Practice Connect briefing

Where the 2026/27 GP Contract Money Really Goes

A practical guide to the income gains, hidden losses, QOF shifts and workforce opportunities inside the 2026/27 GP contract.

£485 million is stated in the headline. What matters to practices is much simpler: what should you model before assuming your position improves, where does that money actually go, and which income streams vanish?

While there is actual new funding in the 2026–2027 package, some prominent 2025–2026 revenue streams are eliminated. Advice and guidance ceases to be an enhanced service that must be paid for separately. Referrals for weight management are now paid in QOF rather than on an item basis. Funding for PCN Capacity and Access is transferred to a new GP reimbursement program at the practice level that is connected to same-day, urgent access.

The largest operational and financial changes from April 2026 are described in this article along with what has been confirmed, what has not yet been published, and what PCN leaders should model going forward.

The headline numbers in context

The 2025/26 settlement was unusually large and included the autumn 2024 funding boost. By comparison, the 2026/27 uplift is more modest, but NHS England still presents it as real-terms growth against the GDP deflator.

The important shift is not just size. It is shape. The 2026/27 package moves more money into targeted routes, removes some visible item-based income, and ties more funding logic to measurable access delivery.

Where the £485 million actually goes

NHS England says the £485 million uplift includes Advice and Guidance funding, the QOF expansion, an assumed 2.5% pay uplift for 2026/27, premises inflation and other recognised cost growth pressures.

That wording matters. “Including Advice and Guidance funding” is not the same as preserving a separate ring-fenced payment stream. It means the old enhanced service funding has been folded into the overall contract package.

The same is true of the pay assumption. NHS England says the 2.5% figure will be revisited in light of pay review body recommendations. Practices should read that as a working assumption, not a finished answer.

The £292 million practice-level shift

This is the biggest structural funding change in the 2026/27 contract.

At PCN level, the Capacity and Access Support Payment and Capacity and Access Improvement Payment are removed from the Network Contract DES. Together, those funding streams amount to roughly £292 million nationally.

That money is being redirected into a new practice-level GP reimbursement scheme. NHS England says practices will be able to use it to recruit additional GPs or increase sessions from GPs already working in the practice, with the stated purpose of strengthening clinically urgent same-day access.

Strategically, the direction is obvious. NHS England is choosing direct GP time at practice level as the access lever, rather than continuing to route the same money through PCN-level capacity and improvement mechanisms.

What remains unclear in the published high-level material is the exact scheme detail: the distribution formula, claiming process, any weighting methodology, per-session reimbursement logic, local cap arrangements and how different sessional models will be treated.

What you are losing

Two clear income streams disappear in April, and both follow the same pattern: an optional enhanced service in 2025/26 becomes either a core contractual expectation or a QOF-based route in 2026/27, with the old per-item payment removed.

Advice and Guidance: from visible ES income to embedded contract funding

In 2025/26, the Advice and Guidance Enhanced Service paid practices £20 per eligible pre-referral request via e-RS, with national funding up to £80 million.

In 2026/27, the enhanced service is retired. Practices are now expected to use Advice and Guidance before planned care referrals where clinically appropriate and in line with local pathways, but there is no separate item payment.

Financially, that makes this one of the easiest places to overlook a real loss. The funding has not disappeared from the national contract envelope, but the identifiable practice-level income has.

The impact will vary dramatically between practices. If you used A&G lightly, the loss may be modest. If you were using it systematically, the disappearing visible income could be significant.

Weight Management: from £11.50 per referral to QOF points

In 2025/26, the Weight Management Enhanced Service paid £11.50 per referral to a structured weight management programme, with national funding of £7.2 million.

In 2026/27, the enhanced service is retired. Obesity-related income now sits inside QOF via two new indicators:

• OB004 – referral to weight management programmes: 5 points
• OB005 – shared decision-making and pharmacotherapy: 13 points

Together that gives 18 QOF points. Nationally, those additional points form part of the QOF expansion worth about £25 million.

Whether this is financially better or worse than the old enhanced service depends entirely on your current referral activity, register size, coding quality and likely achievement against the new thresholds.

QOF 2026/27: the changes in detail

QOF 2026/27 is more than a rebasing exercise. Several indicators have been introduced, replaced or materially amended, and the threshold and points landscape has moved enough to make last year’s operating assumptions unsafe.

The biggest indicator changes at a glance

Points movements should change local priorities

Some of the QOF point changes are large enough to alter the annual workload plan. CHOL003 falls sharply from 38 points to 20. DM034 doubles from 4 to 8. DM035 rises from 2 to 8. NDH003 increases from 18 to 20. New and reallocated indicators also pull attention into cardiovascular disease, diabetes, heart failure and obesity.

The practical message is simple: if a practice carries last year’s QOF priority stack forward unchanged, it risks spending time in the wrong places. Some previously dominant indicators now carry less weight, while newer or reworked indicators demand fresh implementation effort, tighter coding and more deliberate clinical ownership.

