GP contract 2025/26 explained: funding, incentives and the workforce

Context

In January 2019, a five-year GP contract framework was agreed. This was intended to stabilise general practice, enabling it to become a key delivery vehicle for many of the commitments in the NHS Long Term Plan and to provide a wider range of services to patients. A key development was a voluntary extension to the GP contract, known as a Directed Enhanced Service (DES). This was offered to general practices, typically covering populations of around 30,000 to 50,000 people, that came together as primary care networks (PCNs). This extension was intended to be a mechanism for distributing a significant proportion of new funding into general practice.

The five-year contract expired in 2024; however, it was not possible to negotiate a new five-year framework due to the potential changes following a general election and the lack of a long-term financial settlement for the NHS. In March 2024 the Department of Health and Social Care published contract arrangements for 2024/25, which were not welcomed by GPs. As a result, in April, GP leaders at the British Medical Association (BMA) formally entered into a dispute with NHS England over the contract changes.

In February 2025, the Department of Health and Social Care published a changes to this contract for 2025/26. These changes were accepted by GP leaders at the BMA, ending their dispute with the government and NHS England.

This explainer sets out the key elements of the contract arrangements for 2025/26 and potential implications for the wider health system.

Overall funding in the 2025/26 GP contract

In 2025/26, the government will invest £13.176 billion in the GP contract, an overall increase from 2024/25. £969 million is being invested into the contract, which is made up of £889 million invested into the core contract and the Network Contract Directed Enhanced Service (DES), alongside £80 million specifically to promote the use of the e-referral advice and guidance system between GPs and secondary care. This is in addition to £433 million, which had been added to the contract in autumn 2024. The new investment for 2025/26 provides 7.2% cash growth, or 4.8% growth in real terms, on the overall 24/25 contract. This includes:

• funding for an anticipated 2.8% salary increase for contractor GPs, salaried GPs and other practice staff

• funding to cover the costs of growth pressures, including from higher costs of running premises and an increase in patients

• funding to reflect the increased level and complexity of activity.

A further uplift may be made following the government’s response to the Doctors’ and Dentists’ Pay Review Body outcomes for 2025/26.

New requirements in the 2025/26 GP core contract

Digital requirements

There is a new requirement in this year’s contract that practices must keep their online consultation tool open to allow patients to submit non-urgent appointment requests, medication queries and admin requests throughout core hours (8.00am–6.30pm). This will come into effect from 1 of October 2025, as will changes to GP connect that will allow registered pharmacy professionals to have access to patient records and be able to update them. NHS providers and private providers, where given consent by the patient, will also be given access to a patient’s GP care record, but this will be to read only rather than update, and is for the purposes of direct patient care.

Patient charter and patient safety

NHS England will publish a patient charter to improve transparency by setting out the standards of care that a patient can expect from their GP practice. Each practice will need to publish the charter on their own website. In addition, following the publication of the primary care patient safety strategy in September 2024, practices will have to record patient safety events relating to services they deliver. They will also be able to record patient safety events that occur in other health care settings, for example an unsafe discharge from hospital. The aim is that this will support information sharing across the system so services can continually improve.

Incentive schemes in the 2025/26 contract

Quality and Outcomes Framework (paid to GP practices)

The Quality and Outcomes Framework (QOF) is a voluntary programme that individual practices can opt in to in order to receive payments based on meeting specific performance indicators. The framework covers a range of clinical areas, and each area has a range of indicators that equate to a number of QOF points. At the end of the financial year, practices receive an amount of money based on points achieved in the QOF.

A consultation on incentive schemes undertaken in early 2024 has resulted in some changes. Due to the Covid-19 pandemic, NHS England and NHS Improvement had already announced changes to the QOF. These changes suspended some indicators so that practices could focus on other priorities, such as vaccinations, but still paid practices for the QOF activity to protect their income. This approach continued, and from April 2024, 32 of the 76 QOF indicators were suspended, with the income protected so that practices will be awarded QOF payments based on their performance in previous years. These 32 indicators, equating to 212 QOF points worth around £298 million in 2025/26, have now been permanently retired. This money will instead be split across the global sum, increases for routine childhood vaccinations and for locum reimbursement rates. The remaining 141 QOF points (worth around £198 million) will be targeted towards cardiovascular disease prevention. The value of a QOF point has also increased, from £213.43 to £220.62.

