1. Introduction

1.1 Purpose of this document

This document provides supplementary information to support general practice and commissioners to implement the 2026/27 GP Contract requirements.

It is intended to support practical delivery by describing the policy intent, operational expectations and implementation considerations for the changes outlined in the letter on changes to the GP contract, published on the 24 February 2026. It does not introduce new contractual requirements beyond those set out in the letter.

This information is intended to complement, not replace, the requirements that will be specified in the revised GP contract and contract variations when published. Practices and commissioners should ensure they are familiar with, and act in accordance with, the contractual and regulatory framework once published. This includes:

• GP Model Contracts and Contract Variations
• The GMS Statement of Financial Entitlements (SFE) 2026
• Primary Medical Services (Directed Enhanced Services) Directions 2026
• The 2026/27 Network Contract DES documents (including the specification and Part A and Part B guidance)
• 2026/27 Quality and Outcomes Framework (QOF) guidance
• 2026/27 respiratory syncytial virus (RSV) guidance

This supplementary information document will be updated and refreshed as required.

2. Supplementary information on specific contract areas

2.2 Practice level GP reimbursement scheme

In the letter announcing the changes to the GP contract we set out that we would introduce a new practice-level GP reimbursement scheme. The scheme is designed to increase GP capacity and will support clinically urgent same day access in general practice.

How the funding can be used

The details of the scheme are included in the May 2026 amendment to the GMS Statement of Financial Entitlements (SFE). Practices can claim funding from 1 April 2026 until the 31 March 2027. The funding for the practice level GP reimbursement scheme will remain within the core GP contract recurrently beyond 2026/27 (that is, it won’t transfer back to Primary Care Networks (PCNs)). 

Practices are able to claim reimbursement for:

• the employment of a new salaried GP (or a contribution towards the cost of a new GP).
• extra sessions from existing salaried GPs within the practice
• where the practice is a core member practice of a PCN, for the continuation of a salaried GP where the post was previously funded (and the funding has stopped – or will stop) through either:
  • the PCN Capacity and Access Payment or
  • the PCN Test Sites programme.

This means that GPs previously funded via the Capacity and Access Payment or the PCN Test Sites programme can transition to the scheme. To support this, practices within the same PCN can transfer their funding entitlements to each other under the scheme.  They will need to write to their ICB to confirm this arrangement.  

Other contractual changes have also been made to support the transition of staff funded via the Capacity and Access Payment or the PCN Test Sites programme. Please see the section below for further information. 

GPs who are locums within the practice can also be funded via the practice level GP reimbursement scheme, but they must hold an employment contract with the practice for the additional sessions (that is, they would be a new salaried GP under the scheme). 

Practices which have more than 3,500 patients per GP will need to contact their ICB before accessing funding via the scheme. This is intended to be a supportive touchpoint with the ICB to help understand the factors contributing to their GP to patient ratio and to discuss any other support the practice may need. This requirement is not intended to be a barrier to practices accessing the funding.  

Additionality

The practice level GP reimbursement scheme includes some additionality criteria to provide assurance that the funding is supporting additional GP capacity. These are:

• new GPs employed via the scheme must not (at the date they start employment) have been employed as a salaried GP in the practice within the previous 12 months. The exceptions are:
  • where they were previously providing cover for a GP who was absent due to sickness, suspension, maternity leave, paternity leave, neonatal care leave, adoption leave, shared parental leave or study leave.
  • the GP has retired but is returning to work and is funded via the scheme.
• existing GPs within the practice who are increasing their participation can deliver up to a maximum of 9 sessions per week, for example, a GP currently working 4 sessions per week can deliver an additional 5 sessions under the scheme.

Contractors will also need to confirm that they are not already claiming reimbursement in respect of the same costs for the salaried GP and that funding is not being used to cover an absent GP (as there are separate provisions for absent GP cover within the SFE).

Amounts that can be claimed

The amount of funding available to each practice under the scheme is £4.57 multiplied by the practice adjusted population per practice at 1 January 2026 (noting that practices within a PCN can choose to transfer their entitlements to each other). Funding is embedded within PMC baseline allocations.

