP contract. This is the new money flowing into general practice for the year, set against the £13.863 billion total contract value. It covers pay uplifts, expenses, the embedding of Advice and Guidance funding into core contract, and the changes to QOF.
That is 3.6% cash growth or 1.4% real terms growth. The pay assumption is 2.5%, to be revisited in light of pay review body recommendations.
But the number that matters most is £292 million.
That is the amount being repurposed from the PCN-level Capacity and Access Payment (CAP) into a new practice-level GP reimbursement scheme.
The CAP, made up of the Capacity and Access Support Payment (CASP) and the Local Capacity and Access Improvement Payment (CAIP), is being removed from the Network Contract DES.
The money is moving from the network level back to individual practices, specifically to fund GP recruitment and additional sessions for same-day urgent access.
At the PCN level, the ARRS restriction limiting GP recruitment to recently qualified GPs has been removed. The maximum reimbursable amount is increasing to the top of the salaried GP pay range, plus on-costs. PCNs can also recruit a broader range of ARRS roles, where agreed with commissioners.
Access: What Is Now a Contract Obligation
Several access requirements have moved from expectation into contract obligation. These are enforceable.
Clinically urgent patients must be seen the same day. It is for the practice, not the patient, to determine what is clinically urgent.
Practices must not ask patients to call back on another day.
For non-urgent contacts, an appropriate response is required by the end of the next core hours period. That means telling the patient how and when their issue will be managed, not necessarily resolving it.
Online consultation systems must not cap requests during core hours.
Practices must display opening times for all modes of access on their website, in their leaflet, and on their premises.
Five demand metrics will also be collected: call waiting time between 8 and 10am, call waiting time across core hours, percentage of clinically urgent patients seen the same day, percentage of non-urgent patients seen within one week, and percentage of non-urgent patients seen within two weeks.
NHS England is clear that this is not about performance managing individual practices. It is about understanding demand across the system.
Where unwarranted variation is identified, ICBs now have a contractual power to require practices to engage with support.
QOF: 18 New Points and an Equity Mechanism
QOF has been updated with an additional 18 points, worth approximately £25 million nationally.
Changes include:
A new diabetes indicator covering all eight NICE care processes
Two new obesity indicators
Updated heart failure indicators reflecting four-pillar treatment
Updated childhood vaccination indicators for the MMRV vaccine
New blood pressure control indicators combining and replacing separate CHD and stroke measures
The Weight Management Enhanced Service is retired and absorbed into QOF.
The change worth paying most attention to is the new improvement threshold for the three childhood vaccination indicators.
Practices that cannot meet the existing achievement thresholds can now earn QOF points by demonstrating improvement against their own two-year baseline. At year-end, practices receive whichever allocation is higher: standard threshold achievement or the improvement sliding scale.
This is a deliberate equity measure. It recognises that practices in more deprived areas face structural barriers to hitting thresholds and creates a parallel route to reward meaningful progress.
Other Changes to Note
Advice and Guidance (A&G) funding has been embedded into core practice funding. The Enhanced Service is retired. Practices are now required to use A&G prior to or in place of a planned care referral where clinically appropriate. This moves from an incentivised activity to a contractual requirement.
There are lots of practical implications with this. The quality of what goes into a referral matters more than it did before. Being clear about the ask, what has already been done, and what the practice is and is not able to do will become increasingly important as this embeds.
Our friends over at EGP Learning have done a brilliant deep dive into the A&G guidance and the practical implications for referral quality. If you want to understand what this looks like on the ground, we would highly recommend checking out their episode found here ⬇️.
The RSV vaccination programme has been extended to all adults aged 80 and over, and all residents in care homes for older adults. An item of service fee is payable per dose. PCNs now have an explicit duty to ensure eligible residents are identified and offered vaccinations, though they do not have to administer them.
Flu and COVID-19 vaccinations can now be delivered collaboratively under the Network Contract DES, removing a restriction that had previously excluded them.
Continuity of care is now a core PCN requirement. PCNs must use risk stratification tools to identify and prioritise cohorts. The contract frames this explicitly as preparation for more meaningful continuity models in future reform.
The General Practice Staff Survey has been extended to all practice and PCN staff. This is now a contract requirement.
For those of you who are not GP partners or Practice Managers, I hope this gives you a fuller picture of what sits behind the scenes of a general practice business.
Understanding how practices are funded, what they are contractually required to deliver, and where the money has moved this year is important context for anyone working in or alongside primary care.
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