Classification: Official
Publication reference: PRN01892

To: Integrated care boards (ICBs):

• primary care leads
• chief executive officers NHS England regions:
• regional directors
• regional directors of commissioning regional directors of primary care and public health
• regional heads of primary care

Dear colleagues,

Update to the GP contract agreements 2025/26: Financial implications

Changes to the GP contract in 2025/26 were confirmed on 28 February.

This confirmed an overall increase in investment of £889 million across the core practice contract and the Network Contract Directed Enhanced Service (DES). This will take the combined total estimated contract values from £12,287 million in 2024/25 to £13,176 million.

In addition to the £889m increase in investment, practices will also have the opportunity to take part in a new enhanced service for advice and guidance, which is funded up to £80 million nationally.

The 2025/26 priorities and operational planning guidance was published on 30 January 2025, setting out national priorities for 2025/26. Initial ICB revenue allocations, including those for primary medical care and other primary care (ICB POD services) were published at the same point.

Revenue finance and contracting guidance for 2025/26 sets out frameworks for payments and allocations for systems, and allocations to support planning and contracting.

Primary Medical Care allocations

ICB primary medical care baseline allocations totalling £11,928 million, an increase of £357 million for initial base growth, were published on 30 January and were adjusted to take account of the following:

• Distance from target adjustment
• Convergence
• An initial base growth of 3.09% – this was an interim uplift pending confirmation of GP contract arrangements for 25/26

For each ICB, a convergence is set based on the distance from target (DfT) after base growth. Further information can be found in the Technical guide to allocation formulae and convergence for 2025/26 allocations.

Following agreement with GPC, the total increase to GP contract funding for 2025/26 will be £889 million. The remaining growth is therefore £532 million, being the difference between the baseline growth £357 million and the agreed £889 million.

We have increased ICB allocations to reflect this.

Of the £889 million that GP contractual payments have increased by, £17.8 million is attributable to changes in the item of service payments for childhood immunisations. These are funded from section 7a budgets which are held by regional commissioners and sit outside of primary medical care allocations.

In 2024/25, some ARRS funding was allocated to ICBs on a drawdown basis in line with claims, and all of the GPs in ARRS funding was allocated on this basis. In 2025/26, all ARRS funding, including for GPs, will be added to allocations for ICBs. There will not be a requirement to draw this down separately. The value of this funding in 2024/25 was £534 million for the ARRS scheme and £82m for the GPs in ARRS scheme. ICBs should continue to issue this funding to PCNs in line with the PCN DES.

We have increased allocations to reflect both of this. The growth in ARRS entitlements between 2024/25 and 2025/26 forms part of the £889 million increase in contract funding and ICBs are funded for this as noted above.

We have agreed to fund advice and guidance in primary medical care and have set aside a further £80 million for the costs of this. Funding for this has not been added to ICB primary medical care allocations. There will be a separate drawdown process for accessing this funding.

Table 1 shows how the changes above affect the national level of primary medical care allocations for 2025/26. Annex A shows how ICB allocations are updated to reflect this.

Table 1

This includes:

a. funding an assumed increase in salaries of 2.8% in 2025/26
b. continuation of GPs in ARRS
c. funding to cover the costs nationally:
i. of other cost growth pressures, including from premises and list growth
ii. to reflect the increased level and complexity of activity

Additional allocations

ICBs should note that some funding previously allocated as Service Development Funding has been transferred to core ICB allocations for 2025/26 after base growth and convergence. This is in line with the need for reform and productivity improvement to deliver on the government’s goals for the NHS. To support local systems to deliver, we are removing most ringfences that limit system flexibility.

For 2025/26, most SDF bundles will move into ICB core programme allocations subject to a reduction to support overall financial balance. Where funding has been transferred into ICB core programme allocations this is no longer ringfenced, and there are no additional performance requirements beyond those set out in the 2025/26 priorities and operational planning guidance.

