Introduction
NHS England has now published an update to the Primary Medical services Policy and Guidance Manual (PGM) – Version 6.
This document signposts and describes the key changes.
Background
The PGM supports local commissioners in their delegated primary medical care commissioning responsibilities, providing a suite of polices and guidance that support the legal, safe and effective commissioning and contract management of primary medical care services.
The PGM is subject to periodic review and refresh to ensure it remains fit for purpose and reflects the latest legislation, policy and guidance.
General
Substantive changes or additions in version 6 are highlighted yellow. Some content has also been moved or summarised to improve navigation or readability with these areas highlighted green. Templates and annexes have also been updated to align with these changes as appropriate.
Key changes
Part A: Commissioning and transformation support
| Chapter reference | Topic | Change |
|---|---|---|
| Chapter 4 (new) | Commissioning and transformation support (CATS) | New guidance describing NHS England support to commissioners to improve general practice through their commissioning and transformation responsibilities, signposting a series of additional resources that seek to: support understanding of practice variation and practice support needs (practice and PCN level frameworks, General Practice Dashboard). Support identifying and implementing the most appropriate support for practices (intervention support approach, practice level support). Understanding and developing ICB capability in the above context (‘CATS tool’, primary care transformation peer ambassadors, first steps to inform commissioning development offers). |
Part B: General contract management
| Chapter reference | Topic | Change |
|---|---|---|
| Chapter 1 | Contracts described | Table addition (1.1) comparing contracts to confirm all primary medical service contracts can be entered into as new contracts; that is, new GMS contracts, subject to meeting this requirements of the Provider Selection Regime. |
| Chapter 1 (1.5) | Provider Selection Regime (PSR) | Revised content to further align PGM with statutory PSR guidance. This includes a reminder of delegated responsibilities to seek NHS England regional sign-off of commissioning plans for new contracts over 5 years and notification generally on novel, contentious or repercussive matters. In support of notification of novel, contentious or repercussive matters a new policy requirement is also introduced where NHS England regional notification and sign-off is now required for all contract modifications (excluding enhanced services) with a lifetime contract value of £500,000 or more, or 25% or more. |
| Chapter 2 | Assurance framework for contract reviews | Updated to align with the resources of Commissioning and Transformation Support programme. |
| Chapter 3 | Managing patient lists | Revised and updated content to: enhance description of national primary care support services and systems throughout this chapter. Remind on statutory requirements for practice reasons for removing patient from a practice list. |
| Chapter 3 | Part B1: general list maintenance for primary medical services | Further description added of activities in scope of national rolling programme of list maintenance (GP list reconciliation and actions from returned mail). (New policy) Amendments to reflect: GP contract changes to reduce notice period to GP practices for removing suspected gone away patients (FP69 process). Use of digital communications in patient list maintenance processes. |
| Chapter 4 | Refusing patient registration | Clarification statement added (4.10.2) following closure of loophole in 2025/26 GP contract to confirm patients should not be refused registration because previously subject to an 8-day removal. |
| Chapter 6 | Managing [non-violent] patient behaviours | Updated to reflect and align with changes in the violence prevention and reduction standard (2024). |
| Chapter 7 | Managing violent patients – Special Allocation Scheme | Minor updates to reflect PCSE processes and alignment with violence prevention and reduction standard (2024). |
| Chapter 8 | Contract variations | Process for management of national contract variations reinforced/strengthened in light of recent legal case which upheld GP contract appeal as found a commissioner had failed to give [proper] notice of a variation. Key prompts for PSR consideration highlighted. |
| Chapter 8 | Contract variations (continued) | Branch sites – clarification that the considerations around closing a branch site apply equally when deciding to agree a variation to include a new branch site. Consideration of the mechanics for transferring branch sites between PCNs is also provided. Guidance on the management of partnerships splits where no clear successor has been updated to confirm commissioner may terminate the contract following changes to the 2025/26 GP Contract (effective 1 September 2025). |
| Chapter 10 | Practice closedown (planned/scheduled) | Further guidance on observing PSR in context of managing contract extensions. |
| Chapter 11 | Discretionary payments (made under section 96 of the NHS Act) | Process for financial assistance for individual provider (11.3) updated to reflect delegated commissioning to ICBs. |
| Chapter 12 | Premises running costs and service charges | Policy updated to align with and support NHS (GMS – Premises Costs) Directions 2024, Part 5 Directions 47 and 48. |
Part C – When things go wrong
No change to policy and processes to be followed.
Part D – General
| Chapter reference | Topic | Change |
|---|---|---|
| Chapter 1 | GP IT operating model: data and cyber security arrangements | Updated to align with latest GP IT operating model. |
| Chapter 2 | Locum reimbursement protocol | Updated to reflect outcome of 2025/26 GP contract agreement which includes: reimbursement rates updated to 2025/26 Statement of Financial Entitlements. The addition of neonatal leave under the definition of parental leave. Eligibility for locum reimbursement now applying to GPs funded via the Additional Roles Reimbursement Scheme (ARRS). |
| Chapter 5 (new) | Provision of clinical waste services | New content to provide further guidance and support on delegated commissioning responsibilities for procuring, managing and monitoring contracts for collection and disposal of clinical waste and relevant duties which commissioners or their GP contractors must fulfil. |