Capacity and Access Support Payments

There has been a significant focus on improving patient experience of access. The Capacity and Access Support Payment (CASP) funding was introduced in 2022/23 and is paid to primary care networks. It is worth £204 million in 2025/26 and is paid unconditionally to PCNs. There is also a Capacity and Access Improvement Payment (CAIP) which 2025/26 is divided into two parts: £58.4 million for supporting implementation of the modern general practice model, and £29.2 million to support practices to use population health risk stratification tools to assess local need and to identify patients who would most benefit from continuity of care.

Advice and guidance enhanced service (A&G)

From April 2025, practices will be able to take part in a new enhanced service, worth up to £80 million, for ‘advice and guidance’ (A&G), which is intended to incentivise GPs to use the e-referral system to access rapid specialist advice from consultants before making a referral. This will provide a £20 item of service fee (IoS) per ‘pre-referral’ A&G request with funding capped for each ICB. The ambition is that this will support patients to receive the care they need in primary and community care settings, as opposed to being added to the elective waiting list. A&G featured in the elective reform plan published in January 2025 and NHS England has set a target to reach 4 million advice requests from GPs in 2025/26, up from 2.4million in 2023/24.

Changes to the PCN DES

When the PCN contract extension was initially introduced, the intention was that primary care networks would eventually be required to deliver seven national service specifications, with two more added for 2021/22. In 2024/25, eight of these service specifications were replaced by one overarching specification, with enhanced access remaining as a separate specification. The new overarching specification focuses on supporting resilience and care delivery, improving health outcomes, reducing health inequalities and targeting resource to deliver proactive care.

Other changes to the DES have include simplifying the requirements for PCN clinical directors and combining the payment for PCN clinical director and PCN leadership and management into core PCN funding in order to provide PCNs with more autonomy in how they are led and managed.

The Impact and Investment Scheme now focuses on just two indicators: the number of people with learning disabilities who have an annual health check and an indicator to promote faecal immunochemical test (FIT) testing in people with suspected lower gastrointestinal cancers.

Additional Roles Reimbursement Scheme

A central feature of the 2019 GP contract was the Additional Roles Reimbursement Scheme (ARRS), which was introduced to support the recruitment of 20,000 staff into general practice by 2023/24, such as first contact physiotherapists, paramedics and pharmacists. Initially, the scheme provided part-funding for a small number of roles but was then expanded to cover a wide number of different roles. To date, the scheme has successfully enabled the recruitment of over 37,000 new patient-facing staff.

In 2025/26 newly qualified GPs and practice nurses have been added to the scheme, which is intended to address perverse incentives with ARRS roles being prioritised for employment over staff usually paid from core funding. However, this changes the nature of the scheme as it had been focused on ‘additional roles’ that broaden the skill mix and range of services available to patients in general practice rather than funding core GP roles.

What next?

The previous five-year contract included annual funding increases of just over 2%. However, the current economic climate, marked by high inflation and rising costs, meant that the contract did not keep pace with inflation rates and in combination with rapidly rising demand for services has put significant pressure on practices.

With a new government, a new NHS 10 Year Health Plan in development, and an upcoming multi-year spending review, it has not yet been confirmed whether a new five-year framework will be negotiated for general practice. The BMA have accepted the 2025/26 contract and the Secretary of State has committed to a full renegotiation of the national contract within this parliament. This will be critical in supporting the government’s stated ambition to shift the focus on the NHS into the community, addressing questions such as workforce sustainability, the future of the partnership model and of primary care networks.

For more information on what primary care networks are, how they are funded, and what difference they might make, please see ‘Primary care networks explained’.