GP Contract 2026/27

PCN funding, in terms of ARRS allocation, Enhanced Access, and PCN leadership funding will rise by £69 million but the overall spend on the PCN DES will decline because of the transfer of £292 million to provide ring fenced funding for the GP practice reimbursement scheme.

Within the SFE, the maximum reimbursement claims for parental, sickness and other reimbursements will rise by 2.5% (with a further post – DDRB increase possible). However, GPC England was not able to secure an increase in immunisations IoS (Item of Service) fees either within the SFE or in terms of the £10.06 paid in the seasonal vaccination (COVID-19 and Influenza) programmes, which is in GPC England opinion placing the viability of essential public health vaccination programmes at risk by potentially creating disengagement by GP Practices.

Within the PCN DES the requirements associated with GP recruitment under the ARRS programme have been further relaxed with the post-certification two-year rule waived and the maximum salary (plus on-costs) increased. As I noted, further details of the GP practice-based reimbursement scheme are awaited but are expected to mirror the ARRS on these points. As a result, the Capacity and Access Payments (comprising the Capacity and Access Support Payment (CASP) and the target based Capacity and Access Improvement Payment (CAIP)) are being abolished. PCN/practice colleagues should carefully review current spend based on this income although it is intended GPs engaged via this source can be transferred over to the GP Practice reimbursement scheme now funded by these payments.

There are a number of PCN responsibilities that will now be included within the PCN DES specification directly including:

• risk stratification of patient cohorts for continuity of care
• aligning of cancer referral arrangements amongst PCN member practices
• alignment of PCNs in relation to neighbourhoods – although it is stated this is: “not intended to signal widespread reconfiguration of PCNs”

There are also drafted responsibilities for PCNs in relations to vaccination of care home residents and the LMC has written to all practices regarding this issue as it appears to create a substantial risk and workload for PCNs based on the individual decision of one or more member practices in relation to the seasonal vaccination programmes. Colleagues are advised to await clarification of this issue before responding to ICB requests (unfortunately sometimes couched as demands) in relation to this issue.

In relation to QOF, the LMC will circulate an update in terms of the new and amended QOF Indicators and also the amended QOF childhood vaccination indicator arrangements. The latter are supposed to be a response to concerns raised by colleagues in relation to the impact of losing significant QOF point income as a result of individual parent decisions about vaccinations within these small cohort sizes, but it does not address this. Abolition of the QOF childhood vaccination indicators and transfer of the funding to supplement IoS fees, or allowing parental dissent as a personalised care adjustment within QOF, would have been both simple and more supportive of the childhood immunisation programme.

NHS England has retired the Advice and Guidance Enhanced Service and incorporated the funding into Global Sum; this constitutes £1.28 of the total £5.35 increase in 2026/27. The LMCs advice to colleagues remains unchanged from April 2025, when the Enhanced Service was introduced. There will be some patients whom you may be able to look after appropriately within General Practice if you can obtain additional specialist guidance. If so, this should be requested, but, after March-end 2026, no IoS fee can be claimed, as it could not be prior to April 2025. The LMC recommends colleagues continue their approach unchanged; clearly if the “advice and guidance response” reflects what patients would be assessed as needing after a direct specialist evaluation then it is likely the most suitable option is, in fact, a referral to a specialist for that opinion.

Clearly the more concerning development is being unable to obtain a direct specialist assessment of your patient on request; this may be an outcome of evolving Single Point of Access (SPA) arrangements. For the LMC, ensuring a patient can continue to obtain a direct assessment is a sine qua non of “locally agreed referral arrangements” and additional updates will be circulated to all colleagues.

Alongside the above arrangements this 2026/27 Contract continues to press General Practice in terms of access arrangements despite NHS England/DHSCs being warned that General Practice has reached saturation capacity and their concern should be making arrangements for patients who cannot be seen by their General Practitioner. Additional and sustained investment into General Practice is required. NHS England/DHSC were also warned that creating additional contractual demands in terms of access was likely to create waiting lists for routine care appointments within GP Practices – this should be considered by all practices in terms of managing the mismatch between capacity and demand partly created by changed Regulations, and the recommended continued implementation of the BMAs Safe Working Guidance in terms of appointment length and daily numbers of consultations.

Although some contractual terms such as:

• opening times for all modes of access available on the practice website, leaflet and within practice premises, and,
• not simply responding to a patient contract by asking them to call back on a future day, rather than providing a response which may include an appointment offer on a later day,

may reflect current practice arrangements the others, which include:

• no cap on the number of requests that can be submitted online each day, and
• that anyone considered (by the GP/other practice clinician) to have an urgent request receives a same day response, although this doesn’t mean the clinical issue will necessarily be resolved that day

are likely to create a significant workload.

The Regulations are being amended to clarify that an “appropriate response” does not have to be provided within the same day, but to within the next day core hours period, to prevent the implication of being contractually required to work beyond core hours. However, it is clear this is what most GPs (and other staff) are already having to do.

In relation to Community Pharmacy, GP practices should have a monitored email to receive pharmacy information if GP Connect is not available or does not support the information pharmacies need to send. This does not have to be a new email.

In addition, changes are being made to align the current arrangements for patient choice in terms of dispensing medication from pharmacies to extend this to obtaining services from pharmacies, that is, to ensure that when patients are signposted to pharmacy services they are not diverted to a particular pharmacy or pharmacy provider. GPC England is preparing advice to GP colleagues on this point, analogous to the ”prescription direction” guidance that is already available in relation to dispensing.

Additionally, there are a number of further contractual changes, including:

Practices with “unwarranted variation” required to engage with support from their
commissioners

Online and video consultations reporting to align with Cloud Based Telephony

PMS Regulations to align with GMS contracts in relation to commissioner approval for
subcontracting arrangements

GP and PCN staff to participate in NHS staff survey

GP practices required to share data with local Lung Cancer Screening Programme

Patient registration submissions from practices must be on-line, even if still submitted to the practice by the patient on paper

Extension of the SFE funded vaccination programme to include JCVI (Joint Committee on
Vaccination and Immunisation) eligibility recommendations for RSV