Childhood immunisations now have a second route to points

One of the most strategically important QOF changes in 2026/27 is the new improvement methodology for VI001, VI002 and VI003. Practices can now earn points either through the standard threshold model or through an improvement calculation based on performance uplift against baseline achievement, with the higher of the two calculations applying.

The improvement route only starts once a practice achieves at least a five percentage point improvement from baseline. Baselines are based on average annual achievement across 2024 to 2026. That matters because it gives lower-performing practices a more realistic route into points while still preserving the standard threshold model for practices that are already performing strongly.

Financially and operationally, this is a meaningful change. The childhood immunisation indicators no longer work only as a high-threshold model that mostly rewards already strong performers. They now also reward improvement, which should change how many practices think about recovery work, outreach and recall design.

ARRS becomes materially more useful for GP recruitment

The single biggest workforce change is the widening of GP eligibility under the Additional Roles Reimbursement Scheme. The old rule limiting claims to recently qualified GPs has gone. In 2026/27, any GP can be eligible provided they have not been substantively employed as a General Medical Practitioner in a Core Network Practice of the PCN at any point in the previous 12 months.

The reimbursement ceiling rises sharply as well. The salary element of the maximum reimbursement increases from £82,418 in 2025/26 to £118,759 in 2026/27, or £120,921 in London. Once employer on-costs are included, the annual equivalent maximum reimbursement reaches £152,900 outside London and £155,698 in London. PCNs can also recruit a broader range of ARRS roles where locally agreed with the commissioner, including other non-direct patient care roles.

The minimum role requirements have also been updated for Social Prescribing Link Workers, Physician Associates, First Contact Physiotherapists, Dietitians, Podiatrists, Occupational Therapists, Paramedics and Advanced Nurse Practitioners. So this is not just a GP story. PCNs should assume their ARRS governance, templates and recruitment assumptions all need a refresh.

Capacity and Access Payment 2026/27: what practices need to do

One of the most important structural changes in the contract is the removal of the Capacity and Access Support Payment and Capacity and Access Improvement Payment from the Network Contract DES. In their place, NHS England is introducing a practice-level GP reimbursement scheme funded by the same £292 million. That shifts money that previously flowed through PCNs much closer to the practice front door.

The stated purpose is straightforward: practices use the funding to recruit additional GPs or increase sessions from GPs already working in the practice, with the aim of strengthening clinically urgent same-day access. Put simply, this is not a general uplift that can be absorbed into routine overhead. It is targeted GP capacity money tied to access.

The contract framework points in the same direction as the core access requirements: practices are expected to deal with requests identified as clinically urgent on the same day, they cannot ask patients to call back or make contact on another day, and online consultation systems must not cap requests during core hours. That means practices should not think about the new reimbursement scheme in isolation. It sits inside a broader access model that is becoming more explicit and more measurable.

The five access metrics now matter

Practice-level data collection will focus on five practical indicators that tell NHS England a lot about how access is working on the ground: call waiting time between 8am and 10am, call waiting time during core hours, the percentage of clinically urgent patients seen on the same day, the percentage of non-clinically urgent patients seen within one week, and the percentage seen within two weeks.

The rules leave the determination of clinical urgency to practices, which is sensible but also risky. The narrower your definition, the easier it becomes to show strong same-day performance. The broader it is, the more operational pressure you will create for yourself. Either way, practices need a consistent internal definition from day one. Otherwise the data becomes noisy, hard to defend and almost useless for improvement.

Three access rules practices should treat as live from day one

The practical challenge is that the phrase “dealt with” is broader than “seen face to face”. In most practices it will include triage, advice, remote clinical contact and a clear management decision as well as appointments. The important thing is not to pretend the rule does not exist. It does, and practices should define what same-day urgent handling means operationally inside their own access model.

Continuity, care homes, cancer and screening are all tighter

The DES now makes risk-stratified continuity a core requirement. PCNs are expected to identify and prioritise patients who would most benefit from continuity of care and build operational pathways around them.

Care home responsibilities are also broader: PCNs must make sure eligible aligned care home residents are identified and offered seasonal and routine vaccinations, whether delivered by the practice, the PCN or another provider under agreed arrangements. RSV has also been extended to all people aged 80 and over and all residents in care homes for older adults.

Cancer and screening requirements have also become clearer and more explicit. Referral quality is expected to align with NICE NG12, electronic safety-netting is now very much expected, and PCNs have clearer responsibilities for supporting eligible patients to take up cancer and non-cancer screening.

Participation, deadlines and governance still matter

PCNs with no membership or information changes continue automatically from 1 April 2026. Changes, opt-ins and opt-outs must be notified to commissioners by 30 April 2026.

On top of that, the General Practice Staff Survey is now a mandatory participation requirement for practices and PCNs, including sharing staff contact details with the ICB for personalised links.

Neighbourhood alignment is also now a live requirement in limited cases where geography clearly does not reflect local communities.

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