GP Contract 2026/27 — Partners Playbook

What is the GP Contract?

In one sentence:The GP contract is the legal agreement between your practice and the NHS that defines what services you provide, how you're paid, and what standards you must meet.

It's renegotiated annually between NHS England and the BMA. The outcome affects your income, your workload, and the rules you operate under. For 2026/27, the total contract value is £13.86 billion — a £485 million uplift (3.6% cash, 1.4% real terms after the GDP deflator).

Why this matters right now

Same-day urgent access is now a contractual requirement, not guidance
£292 million has moved from the PCN-level CAP to a new practice-level GP Reimbursement Scheme
18 new QOF points (~£25m) including obesity, updated diabetes, and heart failure indicators
Advice and Guidance embedded in core funding — the enhanced service is retired
ARRS GP eligibility expanded — any GP can now be recruited, not just recently qualified

The basics haven't changed

Your practice remains an independent contractor. You hold your own contract (GMS, PMS, or APMS). Patients register with your practice. You decide how to organise your clinical work. The contract sets the framework — you run the practice.

Contract Types

There are three types of GP contract in England. Most of the headline changes each year apply to GMS, with PMS and APMS practices receiving equivalent adjustments through their local agreements.

1

GMS (General Medical Services)

The nationally negotiated contract between NHS England and the BMA. Identical terms everywhere. Most practices in England hold a GMS contract. Funding via the Carr-Hill weighted Global Sum.

2

PMS (Personal Medical Services)

A locally negotiated contract with your ICB. Can include additional services beyond the core GMS spec. Typically offers a locally agreed Global Sum equivalent, often with premium payments for extra services. Around 25% of practices.

3

APMS (Alternative Provider Medical Services)

A time-limited contract, usually awarded by competitive tender. Often held by companies, social enterprises, or NHS trusts rather than traditional partnerships. Used to fill gaps in provision — can include or exclude specific services.

How Your Practice Gets Paid

Practice income comes from several distinct funding streams. The balance varies by practice, but here's the typical picture for a GMS contract:

Click each segment to see what it covers

Main funding streams for a GMS practice
Funding stream	What it pays for	Approx. share
Global Sum	Core practice running costs — staff, premises, day-to-day care. Adjusted by the Carr-Hill formula for patient demographics and local costs.	~60%
QOF	Quality and Outcomes Framework — payments for meeting clinical and public health indicators across defined domains.	~8%
Enhanced services	Additional services beyond core contract — directed (DES), national, and local (LES). Includes PCN DES, vaccinations, minor surgery.	~12%
Premises	Reimbursement towards rent, rates, and clinical waste. Either notional rent (owned) or actual rent (leased).	~9%
Other	Seniority, dispensing fees (rural), locum reimbursement, PCN participation, GP Reimbursement Scheme (new 2026/27).	~11%

The Carr-Hill Formula — how your Global Sum is calculated

The Global Sum isn't a flat rate per patient. It's adjusted by the Carr-Hill formula, which weights your list size based on how much work your patients are likely to generate:

1

Start with your raw list size

The number of patients registered with your practice. This is your starting point — but it's not what you're paid on.

e.g. 10,000 registered patients

2

Apply Carr-Hill weighting factors

Six factors adjust your list: age/sex, care home patients, list turnover, rurality, deprivation, and staff costs. Each factor can increase or decrease your weighting.

e.g. Older population + high deprivation → weighting factor of 1.15

3

Calculate your weighted list size

Raw list × weighting factor = weighted patients. This is the number the Global Sum is actually based on.

e.g. 10,000 × 1.15 = 11,500 weighted patients

4

Multiply by the Global Sum per weighted patient

NHS England sets a national price per weighted patient. Your Global Sum = weighted patients × this rate.

e.g. 11,500 weighted patients × national rate = your annual Global Sum

The six weighting factors

1

Age and sex

The biggest factor. Older patients and very young children generate more consultations. A practice with an elderly population gets a higher weighted list size.

2

Nursing and residential homes

Additional weighting for patients in care homes, reflecting the higher workload of regular visits, medication reviews, and care planning.

3

List turnover

New patients require more admin (registration, records, initial assessments). Practices in areas with high population mobility get extra weighting.

4

Rurality (Market Forces Factor)

Adjusts for the additional costs of delivering care in rural areas — travel time, smaller scale, recruitment challenges.

5

Deprivation (additional needs)

Patients in more deprived areas have more health needs. The formula applies an additional needs index, though many argue it still under-compensates.

6

Staff Market Forces Factor

Adjusts for regional variation in staff costs. A London practice has higher salary costs than one in a low-cost area.

