The headline says £485 million. But where does it actually go? And what income are you losing that you might not have noticed yet?
This article walks through every significant financial move in the 2026/27 GP contract, from the money that's arriving to the money that's disappearing, and tells you what to model for your own practice.
The headline numbers in context
Year | Uplift | Cash growth | Real growth | Total contract value |
|---|---|---|---|---|
2025/26 | £889m | 7.2% | 4.8% | £13,176m |
2026/27 | £485m | 3.6% | 1.4% | £13,863m |
The 2025/26 uplift was unusually large. It included the £433 million autumn 2024 boost and represented a genuine catch-up after several years of below-inflation settlements. The 2026/27 uplift is a return to a more typical level, but still delivers real-terms growth against the GDP deflator.
Within the £485 million: Advice and Guidance funding is now included (no longer separate), Quality and Outcomes Framework (QOF) expansion accounts for approximately £25 million, and the remainder covers a 2.5% pay assumption (subject to the pay review body's recommendations), premises cost inflation, and other cost growth pressures.
The 2.5% pay assumption is explicitly provisional. The letter says it will be revisited "in light of pay review bodies' recommendations." If the Doctors' and Dentists' Review Body (DDRB) recommends higher, the pay element may be adjusted. If it recommends lower, practices keep the difference. Budget cautiously.
The £292 million practice-level shift
This is the single biggest structural change in the contract, and it deserves close attention.
Where the money comes from: the Capacity and Access Support Payment (CASP, £204 million, unconditional) and the Capacity and Access Improvement Payment (CAIP, £87.6 million, two conditional domains) are both being abolished at Primary Care Network (PCN) level.
Where the money goes: directly to practices, via a new practice-level GP reimbursement scheme. Practices can use it to recruit additional GPs or to increase sessions from GPs already working in the practice. The stated purpose is to support clinically urgent same-day access.
What we do not know: how practices apply or claim, whether funding is weighted by list size or deprivation, per-session rates, practice-level caps, and whether locum costs qualify. None of this has been published. The letter says guidance is coming "in the coming weeks" and a webinar on 2 March will provide more detail.
The strategic read is clear. NHS England is betting that giving money directly to practices for GP time is a better lever for same-day access than routing it through PCNs for network-level improvement. The trade-off is that same-day urgent access is now a binding contractual obligation. The funding and the obligation are explicitly linked.
Your action: do not budget this income until the scheme details are published. But start thinking now about whether you would recruit a new GP, add sessions to an existing one, or use locums. When the guidance drops, the practices that move first will benefit most.
What you are losing
Two income streams disappear in April. Both follow the same pattern: an optional Enhanced Service (ES) in 2025/26 becomes either a mandatory obligation or a QOF indicator in 2026/27, with the per-item payment removed.
Advice and Guidance: from £20 per request to nothing per request
In 2025/26, the Advice and Guidance (A&G) Enhanced Service paid practices £20 for every pre-referral A&G request submitted via the e-Referral Service (e-RS). The service was optional, claimed via the Calculating Quality Reporting Service (CQRS), and worth up to £80 million nationally.
In 2026/27, the ES is retired. The requirement to use A&G before planned care referrals where clinically appropriate is now written into the core practice contract. It is mandatory for all practices, and there is no per-item payment.
The £80 million has been absorbed into the general £485 million uplift. The contract letter's phrasing is telling: the total uplift is described as "including Advice and Guidance funding." That is not the same as ring-fenced.
The financial impact varies dramatically by practice. A large, proactive practice submitting 1,000 or more A&G requests per year was earning £20,000 or more from the Enhanced Service. That identifiable income is gone. The work continues, and indeed is now mandatory. The only offset is whatever share of the general uplift reaches your Global Sum.
Your action: pull your 2025/26 A&G claim data from CQRS. Count your approved requests and multiply by £20. That is your gross income at risk. If the number is significant, raise it at your next partnership meeting.
Weight Management: £11.50 per referral becomes QOF points
The Weight Management Enhanced Service paid £11.50 per referral to a structured weight management programme. Total national funding was £7.2 million.
