GP Contract 2025/26: what you need to know

Overview 

The 2025/26 contract tackles challenging practice finances through increases to core funding and changes to key incentives. There will be an £889 million uplift to core contract funding, and an additional £80 million available for the use of e-referral system (e-RS) advice and guidance between GPs and consultants (£20 per ‘re-referral’ request from GPs). This is a 7.2 per cent increase in addition to the £433 million announced last autumn. 

Incentives have also been affected, with the 32 temporarily frozen QOF indicators permanently retired, allowing £100 million to go into the global sum increase and the remaining funds to support a renewed focus on nine remaining CVD indicators (worth £198 million). Other uplifts include childhood vaccination service charges going up £2 to £12.06, and SFE rates for locums rising between 15.9 and 17.1 per cent, and a fully funded GP pay rise in line with doctors’ and dentists’ remuneration (DDRB) guidance.

Access was also a major focus, with updates to the capacity and access payment and improvements to shared patient records and online access to be introduced by October 2025.  The expansion of online consultation tools to allow patients to submit requests at any time during core hours aims to improve patient experience of booking routine appointments and medication queries. Safeguards will prevent urgent queries being submitted online and these will be designed by NHS England in collaboration with GPC England and the Joint GP IT Committee. 

For primary care networks (PCNs), the ARRS scheme has been expanded for 2025/26 and the Capacity and Access Improvement Payment has been simplified into modern general practice access and risk stratification. The ARRS update has seen GPs and practice nurses added to the core scheme, without caps on recruitment. The reimbursable rate for GPs on the scheme has been uplifted in line with the BMA recommended pay range for salaried GPs (£9,305 to £82,418 plus onboarding costs), but previous stipulations on newly qualified status remain. A joint review of the ARRS and its future will be conducted through 2025/26.

Analysis 

The 2025/26 GP Contract is the first one negotiated by this Labour government and marks a potential turning point in relations between government and the health service. The contract has been billed as slashing red tape, tackling the 8am scramble, improving continuity, and addressing the real terms cuts faced by the sector under the previous government. 

This is also the first GP contract to be accepted by the GPC as it was proposed; a feat indicative of the positive response to the direction of travel set by the government to shift more care into the community. This news is not only well received by general practice, but providers across the system are responding positively as it has brought the end of collective action by practices. The mental health sector has been especially hit by the impact on shared care agreements, and integrated care boards (ICBs) have struggled to find the capacity to manage the impact on other services. A return to previous activity, supported by increased core funding and approval from the GPC, would stabilise systems and begin to improve both patient and staff experience.

However, while overall very positive, there is still more to be done to address challenges facing the sector. As such we will continue to work alongside NHS England and the Department of Health and Social Care to support primary care towards a sustainable future.

Access

The government’s commitment to the shift from analogue to digital is evident in the measures to improve access through the expansion of online consultation tools and shared records. 

From 1 October 2025, practices will be required to keep online consultation tools open to routine requests for the duration of core hours. The scope for digital access and triage has been a growing priority since the pandemic, but the additional administrative workload of online requests has been hard to balance in some practices. We saw this challenge addressed during collective action, with many practices choosing to turn off their systems once capacity for on-the-day appointments had been reached. While commitments to keeping these systems switched on will improve patient experience of access by providing them an open channel to their practice, we will continue to monitor members’ experience of the approach and its impact on activity. 

Using online tools also has the potential to support improved continuity by allowing practices to triage patient requests to the most relevant practitioner. This would positively impact patients with long-term conditions, but those with urgent requests who would still benefit from continuity must be accounted for when the system safeguards are designed.

In our Future of Primary Care Report, the NHS Confederation calls for the creation of a single, shared patient record, supported by interoperable IT systems commissioned at scale. The step to roll out access to the patient record to pharmacists is a positive step towards this goal. Moreover, allowing other NHS providers to have read-only access supports informational continuity for patients accessing different parts of the system. But more work to support interoperability, and fully accessible shared records, should be ongoing to support continuity across the health system.

In addition to the prioritisation of digitally supported access, PCNs have seen their Capacity and Access Improvement Payment simplified and resource ringfenced to support risk stratification activity. The payment has been streamlined to two payments: one, worth £58.4 million, will remain committed to supporting the Modern General Practice model, and the remaining £29.2 million will support practices to use population health risk stratification tools to assess the need in their communities and identify patients who would benefit most from continuity of care. 

This aligns to our recommendation that risk stratification should be prioritised and resource provided to reduce unfunded PCN activity and support those PCNs struggling with financial constraints. Moreover, risk stratification will provide the evidence base that practices and PCNs need to shape their services, including the updated approach to online consultation tools, to ensure that those patients at greater risk are prioritised for continuity of care.

