GP contract 2026/27: what you need to know

Overview              

Finance and incentives

In 2026/27, the GP contract will be uplifted by £485 million. This uplift represents a 3.6 per cent total increase, and a real-terms growth of 1.4 per cent. This growth includes an assumption of 2.5 per cent pay uplift. In addition to this core uplift, £292 million will be repurposed from the Capacity and Access Payment (CAP) into a practice-level GP reimbursement scheme, working out to approximately £47,000 per practice. This funding will replace the CAP in the primary care network direct enhanced service (PCN DES) and be available to practices to increase GP capacity through funding extra sessions or recruiting additional GPs. The contract stipulates that practices with a high GP-to-patient ratio will have to apply for the funds through their integrated care board (ICB).

The Quality Outcomes Framework (QOF) will be updated to improve alignment with NICE guidance on childhood vaccinations, diabetes care, obesity and heart failure. These changes will be supported by an additional 18 QOF points, with a combined value of around £25 million. Several QOF measures will be combined, and the Obesity Enhanced Service will be retired, in favour of two new QOF targets for providing weight management services, including delivering weight loss injections. For vaccination indicators, practices will be able to earn points for progress made towards childhood vaccination thresholds for the first time. This aims to provide financial support to practices, often in deprived areas, which have struggled to meet high QOF targets, despite progress made on key vaccinations including MMR, and ultimately miss out on payments as a result. Practices will also be required to offer RSV vaccinations to all registered older adult care home residents and all patients over 80 years old who have not previously been vaccinated. 

The Advice and Guidance (A&G) Enhanced Service will be retired, with A&G embedded into the core funding offer. Practices will be required to use A&G prior to, or instead of, a planned care referral, and to follow locally agreed referral pathways. NHS England will provide additional guidance on how to implement effective A&G and clarify expectations for communications and triage standards. 

Access

The contract introduces requirements to support timely access to GP services. Under the new contract, practices must not ask patients to make contact another day and must provide patients with a timely update on the next steps for their query by the end of the next working day. For clinically urgent patient requests, the contract includes a requirement for practices to provide a same-day response. Autonomy to determine the clinical urgency of a request will rest with a GP or appropriately trained professional. Practices which do not meet this target, or where unwarranted variation is identified, must engage with ICB support services to improve. In addition, all practices must ensure that patients are able to access online consultation systems throughout core hours, without capping the number of responses or turning off online systems. The contract also mandates access to online registration for all practices. Opening times for all modes of access available within core hours (walk-in, telephone and online consultation) must be displayed on practice websites.

To improve available data on patient access and demand, cloud-based telephony regulations will require practices to provide timely data on video and online consultation services. This data will be used to monitor access, patient experience and system performance. NHS England will also collect data against five key access metrics:

• Call waiting time between 8am and 10am.
• Call waiting time during core hours.
• Percentage of clinically urgent patients seen on the same day.
• Percentage of ‘non-clinically urgent’ patients seen within one week.
• Percentage of ‘non-clinically urgent’ patients seen within two weeks.

Additional data-sharing arrangements will be introduced to support cancer screening services, with all practices required to share data with the Lung Cancer Screening Programme.

Working with community pharmacy

Additional regulations to improve access and communication across the interface with community pharmacy will be introduced in 2026. To improve patient choice in accessing community pharmacy services, practices must reconfirm the nominated pharmacy when issuing a new prescription to patients. This will not apply to repeat prescriptions. Practices will also need to ensure tools used to refer patients into community pharmacy services offer a full choice of pharmacy providers. Improvements to cross-interface communication will require practices to have a dedicated, monitored email address which community pharmacy providers can contact if GP Connect is unavailable, or for activity not currently available within GP Connect, such as the introduction of independent prescribing by community pharmacy. This email address must be shared within the Directory of Services and can be an existing practice email address.

Network contract DES and PMS

Changes to the PCN DES focus on repurposing funding, clarifying PCN-level responsibilities, and updates to workforce management. New core responsibilities include clarity on their role in vaccinations, continuity of care and neighbourhood alignment. From April 2026:

• PCNs must identify cohorts which would benefit from continuity of care using risk stratification tools, embedding continuity of care in PCN core practice
• PCNs must work collaboratively with their ICB on neighbourhood alignment where existing PCN geography does not match natural communities. Natural neighbourhoods will be defined by ICBs and local authorities
• PCNs will receive clearer guidance around identifying eligible older adult care home residents for seasonal and routine vaccinations and will be able to collaborate on delivering the seasonal vaccination enhanced service to deliver COVID-19 and flu vaccinations
• the DES will provide greater clarity around proactive cancer screening responsibilities, referrals and strengthening safety netting, in line with NICE guidance.