Is your Carr-Hill weighting right?

It's worth checking. If your practice demographics have changed — more care home patients, a new housing estate, changing deprivation levels — your weighting should reflect that. Errors in the data that feeds Carr-Hill directly reduce your income.

MPIG (Minimum Practice Income Guarantee)

If the Carr-Hill formula would give your practice lessthan you received under the old funding model, MPIG makes up the difference. It's a legacy correction payment, and it's being gradually phased out. If your practice receives MPIG, the amount reduces each year — plan for this in your financial forecasting.

What's Changed for 2026/27?

The 2026/27 contract brings a £485 million uplift (3.6% cash) with a 2.5% pay assumption. Here are the changes that matter most:

£13.86bn

Total contract value

Up from £13.38bn

£485m

Annual uplift

3.6% cash

1.4%

Real-terms growth

After GDP deflator

2.5%

Pay assumption

For 2026/27

+18

New QOF points

~£25m additional

£292m

CAP repurposed

Now practice-level

GP Reimbursement Scheme (new — replaces CAP)

The biggest structural change. The PCN-level Capacity and Access Payment (CAP) — £292 million — has been retired. That money now flows to individual practices through the new GP Reimbursement Scheme.

Purpose: Recruit additional GPs or increase existing GP sessions
Goal: Build clinical capacity for same-day urgent access
Key shift: Funding moves from PCN to practice level — your practice applies directly, not through your PCN

What's moved to core contract

Advice and Guidance:Previously an enhanced service, now embedded in core funding. You must use A&G before planned care referrals where clinically appropriate. The separate enhanced service payment is retired.
RSV vaccination: Extended to all adults aged 80+ and care home residents (Item of Service fee applies)

New contractual requirements

Online registration: Must be used in all registration cases
Pharmacy email: Dedicated monitored email address for community pharmacy communications (where GP Connect unavailable)
Access transparency: Display all access modes (walk-in, telephone, online) on website, leaflet, and premises
Lung cancer screening: Practices must share data to support targeted screening programmes
Staff survey: Participation in the General Practice Staff Survey is now mandatory; share staff contact details with ICB
ICB engagement:Practices must engage with ICB support where “unwarranted variation” in performance is identified

The real-terms picture

A 3.6% cash uplift sounds reasonable — but with a 2.5% pay assumption, rising indemnity costs, utility bills, and CQC fees, the real-terms growth of 1.4% may not feel like growth at all. Factor in that the £292m CAP money is being repurposed (not added), and the actual new money for most practices is modest. Plan your 2026/27 budget carefully.

Access Requirements

Access is the biggest operational change in 2026/27. What was previously guidance or aspiration is now contractual:

Same-day urgent access (mandatory)

Requests identified as clinically urgent — as determined by the GP practice — must be dealt with on the same day. This is a core contractual obligation, not optional.

Clinically urgent: Your clinical team decides what qualifies — but the expectation is that genuinely urgent problems get a same-day response
Non-urgent: Must receive an appropriate response by the end of the next working day
No call-back requests: You must not ask patients to call back or make contact on another day

Data you'll need to report

Practices must collect and report metrics on access performance:

Call waiting time between 8am-10am and during all core hours
Percentage of clinically urgent patients seen on the same day
Percentage of non-urgent patients seen within 1 week and within 2 weeks

Digital access requirements

Online consultations uncapped: Systems must not cap the number of requests during core hours — parity with phone and walk-in
Online registration: Must be available and used for all registration cases
NHS App enabled: Patients should be able to access your services through the NHS App
Website transparency: All access routes (walk-in, phone, online) clearly displayed on website, practice leaflet, and premises

How to approach this practically

The contract says “clinically urgent as determined by the GP practice” — you define what's clinically urgent through your triage process. Get your triage right (structured, consistent, at first contact) and you have a defensible system. The GP Reimbursement Scheme money is specifically there to help you build the capacity you need.

QOF Changes for 2026/27

The QOF framework gains 18 new points (worth approximately £25 million) with significant reshuffling of existing indicators. The theme: simplify, combine, and align with current NICE guidance.

