GP Contract 2025/26

Written: 03rd of March 2025

I am writing to all colleagues to provide details of the arrangements for the GP Contract in 2025/26.

The LMC will also provide a number of webinars for colleagues, additional guidance papers, and I would like to invite colleagues to a F2F evening roadshow in Crawley on Thursday 3rd April to discuss the Contract in detail. Further details will follow shortly.

Core Practice Finance and Global Sum

The overall investment in the core practice contract (including the PCN DES) will rise by £889 million (7.2%) for 2025/26. This represents new funding, as announced by the Secretary of State before Christmas. An additional £100 million is being transferred from QOF (further details below) to maximise Global Sum investment. Of this combined figure, [£989 million] 75 % (£742 million) will be invested directly in Global Sum. A further approximately 3% (£30 million) will support an uplift in immunisation IoS fees and the reimbursement arrangements for, primarily, parental and sickness leave [further details below].

As this latter investment figure, that is, the SFE leave and immunisation IoS uplift; is not yet precisely known the anticipated Global Sum uplift of £9.40 [8.36%) may change slightly, and I will circulate the exact sum (and OOHs deduction, which remains at 4.75%) once this is available.

Colleagues should also note the DDRB recommendations for 2025/26 will not be available prior to March end 2025, and therefore this figure, and the Government’s response, is not yet known. The Government is working on an assumed salary uplift of 2.8% across the public sector.

“Business Pressures”

These represent a euphemism for the planned rises in the employer National Insurance Contribution [NIC] and NIC payment threshold change and the National Minimum and Living Wage. GPC England surveyed practices asking for their estimate of the impact of these changes on payroll costs and in aggregate across England, these costs were estimated at £187 million. This would, on a weighted per patient basis, be £2.97, meaning a Global Sum uplift without these changes would be £6.43 [final figure awaited] representing a 5.72% uplift.

GPC England had no way of obtaining a sufficiently accurate estimate of any additional costs associated with an concomitant uplift in differential salary costs, which it is recognised practices may need to make.

As in previous years, partners should consider whether it is appropriate to offer staff an interim 1st April 2025 salary increase, noting the pay assumption ceiling given to the DDRB by the DHSC, or await a final Government response to this award recommendation before any decision. This is entirely at partners’ discretion.

QOF

Last year 32 indicators were income protected during 2024/25, based on 2024/25 prevalence and QOF point value, and 2023/24 achievement.

These 32 indicators will be permanently retired in 2025/26 (see Appendix 1). This represents 212 QOF points, representing approximately £298 million [based on 2025/26 QOF point value], which is estimated to be £225.91.

Of these 212 QOF points 71 [representing £100 million] are being permanently retired, with this funding being pooled along with the newly announced investment of £889 million; allowing the increase in Global Sum, immunisation IoS fees, and SFE leave reimbursements.

The remaining 141 points (£198 million) are being distributed proportionately across nine CVD disease indicators, highlighting the Government’s priority of public health prevention. The upper achievement thresholds for these indicators will increase, but the lower thresholds are unchanged. Details of these changes are listed in Appendix 2.

There are also a small number of changes to QOF indicator wording [but not thresholds, where applicable] to align with NICE guidance (Appendix 3).

Vaccination and Immunisations – Items of Service Fees

The IoS fee for the following immunisations will rise by £2 [19.88%] from £10.06 to £12.06:

All routine childhood immunisations [Table 1]
The Hepatitis B vaccination for at risk infants/babies [Table 3]
The MMR 6+ update [Table 4] Routine adult immunisations [Table 2] and other vaccinations in Tables 3 and 4 remain at £10.06.

The annual Covid and Influenza Enhanced Service specifications for 2025/26 have not yet been published but were not included in these negotiations.

There are other changes to the immunisation arrangements, recommended by JCVI and listed later in this letter.

Statement of Financial Entitlements (SFE) Leave reimbursements

Leave reimbursements for Parental [Section 9] Sickness [Section 10] Study Leave [Section 11] and payments to Suspended Doctors [Section 12] will be increased by between 15.9% to 17.1%.

Colleagues will recall these payments were uplifted by 6% during 2024/25 and these additional uplifts represent the uplift that would have occurred had DDRB uplifts from 2018/19 been successively applied.