When practices are making claims for either a new salaried GP, or a GP that was previously funded by either the Capacity and Access Payment or the PCN Test site programme, they can claim the lower of either of the following amounts (which include the cost of the salary of the GP and the employer’s contribution for national insurance and pension):

• the actual cost incurred by the practice
• the maximum sum of £152,900 and (or £155,698 where London weighting applies).

When practices are making claims for additional sessions for existing GPs within the practice, they can claim the lower of either of the following amounts (which include the cost of the salary of the GP and the employer’s contribution for national insurance and pension):

• the actual cost per hour incurred by the practice
• the maximum hourly rate of £90.61 (£92.27 where London weighting applies).

Making claims

Practices will submit reimbursement claims via the CQRS (Calculating Quality Reporting Services) Local system used by ICBs across England to administer claims and payments for primary care providers. ICBs are responsible for onboarding their practices to the GP reimbursement scheme service in CQRS Local and managing user accounts.

CQRS Local user guides are available for practices and commissioners. These cover the signup, processing claims, and account management processes. Unlike other CQRS Local services, the GP reimbursement scheme will be configured nationally. So ICBs are not required to undertake any of the service creation steps that are referred to in these guides. A separate user guide for the GP reimbursement scheme will be available shortly.

For detailed information on the system and how to submit GP reimbursement claims, please read the user guides. The service introduces new features to CQRS Local, designed to simplify the claims process and reduce administrative burden for practices and commissioners. Practices can submit a claim once and have it automatically copied for up to the next 3 months. Commissioners can then approve all future claims in a single click, and payments are automatically generated at the end of the following calendar month.

If anything changes that might affect reimbursement, practices should tell their commissioner as soon as possible, ideally before the changes take effect. Notifiable changes include practice mergers and patient list size changes significantly affecting the patients per GP ratio – for example, taking it over 3,500 per GP. Changes to claims, such as GP leavers and starters or changes to individuals’ hours worked, are not subject to notification. These should be reflected in amendments to the reimbursement claims.

Capacity and Access Payment and PCN Test Site programme funding

From 1 April 2026, PCN Level Capacity and Access Payment funding (£292 million) that had previously supported PCN access arrangements was removed from the Network Contract DES, to enable the introduction of the practice level GP reimbursement scheme. In addition, funding for the 22 PCN test sites will end in April 2027.

In order to support transitional arrangements for staff funded by these sources, contractual changes have been made. As set out above, GPs previously funded via the Capacity and Access Payment or the PCN Test Sites programme, can transition to the practice level GP reimbursement scheme. 

In addition, exemptions have been created in the Additional Roles Reimbursement Scheme (ARRS) additionality rules to allow GPs, plus Band 5 and Band 6 practice nurses, to transition into ARRS (where funding exists). The previous additionality rules prevented this from happening within 12 months of the individual having been employed by a PCN member practice or the PCN. 

The details are contained in the 26/27 Network Contract DES specification. To note – other PCN staff funded by either the Capacity and Access Payment or the Test Site programme, are also able to transition to the ARRS and no additionality rules prevent this. 

2.2 Patient contact with the practice

Good patient communication is key to the general practice relationship with patients from the first point of contact. In the letter announcing the changes to the contract we said we would include a requirement that practices must not ask patients to call back, or make contact, on another day.

By this, we mean that practices should have arrangements in place to ensure that patients are able to make contact with the practice and have their request appropriately managed without being asked to re-contact the practice on a subsequent day. The purpose of this is to ensure timely access and reduce unnecessary barriers for patients seeking care or advice.

It is recognised that practices may not be able to resolve every patient query immediately, particularly when this is not clinically or operationally appropriate. In such cases, practices should communicate clearly with patients, which should include taking account of their language and communication needs, about expected response times and the steps being taken to address their needs and keep patients updated as required.

The appropriate response must be to either; invite the patient for an appointment (in person, by telephone, or via online/video consultation); provide advice or care by another method; signpost the patient to appropriate alternative services or communicate with the patient to request further information or advise them when and how they will receive additional details. Practices should use their professional judgement to determine the most suitable response based on the specific circumstances and clinical urgency.

Where practices experience sustained or significant capacity or demand pressures, they should use established escalation and support routes through their integrated care board (ICB), to raise their operational pressures and access support.