Funding and incentives

Under the five-year contract and subsequent cost-of-living crisis, primary care has taken a real-terms funding cut. The Darzi report found that funding for primary care had fallen by a quarter since its peak in 2024, creating a challenging environment where activity has increased as funding has declined. The government has sought to address this with the 2025/26 contract which includes a 7.2 per cent total increase to core funds. 

This is the largest increase in investment in over a decade and puts funding growth for general practice ahead of the rest of the NHS. However, prior to publication, our members had shared their concern that any increase was going to be eroded by changes to minimum wage and employers’ National Insurance contribution increases. Since publication, NHS England has estimated the real-terms increase at 4.8 per cent, keeping growth above inflation, and taking a welcome step towards easing pressures and increasing the percentage share of NHS budget allocated to primary and community services as we raised in our recent report.

Incentives for primary care has been a contentious issue for some time. Our members have previously contributed to the incentives review and supported streamlined incentives which saw previous incentive funds redirected to core services through the General Medical Services (GMS) and Direct Enhanced Service (DES). The retirement of 32 previously frozen QOF indicators will therefore be a welcome reduction in bureaucracy. Similarly, the redirection of funds into the GMS and into CVD indicators which support the government’s ambition to reduce premature mortality from heart disease or stroke by 25 per cent within a decade has ensured that the funds are used effectively. 

As the top thresholds for the remaining CVD indicators have been raised, the redirection of funds from the retired indicators has also ensured that for practices which regularly meet the top threshold, they will not be doing more work for the same funds. Instead, the total funds available have increased by £198 million. While some concerns have emerged that retiring these indicators may worsen health inequalities, other members have welcomed the increase in funding for CVD indicators, which will support practices to fund activity which aligns with the Core20Plus5 inequalities model. 

Workforce  

The primary care workforce has grown significantly since the establishment of PCNs, with over 37,000 staff currently employed through the ARRS and new roles added each year. October 2024 saw the introduction of a temporary GP ARRS position, to mixed responses. PCNs found the low reimbursement rate and uncertainty around the duration of the funding had hit recruitment, while others were concerned that one GP per PCN was going to have a very limited impact on activity.

For 2025/26, these issues have largely been addressed, with the inclusion of the GP role in the core scheme, alongside the newly introduced practice nurse, the reimbursement rate and onboarding costs rising to the BMA banding for salaried GPs. Across the ARRS caps on recruitment have been removed, with PCNs now wielding full autonomy over their patient facing workforce. This is a positive step that aligns with the long-term asks of the NHS Confederation to let local leaders lead and empower primary care to build a workforce shaped around local need. 

However, without an increase in the total reimbursement rate for PCNs, those which have already recruited to their maximum allocation cannot benefit from the most recent changes. Moreover, given the current pressures on the GP workforce, some safeguards to protect the existing ARRS staff and ensure that public pressure to increase GP numbers does not come at the expense of a valued mixed skillset workforce.

The future of the ARRS will be reviewed this year, a move which has raised some concern among members who have seen the value of an at-scale workforce scheme in the community. However, the review has the potential to inform a refresh of the NHS Long Term Workforce Plan, which could be updated to reflect the current needs of the sector. The ARRS has had a significant positive impact on PCNs, but has not been without its challenges. This review is an opportunity to work with primary care to better shape the next iteration of at scale workforce and build a model which better supports integration and collaboration with other local providers in a neighbourhood working model.

Viewpoint

This contract sets out a range of welcome measures to support the sector, including confirming the biggest investment into general practice and primary care networks since the end of the five-year contract deal two years ago. This extra £889 million funding provides much needed relief to a sector that has borne the brunt of low financial uplifts over the last two years at the same time as significant cost pressures. The relaxation of rules around use of funding for the ARRS is particularly welcome and something we have been advocating for on behalf of our members for a number of years.

Primary care leaders and their teams will also welcome the focus on continuity of care, which we know is proven to improve experience and outcomes and reduce hospital admissions. Our report, The Future of Primary Care, shows that the sector is supportive of the government’s ambitions to move care closer to home.

Key actions for the NHS Confederation 

Advice and guidance enhanced service

Our members responded positively to the introduction of a funded enhanced service for advice and guidance requests, and we will be working with them to share examples of best practice. Our ongoing work supporting relationship building and delivery across the primary and secondary care interface will also build on the examples of our members and contribute to how requests are managed in participating systems.

Digital improvements ahead of October

We will continue to work with members to explore the challenges and benefits of expanding the use of online consultation tools to the full duration of core hours. Moreover, we will continue to advocate for a focus on improving continuity and exploring the potential benefits of online tools to triage in a manner which prioritises continuity of care.