Specifically for primary care, primary care transformation (£126.751 million at 2024/25 levels) and (GPIT infrastructure and resilience £13.079 million at 2024/25 levels) have been included.

2024/25 values have been adjusted for 2025/26 in line with core allocations.

Further information is available in the Service Development Fund section of the Guidance and in the supporting finance materials section of the Planning NHS Futures section, specifically the supporting schedule and technical guidance.

As part of the primary care access and recovery plan for 2024/25, ICBs received non- recurrent funding to support transition cover and reimbursement to support the uptake of highly usable and accessible digital tools in practices, which is not separately available in 2025/26.

ICBs are expected to continue to fund digital tools for general practice from their core allocations and to prioritise as necessary within those allocations to do so. This is key to supporting government and planning priorities on GP access and moving from analogue to digital.

We will shortly be sharing more detailed primary care SDF guidance.

Quality and outcomes framework

32 Quality and outcomes framework (QOF) indicators which were income protected in 2024/25 have been permanently retired. This equates to 212 QOF points worth c.£298 million in 2025/26.

Of the 212 points, 71 points (worth c£100 million) have been removed outright and will be invested into Global Sum and (following feedback from GPC England) into increases in both the Item of Service Fee for routine childhood vaccinations (from £10.06 to £12.06), as noted above, and the locum reimbursement rates in the Statement of Financial Entitlements (SFE) – which will increase by 15.9% – 17.1%.

The remaining 141 QOF points (worth £198 million) are targeted towards cardiovascular disease (CVD) prevention. The points are redistributed proportionately across nine CVD prevention indicators. Lower thresholds for these indicators are maintained at 2024/25 levels, the upper achievement levels have been raised for 2025/26 to offer the maximum opportunity to earn QOF points for these indicators.

Investment and impact funding

The Investment and impact fund (IIF) in 2025/26 will continue to be worth £305 million. This is available partly through achievement of IIF indicators and the remainder through the capacity and access payments (CAPs).

The CAP will continue in 2025/26 as part of the IIF. The overall amount of funding allocated to the CAP in 2025/26 will remain £292 million.

As was the case in 2024/25, 70% of funding will be paid to PCNs via the capacity and access support payment (CASP) without reporting requirements, proportionate to their adjusted population, in 12 equal payments.

The remaining 30% of funding will be available to PCNs via the capacity and access improvement payment (CAIP). In 2025/26 the Capacity and Access Improvement (CAIP) payment will continue to be worth £87.6 million but will change from three domains down to two. One domain will continue to focus on supporting modern general practice access (worth £58.4 million) while the other (worth £29.2 million) will incentivise PCNs to risk stratify their patients in accordance with need – including to identify those that would benefit most from continuity of care.

Payments will be based on the PCN clinical director’s confirmation that all practices within the PCN have put in place the domains.

The Additional Roles Reimbursement Scheme (ARRS)

In 2025/26, the Additional Roles Reimbursement Scheme (ARRS) will increase in flexibility to support PCNs to respond to their local workforce requirements. Funding in the two ARRS pots has been combined to create a single pot for reimbursement of patient facing staff costs, with no restrictions on numbers or type of staff who are covered – including GPs and practice nurses.

Table 2 – ARRS funding

The salary element of the maximum reimbursement amount that PCNs can claim for GPs will be increased from £73,113 in 2024/25 (the bottom of the salaried GP pay range) to

£82,418 (an uplift of £9,305 representing the lower quartile of the salaried GP pay range) reflecting that some GPs will be entering their second year in the scheme. Proportionate employer on-costs will also be included within the overall maximum reimbursement amount which PCNs will be able to claim.

Vaccinations and immunisations

In response to feedback from GPC England and reflecting the key role that general practice plays in efforts to increase uptake in childhood vaccinations, the Item of Service (IoS) fee for routine childhood immunisations that are part of essential services will increase by £2 to £12.06 in 2025/26.