New QOF indicators for 2026/27
Indicator	What it measures	Points
CD001	Blood pressure control in CVD patients aged ≤79 (non-frail) — replaces separate CHD and stroke/TIA BP indicators	41
CD002	Blood pressure control in CVD patients aged 80+ (non-frail) — combined indicator	20
DM037	All 8 NICE diabetes care processes completed annually (HbA1c, BP, cholesterol, serum creatinine, urine ACR, foot check, BMI, smoking)	10
HF009	Heart failure with reduced ejection fraction — 4-pillar therapy (ACEi/ARB/ARNI, beta-blocker, MRA, SGLT2i)	12
OB004	Patients with BMI ≥30 referred to weight management programme in last 12 months	5
OB005	Patients with BMI ≥30 — shared decision-making conversation or pharmacotherapy for obesity	13

Changed indicators
Indicator	Change	Points
DM034	Primary prevention statin in diabetes — points increased	4 → 8
DM035	Secondary prevention statin in diabetes — points increased	2 → 8
CHOL003	Statin therapy in high-risk CVD — points decreased	38 → 20
NDH003	Pre-diabetes register — gestational diabetes cohort now included	18 → 20
AF006	Anticoagulation in atrial fibrillation — upper threshold raised to 95%	12 (unchanged)
STIA007	Antiplatelet therapy post-stroke/TIA — ticagrelor added to formulary	4 (unchanged)

Retired indicators
Indicator	What it was
CHD015	Blood pressure ≤140/90 in CHD (replaced by CD001/CD002)
CHD016	Blood pressure ≤150/90 in CHD aged 80+ (replaced by CD002)
DM012	Diabetes — 3 of 8 care processes (replaced by DM037 — all 8)
HF003	Specialist referral in heart failure (replaced by HF009)
HF006	ACEi/ARB in HFrEF (replaced by HF009 4-pillar approach)
HYP008	BP ≤140/90 in hypertension (renamed to HYP010 — frailty cohort removed)
HYP009	BP ≤150/90 in hypertension aged 80+ (renamed to HYP011 — frailty cohort removed)
NDH002	Pre-diabetes blood test (replaced by updated NDH003)
STIA014	BP ≤140/90 post-stroke/TIA (replaced by CD001)
STIA015	BP ≤150/90 post-stroke/TIA aged 80+ (replaced by CD002)

Childhood vaccination indicators (updated)

The childhood vaccination indicators (VI001, VI002, VI003) have been updated:

MMRV vaccine added to the indicator definitions
Improvement thresholds introduced:A sliding scale that rewards practices for improving above their 2-year baseline, even if they haven't hit the absolute target
VI001: 5-18 percentage point improvement range
VI002: 5-23 percentage point improvement range
VI003: 5-30 percentage point improvement range

Register changes to check

Asthma register:Business rules now include patients from age 5 (check your register isn't excluding younger children)
COPD register: Rules amended to address under-recording and over-recording — review your register for accuracy

Action for your QOF lead

The combined CVD blood pressure indicators (CD001/CD002) replace separate CHD and stroke/TIA BP indicators, while the hypertension indicators are renamed (HYP010/HYP011). Run your clinical system searches now to see where you stand on the new indicator definitions — don't wait until year-end. The obesity indicators (OB004/OB005) are entirely new territory and will need new recall systems and templates.

Enhanced Services

Enhanced services are additional services beyond your core contract that attract separate funding. The 2026/27 changes are about simplification — moving some services into core and retiring others.

What's changed for 2026/27

Advice and Guidance → core contract:The separate A&G enhanced service is retired. The funding is embedded in your core contract. You must use A&G before planned care referrals where clinically appropriate.
Weight Management ES → retired: Replaced by the new QOF obesity indicators (OB004/OB005). The clinical work is similar, but it now sits within QOF rather than as a separate enhanced service.
RSV vaccination → expanded: Now covers all adults aged 80+ and care home residents (Item of Service fee).

What continues

PCN DES: The Network Contract Directed Enhanced Service continues (see our separate PCN DES guide)
Vaccinations and immunisations: Seasonal flu, COVID-19, pneumococcal, shingles — continue as enhanced services
Minor surgery: Continues as a DES
Local Enhanced Services: These vary by ICB and continue to be commissioned locally

Check your enhanced service income

If your practice earned significant income from A&G or Weight Management enhanced services, that money hasn't disappeared — it's been absorbed into core funding (A&G) or QOF (obesity). But the mechanism has changed, so check your projected income against last year's actuals.

ARRS (Additional Roles)

The Additional Roles Reimbursement Scheme funds PCNs to recruit extra staff. The 2026/27 changes are significant for GP recruitment:

What's changed

GP eligibility expanded: The restriction limiting ARRS funding to recently qualified GPs (within 2 years of CCT) has been removed. Any GP can now be recruited through ARRS.
GP reimbursement increased: Maximum salary reimbursement rises to £118,759 (£120,921 in London) — the top of the salaried GP pay range plus employer on-costs.
Broader role flexibility: PCNs can recruit non-direct patient care roles from the ARRS budget where agreed with the commissioner.
Advanced practice: The mandatory accreditation requirement for advanced practice nurses has been dropped.

