For the first time in four years, NHS England and the BMA’s General Practitioners Committee (GPC) have reached an agreement on the GP contract. This marks a significant shift from the stalemates of recent years and brings much-needed financial investment into general practice. With a £969 million uplift, including an £889m boost to core funding, the contract offers some long-awaited enhancements. But, as always, there are trade-offs that practices must carefully navigate.
Key Wins for General Practice
1. A Substantial Funding Boost
The £969 million investment builds on the £433 million added last autumn, meaning practices will see a meaningful uplift. The Global Sum per weighted patient is expected to rise to £121.90, and key payments such as locum reimbursements and childhood immunisations have also been enhanced.
2. ARRS Expansion – More GPs and Nurses Included
A long-standing issue with the Additional Roles Reimbursement Scheme (ARRS) has been its exclusion of GPs and practice nurses. This contract changes that:
• GPs within two years of their CCT (Certificate of Completion of Training) can now be employed under ARRS, with no cap on numbers.
• Practice nurses can also be funded, provided they have not worked in the PCN in the last 12 months.
• Minimum salaries for ARRS-employed GPs will be increased to £82,418 plus on-costs, aligning with the BMA’s recommended pay scale.
These changes give practices more flexibility in recruitment and could help address workforce shortages.
3. Enhanced Support for Parental and Sickness Leave
The Statement of Financial Entitlements (SFE) payments will finally be restored to real-terms 2025/26 values, offering better reimbursement for locum cover during parental and sick leave. This is a significant step forward, making it more feasible for practices to manage staff absences without financial strain.
4. More Funding for Cardiovascular Disease (CVD) Prevention
The Quality and Outcomes Framework (QOF) is seeing a shift. Thirty-two indicators (worth 212 points) that were frozen for 2024/25 will be permanently retired, with funding redistributed:
• £198 million will go into a renewed focus on nine CVD indicators.
• 141 QOF points will now be linked to these indicators.
• Upper thresholds for these indicators will increase, while lower thresholds remain unchanged.
With CVD being a major cause of mortality, this refocusing aligns with wider NHS prevention strategies.
5. A New £20 Payment for Pre-Referral Advice & Guidance
An Enhanced Service for advice and guidance will offer £20 per GP request for secondary care advice before a referral. This could reduce unnecessary referrals and support better patient management, while also recognising the workload involved in navigating specialist advice.
The Catch: What Practices Need to Watch Out For
While the contract includes some significant gains, there are also hidden challenges that practices need to be aware of.
1. The Push for Digital Access
From October 2025, practices must allow patients to submit:
• Routine, non-urgent appointment requests
• Medication queries
• Administrative requests
This sounds reasonable in principle, but the implementation could prove difficult. The contract acknowledges that safeguards are needed to prevent urgent requests from being mistakenly submitted online, but the details remain unclear. Managing patient expectations and preventing system overload will require careful planning.
2. Higher QOF Targets for CVD Indicators
While the additional £198m investment in CVD prevention is welcome, it comes with a catch—higher upper thresholds for performance. Practices will need to achieve more to secure the same level of funding, meaning this is not a straightforward financial gain.
3. ARRS Expansion: A Double-Edged Sword?
Although the inclusion of GPs and nurses in ARRS is a major step forward, there are limitations:
• Only newly qualified GPs (within two years of CCT) are eligible.
• Practice nurses must not have worked in the PCN or its practices within the last year.
This means experienced staff still cannot be recruited under ARRS, which could limit the benefits for many practices. Additionally, ARRS funding remains complex to navigate, and a joint review of the scheme in 2025/26 suggests more changes may be coming.
4. Advice & Guidance: A Potential Workload Shift
The £20 fee per pre-referral advice request is welcome, but there’s a risk that secondary care providers will use this to shift more workload onto general practice. If hospital teams increase their reliance on GP-managed advice services, this could create additional pressures. The contract states that the impact will be reviewed in Spring 2025, but in the meantime, practices will need to monitor how this plays out.
Final Thoughts: A Step in the Right Direction, But Not Perfect
The 2025/26 contract is a major improvement compared to previous years, with much-needed financial investment, a fairer ARRS scheme, and better support for staff absences. Crucially, this is the first time in four years that an agreement has been reached, which signals a more constructive relationship between NHS England and the profession.
However, not all that glitters is gold.
• The push for digital access could bring operational challenges.
• Higher QOF thresholds mean practices must work harder for their income.
• The ARRS scheme still excludes many experienced GPs and nurses.
• The new advice & guidance system could lead to extra workload if not properly managed.
While this contract offers progress, practices will need to stay vigilant, adapt to changes, and ensure they fully understand the implications before celebrating too soon.
What are your thoughts on the new contract? Will it make a real difference for your practice, or are the challenges too significant? Let’s discuss.