2.3 Same day access for clinically urgent need

In the letter announcing the changes to the GP contract we confirmed that we would amend the GP practice contract to explicitly require that requests identified as clinically urgent, as determined by the GP practice, must be dealt with on the same day. This is intended to support timely access to care for patients where delay may result in harm or deterioration.

Requests identified as clinically urgent by a GP or the practice team must be dealt with on the same day. It is for the GP practice to determine which patients are clinically urgent, in the same way they do now. The decision about whether a patient’s need is clinically urgent is a prospective judgement made on the basis of the information available at the point of first assessment, rather than a retrospective assessment made with the benefit of later information.

Practices should review the Recording same day appointments for all clinically urgent patients guidance which has been published to support practices in appropriately coding clinically urgent appointments within their appointment books.

A practice taking appropriate clinical action on the same day does not necessarily mean a face-to-face GP appointment. The practice must take appropriate action, which might be to:

• invite the patient to attend an appointment;
• provide appropriate advice or care;
• direct the patient to appropriate services; or
• communicate with the patient to request further information, or to explain when and how the patient will receive further information

2.4 Online consultation systems must not be capped

In the contract announcement letter, we said that online consultation systems must not cap the number of requests that can be submitted during core hours*. By this we mean that patients must be able to submit online consultation requests at any point during core hours, and that practices must not place limits on the number of requests that can be submitted during that time.  

* ‘core hours’ means, the period beginning at 8am and ending at 6.30pm on any day from Monday to Friday except Good Friday, Christmas Day or a bank holiday.

Practices should ensure that patient communications clearly explain the purpose and appropriate use of online consultation systems, including how requests will be managed and triaged. It does not mean every online request must result in a same day appointment nor are practices expected to provide unlimited appointments.

Practices are encouraged to monitor demand and use established escalation and support routes through their ICBs to raise operational pressures and access support where necessary.

GP practices are expected to plan and organise their capacity appropriately to meet the reasonable needs of their practice population, recognising that demand patterns are generally predictable and can be managed through appropriate workforce, appointment and operational planning.

2.5 Respiratory Syncytial virus (RSV)  

In the letter announcing the change to the GP contract we said we would extend the RSV vaccination programme to include all adults aged 80 and over and all residents in care homes for older adults, in addition to the existing cohorts.

Two RSV vaccinations programmes were implemented from 1 September 2024 – an older adults’ programme for those aged 75 to 79; and a programme for pregnant women to protect infants. 

From 1 April 2026 the RSV older adults programme is being further expanded to also include adults aged 80 years and over, and all residents of care homes for older adults (CHOA) regardless of their age (Expansion of RSV vaccine eligibility to those aged 80 years and older and residents in care homes for older adults letter – GOV.UK).

Further guidance on the RSV vaccination programme is available on our GP contract pages.

2.6 Advice and Guidance and Single Point of Access

In the contract announcement letter, we said that practices will be required to use Advice and Guidance (A&G) prior to or in place of a planned care referral where clinically appropriate and to follow locally agreed referral pathways, including single point of access models once introduced.

By this we mean that GP Practices should continue to prioritise advice and guidance where clinically appropriate. Advice and Guidance is intended to support access to specialist input and not to replace referrals, raise referral thresholds, or transfer inappropriate workload to general practice. Any decision to refer remains with the referring clinician, as has always been the case and this is not changing.

A&G is not a mandatory step before every referral. Practices are required to use A&G, where clinically appropriate, to obtain clinical advice from a consultant to inform clinical decision making in relation to a referral and to follow locally agreed referral pathways.

Under the single point of access (SPoA) model, all requests (for referral or specialist advice) will undergo specialty or sub-speciality level review, to identify the most clinically appropriate next step for the patient. This triage is intended to support timely and appropriate care, not to prevent or delay clinically necessary referrals. This could be an out-patient appointment, A&G, straight to test pathways or other diagnostic and management pathways. A GP will continue to be able to engage in a dialogue with secondary care following the response where further clarification or discussion is needed to support a referral.