What this means in practice

If your PCN has been struggling to recruit GPs through ARRS because of the 2-year restriction, that barrier is gone. You can now use ARRS to bring in experienced GPs — and the reimbursement level is competitive.

The broader role flexibility also means your PCN can think creatively about what the team needs — data analysts, project managers, or other support roles can now be funded through ARRS with commissioner agreement.

Talk to your PCN Clinical Director

ARRS recruitment happens at PCN level, not practice level. If you want to make use of the expanded GP eligibility or the broader role flexibility, raise it at your next PCN meeting. The funding is there — but it needs to be agreed collectively.

Glossary

Contract jargon decoded — the terms you'll encounter in contract documents, SFE amendments, and ICB communications:

Global Sum

The main block of core funding for GMS practices. Calculated per weighted patient using the Carr-Hill formula. Covers day-to-day running costs, staffing, and essential services. The single biggest income line for most practices.

Carr-Hill Formula

The formula that adjusts the Global Sum for each practice based on patient demographics (age, sex), deprivation, rurality, list turnover, care home patients, and local staff costs. Turns your raw list size into a 'weighted' list size.

MPIG

Minimum Practice Income Guarantee

A correction payment for practices whose Global Sum allocation is less than their old funding level. Being gradually phased out — if your practice receives MPIG, it's being reduced each year.

QOF

Quality and Outcomes Framework

A points-based incentive scheme across clinical, public health, and quality improvement domains. Each point has a monetary value (adjusted for list size and prevalence). Practices earn income by meeting indicator thresholds.

DES

Directed Enhanced Service

A nationally specified enhanced service that ICBs must commission and all eligible practices can choose to provide. The PCN DES is the most significant. Others include vaccinations and minor surgery.

LES

Local Enhanced Service

Enhanced services designed and commissioned locally by your ICB to meet specific local needs. Terms, specifications, and payments vary by area. Examples: extended hours, near-patient testing, asylum seeker health checks.

GMS

General Medical Services

The nationally negotiated GP contract. Same terms for every GMS practice in England. Negotiated between NHS England and the BMA's General Practitioners Committee (GPC).

PMS

Personal Medical Services

A locally negotiated contract between a practice and its ICB. Can include services beyond the core GMS contract, with locally agreed funding. Around 25% of practices hold PMS contracts.

APMS

Alternative Provider Medical Services

A time-limited contract awarded by tender, often to non-traditional providers (companies, trusts, social enterprises). Used to fill gaps in provision or provide specific services.

ARRS

Additional Roles Reimbursement Scheme

PCN-level funding to recruit additional clinical and non-clinical staff — pharmacists, physiotherapists, social prescribing link workers, paramedics, mental health practitioners, and now any GP. Maximum GP salary reimbursement: £118,759 (£120,921 London).

CAP

Capacity and Access Payment

A PCN-level payment introduced in 2023/24 for improving access. Retired from 2026/27 — the £292 million has been repurposed into the new practice-level GP Reimbursement Scheme.

Carr-Hill Weighted Patient

Your adjusted list size after the Carr-Hill formula is applied. A practice with 10,000 raw patients might have 11,500 weighted patients if it has an older, more deprived, or higher-turnover population.

Prevalence

In QOF, the proportion of your registered patients on a specific disease register (e.g. diabetes, COPD). Higher prevalence increases your QOF payment for that domain — you're treating more patients with that condition.

Exception reporting

The QOF mechanism for removing patients from indicator denominators when the indicator genuinely doesn't apply — patient declined, contraindicated, recently registered, or clinically inappropriate. Not a loophole — a safety valve.

SFE

Statement of Financial Entitlements

The legal document that sets out exactly what GMS practices are entitled to be paid. The definitive reference for payment disputes. Updated annually to reflect contract changes.

ICB

Integrated Care Board

The NHS organisation that commissions primary care services in your area. Replaced CCGs in July 2022. Phase 1 mergers reduced ICBs from 42 to 36 in April 2026.

Practice Action Checklist

Things to review, discuss with your partnership, or delegate to your practice manager. You don't need to do everything at once — but awareness is the first step.

Where to focus first

Same-day urgent access — this is contractual and will be measured. Get your triage right.
GP Reimbursement Scheme — apply for the funding to build the capacity you need.
New QOF indicators — set up your clinical searches early, especially for the new obesity indicators.