In 2026/27, the Enhanced Service is retired. Income now comes through two new QOF indicators: OB004 (referral to weight management, 5 points) and OB005 (shared decision-making and pharmacotherapy, 13 points). Together that is 18 QOF points, worth approximately £25 million nationally. For an average practice hitting the upper thresholds, that translates to approximately £3,000 to £4,000, depending on your Contractor Population Index and list size.
Whether this is better or worse than the Enhanced Service depends entirely on your practice. A practice making 50 weight management referrals per year was earning £575. For them, the QOF route is better. A practice making 500 referrals was earning £5,750 and may end up worse off through QOF. The QOF income depends on register size, coding quality, and threshold achievement, not just referral activity.
Your action: pull your 2025/26 Weight Management ES claims. Compare the income with a realistic estimate of what you might achieve on OB004 and OB005.
QOF: 18 new points, but watch the redistributions
The net addition of 18 QOF points (c. £25 million) is the first expansion of the framework in years. But underneath the headline, points are being shuffled in ways that create winners and losers.
The changes that could cost you money:
CHOL003 drops from 38 points to 20 points. If your practice was achieving well on cholesterol management, that is a loss of 18 points, worth roughly £3,500 to £4,500 at current point values for an average practice.
Several indicators are retired and replaced with consolidated versions. If your current achievement was strong on the old indicators, check that the new thresholds and point allocations do not leave you worse off.
The changes that could earn you money:
DM034 (primary prevention statin use) rises from 4 to 8 points.
DM035 (secondary prevention statin use) rises from 2 to 8 points.
NDH003 (non-diabetic hyperglycaemia) rises from 18 to 20 points and adds gestational diabetes.
OB004 and OB005 together offer 18 new points for obesity management.
DM037 offers 10 reallocated points for delivering all 8 NICE-recommended diabetes care processes.
HF009 offers 12 reallocated points for 4-pillar heart failure therapy.
The important thing to understand is that CD001 (41 points) and CD002 (20 points) look large but are reallocated from the retired CHD and stroke/TIA indicators they replace. They are not net new income. You need to compare your achievement on the old indicators with what you are likely to achieve on the new ones.
Your action: get your QOF lead to run the numbers. Model the point changes against your current achievement rates. The cholesterol drop and the new composite indicators (DM037, HF009) deserve particular attention.
ARRS: the hidden opportunity
The Additional Roles Reimbursement Scheme (ARRS) changes deserve more attention than they are getting.
Two things happen. First, the restriction limiting ARRS GP recruitment to recently qualified doctors is removed. Any GP can now be recruited via the scheme. Second, the maximum reimbursement increases from approximately £106,000 (2025/26) to an estimated £148,000 to £151,000 (2026/27), based on the top of the DDRB salaried GP pay range plus approximately 28.5% employer on-costs. The exact figure will be confirmed in the Directed Enhanced Service (DES) specification.
This is a 40 to 43% increase in the ARRS GP reimbursement ceiling. It makes ARRS GP posts genuinely competitive with salaried GP positions for experienced doctors.
The opportunity for practices is that ARRS GP recruitment and the new practice-level reimbursement scheme are separate funding streams. A practice could use the £292 million scheme for additional sessions from its existing GPs while its PCN recruits an experienced GP via ARRS for network-level work. These are complementary, not competing.
Your action: talk to your PCN Clinical Director about whether an ARRS GP recruitment would complement your practice-level plans. The experienced GP market just became accessible to ARRS for the first time.
What to do on Monday morning
Pull your 2025/26 A&G claim data from CQRS and calculate your income at risk.
Pull your Weight Management ES claim data and compare with projected QOF OB004/OB005 income.
Ask your QOF lead to model the point changes, paying particular attention to CHOL003 and the new composite indicators.
Start thinking about GP recruitment or session plans so you are ready when the £292 million scheme details land.
Register for the 2 March NHS England webinar (17:00 to 18:00) — this is where the financial detail will start to emerge.
Disclaimer: This article is for informational purposes only and reflects understanding as of 24 February 2026. It does not constitute legal, financial, or medical advice. Practices should refer to the latest official NHS England guidance and contractual documents.
Published by myPM, 24 February 2026.