To support the PCN workforce, the Additional Roles Reimbursement Scheme (ARRS) will reduce restrictions on employing GPs through the scheme. From April, the scheme will no longer limit ARRS GP funding to newly qualified GPs, and the top reimbursement rate for GPs will increase up to the top of salaried GP pay range plus employment on costs. PCNs will also be able to recruit a greater range of roles into the ARRS, where agreed with their commissioner. PCNs will also be expected to participate in the General Practice Staff Survey, and share staff contact details with the ICB for this purpose.

In 2026/27, primary medical services (PMS) sub-contracting regulations will be aligned with the GMS, allowing commissioners to object to sub-contracting arrangements where patient safety, financial risk or delivery of contractual obligations may be affected.

Analysis  

The government has characterised the 2026/27 GP contract as evidence of its commitment to fix the ‘front door’ of the NHS and shift the focus of the NHS out of hospital and into the community. Following the uplifts in this contract, general practice has received an additional £1.7 billion in total over two years, and been supported to take on more GPs, to deliver record numbers of appointments. While the 2026/27 contract is another positive step for practices struggling under challenging financial conditions, it risks destabilising at-scale provision that will be vital in providing the leadership and infrastructure for neighbourhood health. Investment in general practice should, at its core, be accompanied by sustained national and local support for at-scale primary care organisations such as Primary Care Provider Collaboratives, which play a vital role in supporting delivery and connecting at all tiers of primary care leadership to neighbourhood health plans and wider system transformation.

Funding and incentives

We welcome the 3.6 per cent uplift to core general practice, recognising the need to provide financial stability to the sector. However, repurposing PCN CAP funding to bolster practice-level access undermines progress to neighbourhood working by minimising the role, and resource, of at-scale services to provide support and capacity to practices. Many of our members shared examples of PCN services that have been funded through the CAP and will now be at risk. Furthermore, for practices with a high GP-to-patient ratio, access to the new GP reimbursement fund will need to be agreed with their ICB. In light of cost reductions in ICBs and their transition to strategic commissioners, the capacity of ICB primary care teams to provide support and review access may be significantly reduced. In some areas, these teams have been reduced by over 60 per cent, and they may lack the capacity to manage further requests from practices arising from new contractual requirements. As a result, we may see delays to funding being released, and additional strain on ICB primary care teams. A reduction in ICB capacity may mean they struggle to step into the gap left by a reduction in PCN services due to the removal of CAP. This means practices may struggle to access support. 

While repurposing PCN-level funding may present future challenges, members will welcome the changes to the Quality and Outcomes Framework, which reduce bureaucracy by streamlining indicators, and make more funding accessible through rewarding progress towards targets. We have previously recommended the adoption of ‘sliding-scale’ indicators that reward incremental improvement rather than ‘all or nothing’ binary targets and welcome the focus on improving childhood vaccination uptake as a key factor in shifting from sickness to prevention. Moreover, redesigning indicators in line with NICE guidance demonstrates a focus on patient outcomes and practice progress, rather than the ‘box ticking’ that characterised previous iterations of the scheme. 

Embedding Advice and Guidance (A&G) in core practice, is likely to receive a mixed response from members. Current claims processes generate additional administrative workload in primary care, and we found some support for shifting A&G into core, providing it was adequately resourced. Members viewed the A&G process as shifting workload from secondary to primary care, by reducing referrals into secondary services and keeping patients under the care of GPs. NHS England has recognised the importance of the A&G process in reducing unnecessary referrals and committed to working with trusts to delivering national operating standards which should ensure timely access and reduce variation. In future, data tracking the use of A&G should be used to uplift contract funding. We also called for primary care at scale to be embedded in the design of single-point-of-access hubs for A&G, with ICBs working alongside NHS England and secondary care to commission wraparound support that enables GPs with extended roles (GPwER) to manage more patients in the community. Expanding the service to at-scale providers in future would strengthen the role of at-scale providers in delivering left shift and neighbourhood services.