All A&G requests and referrals should be clinically appropriate and authorised by a named GP, consistent with the corresponding requirement on providers that specialist advice is provided by, or under the accountability and oversight of a named consultant.

Where advice and guidance or SPoA processes identify a need for tests or investigations as part of specialist input, responsibility for arranging and undertaking those investigations sits with the provider. This does not change existing arrangements for primary care-initiated diagnostics, which GPs should continue to request where clinically appropriate.

NHS England will continue to engage with general practice professionals, systems, providers and stakeholders to shape the implementation of SPoA, including their interface with A&G services. All new elective pathways and single points of access will be developed collaboratively with general practice and secondary care to ensure they are clinically safe and operationally workable.

This core contractual requirement is supported by £82 million of funding and that full amount is now incorporated into global sum payments from 1 April 2026.

2.7 GP engagement with the Lung Cancer Screening Programme

In the letter announcing the changes to the GP contract practices, we set out that practices will be required to share data with the Lung Cancer Screening Programme (LCSP) as it is rolled out across the country. This means that practices must ensure LCSP providers are able to access the relevant information from their clinical systems needed to identify the eligible patient cohort.

Practices are not required to undertake, fund, or deliver clinical services beyond their current contractual scope for screening programmes. These arrangements are consistent with the approach taken for other NHS screening programmes, where general practice supports the identification of eligible patients but does not deliver the screening intervention itself.

2.8 General practice staff survey

In the letter announcing the changes to the GP contract we said that we would require practices and PCN to participate in the General Practice Staff Survey (GPSS), including sharing staff contact details.

By this we mean that practices [and PCNs] are required to share relevant staff email addresses which will be used to distribute individual survey links to eligible staff members. Completion of the survey is voluntary for individual GP practice [and PCN] employees.

The GPSS serves as a vital tool for gathering insights into workforce experiences across practices. All practices and commissioners should actively engage with the survey to contribute to a comprehensive understanding of staff perspectives.

The survey is intended solely for workforce planning and improvement, and all data collected will be handled securely and anonymously. The data collected will not be used for performance management or assessment of individual practices.

Practices are encouraged to communicate these principles to staff to foster engagement and reassure them about the purpose and handling of survey data.

GP Practices sharing staff email addresses is underpinned by NHS England’s statutory role in commissioning primary medical services and overseeing workforce planning. The data is processed under established NHS information governance principles, ensuring lawful, fair and secure use, solely for administering the survey.

2.9 Changes to GP registration

In the contract announcement letter, we said that the core practice contract would be amended to mandate the use of online registration in all registration cases.

By this we mean that all GP practices must use the online registration service provided by NHS England for every patient registration regardless of whether the patient registers digitally or submits a paper form. Where a patient presents a paper registration form, practice staff are required to enter the patients details into ‘Register with a GP surgery’ system on the patient’s behalf.

Where the online registration service supplied by NHS England does not support integration of registration data with the contractor’s computerised clinical system, or where the online registration service is temporarily unavailable for any reason, the practice may continue to enter the patient registration details directly into their clinical system.

The online service provides a consistent registration experience, reducing administrative workload and improving the quality of patient information received by the NHS.

Digital registration offers significant benefits, including allowing patients to register without visiting the practice and minimising rejected registrations, which helps reduce practice burden.

Practices must continue to offer non-digital and assisted registration routes for patients who are unable or unwilling to use online services. No patient should be disadvantaged by the move to digital registration. Patient-facing communications must clearly explain all available registration routes, using accessible formats and language. Reasonable adjustments must be made to support patients in line with equality and accessibility requirements.

2.10 GP practice collaboration with ICB support

In the letter announcing the changes to the GP contract we said that practices will be required to engage with support from their ICB where unwarranted variation has been identified.

By this, we mean that practices will be required to work constructively with their ICB to address identified issues and support improvement. While the vast majority of GP practices already engage constructively with their ICB, this new requirement seeks to reduce variation in practice engagement. This collaboration is distinct from the processes relating to practice list closures and is intended to be a supportive improvement approach.    

ICB support should be explicit and tailored to the needs of the practice, for example, whether the practice needs support to stabilise, improve or sustain services, with the objective of addressing barriers to continuous improvement in quality and safety of services over time and enhancing patient and staff experiences and outcomes.