Colleagues are reminded that provided eligibility criteria are met, these payments are not discretionary to ICBs, and are not paid pro rata based on the absent GP’s working pattern.

Final details of the uplifted amounts will be circulated when available.

The PCN Direct Enhanced Service

The following changes are being made to the PCN DES

1. The ARRS programme

The ringfenced GP in ARRS funding arrangement, which commenced in October 2024, is being extended for a full year [with a proportionate increase in investment].
The GP in ARRS funding is being amalgamated with the other ARRS funding, creating a single reimbursement pot.
The scheme is being extended to include Practice Nurses.
There are now no restrictions on the numbers or type of staff that can be recruited – including both GPs and Practice Nurses.
The salary element of the claimable GP reimbursement will increase from £73,113 to £82,418. There will be a proportionate increase in employer on-costs and London weighting (where applicable).
The recruitment eligibility criteria for GPs will remain as being within two years of obtaining their CCT and those who have not previously been substantively employed as a GP in General Practice. Once recruited, GPs can remain in post (with continuing eligibility for ARRS reimbursement) after their two year CCT anniversary has passed; this is only relevant at recruitment.
Practice Nurses are eligible within the ARRS programme, but at recruitment cannot have worked substantively in the recruiting PCN/member practice(s) for the previous twelve months.

Ultimately, GPC England believes ARRS is a flawed model because practices should autonomously decide which staff to recruit and be funded sufficiently to enable partnerships to make these choices. However, these changes increase flexibility and the LMC encourages all PCNs to devolve ARRS funding, and recruitment decisions, to individual member practices on a proportionate capitation basis.

Colleagues should, however, ensure they carefully follow HR advice when recruiting, redeploying or releasing staff over time. Practices should now be able to focus recruitment on the most valuable elements of the ARRS workforce.

2. Capacity and Access Improvement Payment (CAIP)

The Capacity and Access Improvement payment [CAIP] remains worth £97.6 million, but will now be divided into two, rather than three domains.

Domain 1 [£58.4 million] will continue to support access;
Domain 2 [£29.2 million] will incentivise PCNs to use a population health risk stratification tool, which would include identifying patients who would most benefit from continuity of care;

The LMC is writing separately to all practices about the 2024/25 CAIP. The Capacity and Access Support payment [CASP] will continue as an unchanged monthly payment to PCNs with no attached conditions; the LMC recommends this is devolved directly to member practices.

3. IIF

There are no changes to the IIF arrangements for 2025/26.

IT Changes

The implementation of both these changes can be deferred to 1st October 2025 to provide time for necessary software and other safeguards to be discussed and introduced.

1. Enabling GP Connect: this requires General Practitioners, by 1st October 2025, to allow:

Community Pharmacy registered professionals to send consultation summaries into the GP practice workflow [the GP Connect Update Record];
NHS commissioned providers to have read only access to patients’ care records for the purposes of direct patient care;
Private providers to do the same, but with explicit patient consent, and for the same purposes of direct patient care.

This requires further agreement, including a working definition of direct patient care and what represents an NHS commissioned service, for example, are ‘Right to Choose’ providers included. Colleagues are recommended to take no action for the present.

2. On-line consultation tools open for the duration of core hours:

This will not be implemented before 1st October 2025 and represented the single most challenging stipulation to achieve a Contract agreement with NHSE/DHSC. I am aware some practices already adopt such an approach, but most do not, and it was pointed out that GP colleagues and their teams will not practice unsafely: this is an overriding professional responsibility towards both colleagues and patients.

However, this change was presented as a sine qua during negotiations and reflects a continuing and erroneous belief by NHS England and the DHSC that access [whilst a public and therefore political concern] is the problem to be solved, whereas in fact demand and capacity are the issues that need to be addressed.

The LMC does not advise practices to make any immediate changes in their on-line platform arrangements unless this is part of a pre-planned practice policy, whilst GPIT Committee discussions continue.

National Enhanced Services

1. The Weight Management Enhanced Service will continue

The Weight Managment Enhanced Service will continue unchanged for 2025/26, with a total funding of £7.2 million and a fee of £11.50 per referral.