The 2025/26 SFE will list all the vaccinations and immunisations which are in scope of the increase in the Item of Service fee. £17.8 million of the funding generated through the retired QOF indicators will be used to cover the estimated costs of this increase.

General practice requests for advice and guidance

In addition to the core allocations in Table1, further funding will be made available to support practices taking part in a new enhanced service worth up to £80 million for advice and guidance which will begin in April 2025. This funding is in addition to the increase of £889 million across the core practice contract and the Network Contract DES.

Practices will be able to claim (subject to eligibility criteria set out in the enhanced service specification) a £20 Item of Service (IoS) for pre-referral requests. We will share separate guidance on how this funding can be drawn down by ICBs.

To maximise requests for advice and guidance, while ensuring expenditure stays within the

£80m national funding envelope for 2025/26, at a local level, Integrated Care Boards (ICBs) may introduce a mechanism to cap the number of (monthly, quarterly or annual) advice and guidance requests which can be claimed per practice.

At any point during the year, the ICB may set a cap or change a cap. If a cap is changed in year, it will not be set below the level of delivered activity at that point. Each practice that signs up to the ES will be notified by its ICB of any cap (where applicable) and any in year changes to the cap. ICBs may want to discuss any capping approach with the Local Medical Committee. Practices may continue to make pre-referral requests above any cap set by the ICB but will not be able to claim payment for those requests under this Enhanced Service.

NHS England will make historical A&G activity data available to support any ICB that may wish to set a cap. Further information can be found in Annex A.

Weight Management Enhanced Service

The Weight Management Enhanced Service will continue in 2025/26. Practices will receive £11.50 per referral with total funding of £7.2 million for the enhanced service. This can be separately drawn down by ICBs and is not included in the allocations for primary medical care.

Yours sincerely,
Ben Day, Director of Financial Strategy and Payments

Annex A – GP Advice and Guidance – 2025/26 funding flows funding approach

Total funding of up to £80 million is available nationally, allocated to ICBs on a ‘fair shares’ basis based on PMC allocation methodology. The maximum funding available to each ICB is set out in Annex B.

Funding has been agreed at a level which supports an ambition of achieving significantly increased uptake nationally. In some cases, local levels of activity and consequent payments to practices may exceed the total available ICB allocations and/or a practice-level apportionment.

ICBs should consider how to optimise both the appropriate use of advice and guidance locally and the deployment of available funding to support.

The agreed Enhanced Service Specification – General Practice Requests for Advice and Guidance (para 7.2) – sets out the ability for ICBs to introduce a mechanism to cap the number of (monthly, quarterly or annual) advice and guidance requests which can be claimed per practice.

The specification notes (para 7.2):

To maximise requests for advice and guidance, while ensuring expenditure stays within the £80 million national funding envelope for 2025/26 at a local level, Integrated Care Boards (ICBs) may introduce a mechanism to cap the number of (monthly, quarterly or annual) advice and guidance requests which can be claimed per practice. At any point during the year, the ICB may set a cap or change a cap. If a cap is changed in year, it will not be set below the level of delivered activity at that point. Each practice that signs up to the ES will be notified by its ICB of any cap (where applicable) and any in year changes to the cap. ICBs may want to discuss any capping approach with the Local Medical Committee. Practices may continue to make pre-referral requests above any cap set by the ICB but will not be able to claim payment for those requests under this Enhanced Service.

NHS England will make historical A&G activity data available to support any ICB that may wish to set a cap.

Funding flows process

Allocations adjustments will be made to ICBs quarterly, adjusted to reflect actual levels of activity and subject to 2025/26 maximum set out in Annex A.

• For quarter 1, an initial allocation will be made based on 25% of the maximum
• For subsequent quarters, further allocations will be made based on latest practice payment claims information from CQRS.
• Final allocations for Q4 will be made based on expected full year activity for 2025/26 and constrained by the overall envelope.

Annex B – GP Advice and Guidance – Allocations