ICBs will be expected to provide clear, consistent, and accessible information outlining the support available to practices, and to ensure that interventions are framed around improvement rather than compliance or performance management process.

2.11 Timely access to data for monitoring

In the letter announcing changes to the GP contract, we said that practices will be required to provide timely data and information related to online and video consultations services, enabling consistent monitoring of access, patient experience and system performance.

By this we mean that practices are required to provide, or allow access to, timely data on online and video consultations aligning with existing requirements for cloud-based telephony data. Access to timely data is intended to support service improvement and enable a better understanding of demand and access, it is not intended to be a punitive performance management process.  

Data will be drawn from existing national data collections operated by NHS England under its statutory powers. The legal basis for these collections is set out in primary legislation, including the Health and Social Care Act 2012, which enables NHS England to collect and use information required to monitor access, service provision and digital delivery in general practice.

2.12 Ensuring patient choice of pharmacy

In the letter announcing the changes to the GP contract we said the practices would be required to reconfirm the nominated pharmacy, whenever a new (non-repeat) prescription is issued – and to ensure that any referral and triage tools used for community pharmacy clinical services offer patients a full choice of provider.

By this we mean that patients must be able to choose, and if they wish, nominate or change their NHS community pharmacy of choice, for electronic transfer of prescriptions or referral for clinical services. Practices must provide clear, accessible information on how patients can nominate or change their chosen pharmacy. Patients should be given unbiased information, free from any influence towards a particular pharmacy.

Any triage or referral tools used by the practice to support access to community pharmacy clinical services must present the full list of available NHS community pharmacies, enabling patients to make an informed choice from all suitable providers. Practices are responsible for ensuring that digital and non-digital referral processes do not restrict patient choice.

2.13 Dedicated GP email address for community pharmacy communication

In the letter announcing the changes to the GP contract we said that practices will be required to have a dedicated, monitored email address. It will be for receiving information from community pharmacies in the event that GP connect is unavailable and for new or emerging pharmacy activity that is not yet supported through GP Connect (for example, independent prescribing in community pharmacy).

By this we mean that practices must maintain a suitable, monitored and secure email (The secure email standard – NHS England Digital, Secure Email – NHS Standards Directory) address to support safe and effective communication with community pharmacy. The purpose of this requirement is to support coordination of care, manage referrals, and ensuring accurate prescription handling where alternative digital routes are not available.

Practices are not required to create a new email address where existing secure email addresses fulfil this function. The email address must be regularly monitored during core practice hours to ensure timely review, and where needed, response. Practices are required to record this email address and keep it up to date in the NHS Directory of Service. Practices and community pharmacies are jointly responsible for maintaining confidentiality and data security in all email exchanges.

2.14 Displaying opening times for all access modes

In the letter announcing the changes to the GP contract we said we will amend the core practice contract to require practices to display opening times for all modes of access (walk‑in, telephone and online consultation) on their website, in their practice leaflet and within practice premises. As a minimum this must be core hours for all modes of access.

Example opening times

These are the times you, or your carer on your behalf, can:

• visit the practice in person,
• call us,
• or go online using the practice’s website or the NHS App.

The core contractual requirement for practices is to ensure access for patients throughout core hours, across all modes of access. This includes setting out the arrangements in place to ensure continuity of access and care, and making clear to patients where and how services will be provided.

There may be some exceptional circumstances where practices seek commissioner agreement to arrange for clinical services to be delivered by another provider, and/or at another location during core hours through a sub-contract. In such cases the published opening times must clearly explain how patients can access services across all modes of access (walk in, telephone and online) during those periods.

Any such arrangements must be explicitly agreed by the commissioner and assessed on their individual merits, having regard to patient access, continuity of care and local population needs. There should not be a blanket or area wide approach to altering clinical service provision during core hours. The practice would remain responsible for ensuring that patients can access appropriate care throughout those hours. 

The overriding presumption is that practices are open for patients during core hours for all modes of access.

Example opening times

These are the times you, or your carer on your behalf, can:

• visit the practice in person,
• call us,
• or go online using the practice’s website or the NHS App.

Publication reference: PRN02423