2. There will be a new national Enhanced Service for Advice and Guidance

This is being funded separately and additionally to the new £889 million contract allocation, with an initial £80 million sourced from NHS England secondary care budgets. This will fund a £20 Item of Service fee for each referral request. This funding will be allocated proportionately to ICBs, but based on current numbers across Englandwould fund approximately 40% increase in requests.

Final details of the Enhanced Service are awaited, including eligibility criteria. Implementation will be coordinated by ICBs in consultation with LMCs and Trusts.

3. The 2025/26 Covid and Influenza Enhanced Service specifications are awaited

But no change to IoS fees or delivery arrangements has been negotiated.

Changes to the GMS/PMS Regulations

There will be a number of changes to the Primary Medical Services (GMS/PMS) Regulations; the policy intention behind these changes has been agreed with GPC England, but the detailed changes to the text of the Regulations are awaited. However, these will cover:

1. Out of Area Registrations

If the numbers of OOA registered patients at a practice are rising rapidly, such GP practices will need to discuss this situation with commissioners.

This will trigger an agreed level of the proportion of OOA registrations compared with all patient registrations, after consultation with the LMC.

Colleagues in some areas of the SSLMC Confederation will be aware of the difficulties caused by a practice choosing to rapidly expand its OOA patient list in terms of safely delivering primary medical services.

This will not be relevant to the great majority of practices who will, if they wish, continue to retain or register OOA patients.

2. Violent Patients

The existing Regulations requiring practices to process the immediate removal of violent and threatening patients with the timely reporting of concerns to the police will be re-emphasised; this right continues but patients are entitled to re-register elsewhere if they have not been immediately removed from their previous practice in a way compliant with the Regulations.

3. Dissolution of Partnerships

The amended Regulations will require a successor to be identified (and identifiable) when partnerships dissolve.

4. Contacting Patients after moving outside the practice area

The amended Regulations will state this may be undertaken digitally by NHS England [as opposed to in writing] and the notice timeframe for deregistration, once the patient is no longer known to NHS England, will be reduced from six to three months.

Learn from Patient Safety Events [LFPSE]

Practices will be required to register for an administrator account with the LFPSE service [unless their local risk management system is already connected] so they can:

Submit patient safety events occurring at the practice.
Submit patient safety events occurring in other healthcare settings.

Statement of Financial Entitlement Changes

1. Vaccination and Immunisations

The Joint Committee on Vaccination and Immunisations [JCVI] has made the following changes to routine childhood and adult schedules for 2025/26.

As Menitorix [Hib/MenC] is being discontinued, an additional dose of Hib containing haemophilus [6-in-1] vaccine, will be offered at 18 months.
A second dose of MMR to be offered at 18 months, brought forward from 3 years 4 months to improve coverage.
An exchange of MenB and PCV vaccine within the childhood schedule (subject to final ministerial approval).
A change to the adult shingles vaccine eligibility for a broader severely immuno suppressed cohorts.
A potential introduction of a varicella vaccine in Q2 of 2025/26 (subject to final ministerial approval).
An amendment to the requirement to record the blood spot test for at risk babies, allowing that recording to take place between 12 – 18 months.

2. Changes to payment arrangements for patients that move practice

At present, depending on the receiving practice’s GP system supplier, a patient who receives a vaccination at their practice and then moves within a month results in either the new practice being paid, or no-one being paid. The SFE change will mean the receiving practice will be paid, aligning this with the “swings and roundabouts” arrangements for practice payments relating to deregistering patients which apply elsewhere.

3. Global Sum adjustments for care home patients

This will apply only to CQC registered care and residential homes.

4. Claims for high volume Personally Adjusted vaccines

These will in future be returned either through the post [as now] or via a new digital portal.

Patient Charter

Following further consultation, NHS England will publish a Patient Charter setting out what a patient can expect from their GP Practice. This should be published on the practice website.

I hope this background is helpful: next year’s Contract is not a solution to the challenges facing General Practice; instead, it is designed to stabilise the current position, enhance investment within Global Sum, and create an environment in which further negotiations can occur without a fin de siecle sense of inevitable decline. This coming year should represent a long awaited turning point in General Practices’ relationship with Government.

Dr Julius Parker, Chief Executive