Access

Access remains a priority for policy makers, and the 2026/27 contract reflects the focus on improving patient experience by reducing waiting times and increasing funding for GP capacity. During the consultation, we heard loud and clear from both primary care and ICB members that the ambition for same-day access could come at the expense of planned and proactive care for the large cohort of patients with long-term health conditions. While the contract does maintain a focus on same-day access for urgent requests, embedding risk stratification and continuity of care in core PCN activity provides safeguards for these patients and recognises the need to balance urgency and continuity for best outcomes. We are also glad to see that the definition of ‘urgent’ care will be set by clinicians, ensuring that clinical decision-making remains at the heart of triage and access decisions. 

Amends to the ARRS also support access improvements, by enabling PCNs to recruit from a broader pool of GPs and allowing greater flexibility to recruit new roles to the scheme. Many members had previously struggled to recruit ARRS GPs due to the newly qualified rule and the low reimbursement rate for the role. Expanding the GPs eligible for recruitment and uplifting the reimbursement rate to reflect average salaried GP wages will significantly reduce the challenge of recruiting GPs to PCNs and potentially add significant GP capacity to PCN-level services. While we welcome this change, future contracts should examine improvements to the reimbursement process. 

The success of introducing access targets and increasing GP numbers will be assessed through the introduction of new requirements for sharing data on demand and access. The five metrics selected by NHS England, and improvements to cloud-based telephony data collection, will reflect the impact of these changes on patient waiting times and will support NHS England to identify areas for improvement. During the consultation, we identified practice-level data as crucial to delivering targeted resources to support areas that may be struggling. It is important to recognise that many at‑scale primary care organisations, along with ICB digital teams, play an essential role in ensuring this data is accurate and appropriately shared. It is vital that this contribution is acknowledged, and that time is allocated to improve the quality and accuracy of these datasets, particularly when the teams that previously provided this support may no longer be able to do so.

Working with community pharmacy

Collaboration across sector interfaces will be essential to delivering a joined-up neighbourhood health system. Our members recognise the vital role of community pharmacy in providing access and continuity to patients, and the need for better alignment between the GP and community pharmacy contracts to support collaboration and streamlining access to services. As such members will welcome the mandate for improved communication with the sector, however it does not go far enough. Pharmacy First is critical tool in integrating access to care, but it relies on general practice ‘gatekeeping’ and risks increasing administrative friction. Future contracts should build on the communication and patient choice built into this contract and streamline patient pathways between providers.

PCNs and neighbourhood working

For PCNs, changes to the DES are largely light touch, clarifying responsibilities and removing barriers to collaboration. Members’ priority will be in the requirement for PCNs to collaborate with ICBs to align PCN boundaries to ‘natural communities’ as defined by ICBs and local authorities. Further guidance will be welcome, as members feel that more clarity is needed to avoid permissive arrangements that create misalignment. Any systems which choose to redefine PCN boundaries must be careful to avoid creating unnecessary ‘noise’ that will detract from service delivery and neighbourhood focus. 

While the strategic focus on neighbourhood health and collaborative working is broadly welcomed by members, significant risks remain due to the uneven pace of delivery across the provider landscape. There is a perceptible lag in the rollout of long-term GMS reform and neighbourhood health contracts when compared to the apparent rapid advancement of advanced foundation trusts and integrated healthcare organisations (IHOs). This disparity risks narrowing the strategic focus of commissioners and local leaders toward trust-led solutions. Such a move could bypass primary care expertise and fundamentally undermine the 10 Year Health Plan’s core ambition of delivering a sustainable left shift of care into the community.

How we are supporting members

The NHS Confederation’s Primary Care Network and its members look forward to working with DHSC and NHS England over the next 12–18 months in linking long-term reform of general practice to the delivery of neighbourhood health and ambitious initiatives such as creating single points of access for advice and guidance and referrals into secondary care. 

To achieve this, the centre must provide clarity on future contractual and financial frameworks that support - not undermine - primary care at scale. Without these steps, there is a real risk that political focus on access metrics - and the perception that this is the sole priority - will overshadow broader objectives such as prevention, integrated neighbourhood care and population health management. Through our work on Primary Care Provider Collaboratives, we are supporting organisations to explore strategic partnerships with NHS trusts for both the delivery of neighbourhood health and to support the outpatient transformation agenda set out in the 10 Year Health Plan.