By Paul Ansbro - Managing Partner for a GP practice in Stockport - Paul writes a blog on substack that's well worth a follow - https://paulansbro.substack.com.
Running a general practice is often described as like managing a small business — except it’s one with NHS rules, fixed prices, uncontracted workload, and a staff team bigger than your old school year. To survive, you need to understand where your income comes from — and why it so often doesn’t match the work you do.
This is the first in a series about how GP practice finances actually work. We'll be lifting the lid on income streams, contract structures, incentives, and the policies shaping your bottom line. This post gives an overview — we’ll dig deeper into each area in future editions.
1. Core Contract Income
Most practices in England are funded through the GMS (General Medical Services) contract, with some operating under PMS or APMS agreements. Core funding is based on the Global Sum, calculated per patient via a complex formula that includes factors like age, sex, rurality, and list turnover.
The current (2025/26) global sum is around £123.34 per weighted patient, but how that translates into actual cash depends on your practice demographics.
This income is meant to cover the delivery of essential primary care — but not everything you do is included.
We’ll break down how the global sum is calculated in a future post — it’s more arcane than you’d think.
2. QOF (Quality and Outcomes Framework)
Despite predictions of its demise, QOF remains a substantial income stream for many practices.
In 2025/26, the QOF payment per point is around £225.49.
The number of points has been reduced to 564 from 635, with some funding moved to the global sum and immunisation enhanced services.
It mostly now rewards achievement against long-term condition indicators.
Expect more on QOF — what still matters, what doesn’t, and how its relevance is evolving.
3. Enhanced Services
Practices can earn additional income through Directed Enhanced Services (DES) and Local Enhanced Services (LES):
DES (e.g. immunisations, learning disability health checks, PCN services)
LES (commissioned locally, e.g. minor surgery, contraception services, wound care, ECGs)
These vary by region and often depend on good relationships with commissioners. They can be well-paid — but often bring admin and delivery headaches.
4. PCN-Related Income
Even though it arrives via the PCN DES, some funding flows directly to practices:
IIF (Impact and Investment Fund) payments
Care home premiums
Enhanced Access funding
Capacity & Access funding
PCN leadership and participation payments
There’s also indirect income: for example, the ARRS scheme funds staff who work across practices. We’ll cover how PCN money works — and who really benefits — in a future post.
5. Premises and Reimbursement Income
If you own your premises or lease it for NHS use, you may receive:
Notional rent (for owned buildings)
Reimbursed rent (for leased premises)
Facilities and service charges
CQC compliance, IT and telephony support
These payments are administered via NHS England and ICBs — and are often the source of frustration.
6. Teaching and Training Income
Many practices support the next generation of GPs — and can generate meaningful income from doing so:
Undergraduate teaching: via university placements (payments vary widely)
GP Specialty Training: via the Trainer Grant, placement fees, and educational supervision funding
Nursing and PA students: increasingly common and often paid via HEE or local schemes
Aside from funding, teaching can also be a route to workforce development, recruitment, and reputation-building.
We’ll share a more detailed breakdown of training income in a dedicated post.
7. Private and Non-NHS Income
Practices may generate additional income through services outside the NHS contract:
Private medicals and insurance reports
DVLA, firearms, visa and adoption medicals
Travel vaccines (non-NHS)
Research
Occupational health or company retainer work
While not core income, these services can provide flexibility — especially as NHS funding tightens.
What’s the Big Picture?
Understanding your income is the first step to controlling it. This post is a broad overview — but each of these categories hides layers of complexity. Over the coming weeks, we’ll unpack the details:
How global sum funding really works
What’s happening with QOF and IIF
How PCN income is distributed
Where your teaching money comes from
What to consider before taking on a new service
Disclaimer: This article is for informational purposes only and reflects the author's understanding as of August 2025. It is written by Paul Ansbro, Managing Partner of a GP practice in Stockport, and all views expressed are his own. This content does not constitute legal, financial, or medical advice. Practices should consult with relevant professional bodies or legal counsel for specific circumstances and always refer to the latest official NHS England (and other relevant bodies) guidance and contractual documents.