The Institute of General Practice Management (IGPM) has reviewed the recently announced changes to the 2025/26 GP contract in England. While we welcome the positive developments, particularly the increased funding and reduced bureaucracy, we also have concerns around deliverability, clarity, and the ongoing pressures faced by practice teams.
This document offers a short summary of the key contractual changes, along with our reflections on what they mean for practices and the wider general practice workforce.
Funding and Core Contract Changes
- £889 million uplift across core and PCN contracts — the biggest in over a decade. While this is welcome, it comes against a backdrop of inflation, increased staffing costs, and rising patient demand. Whether this truly translates to a real-terms increase for all practices remains to be seen.
- New Enhanced Service: Advice & Guidance — up to £80 million nationally for managing referrals differently. We support funding for activity already taking place, but question whether this will introduce additional administrative complexity or gatekeeping expectations.
QOF (Quality and Outcomes Framework) Adjustments
- Retirement of 32 indicators (212 points) — intended to reduce red tape and workload. This is positive but has been offset by a significant redirection of effort into a new cardiovascular disease (CVD) prevention domain.
- New CVD indicators (141 points) with higher achievement thresholds. Practices will need clear guidance and support to deliver meaningful change, especially in areas of deprivation or with low patient engagement.
- A portion of QOF funding is being absorbed into the Global Sum, but clarity on the impact for individual practices is lacking.
Digital & Access Requirements
- By October 2025, practices must:
- Keep online consultation systems open throughout core hours.
- Enable GP Connect for record-sharing and pharmacy consultation summaries.
These ambitions are welcome but will require clear national guidance, local IT support, and time for implementation — none of which are adequately addressed so far.
- A new Patient Charter is due to be published and displayed on all practice websites. We would like to see this co-developed with patient-facing teams and ensure it reflects the reality of general practice delivery.
Workforce and ARRS Developments
- The ARRS scheme is made more flexible with a pooled funding pot — a move we broadly support.
- For the first time, GPs and practice nurses are explicitly included in the scheme, but the mechanism for this remains unclear. The IGPM is concerned that this could create confusion or risk duplicating roles already funded by core practice budgets.
- The increase in reimbursable GP salary cap is positive but may create disparity between ARRS-funded and core-funded GPs.
- There is also a new emphasis on continuity of care, particularly for vulnerable groups. While welcome, this may require structural and staffing changes at practice level that are not addressed in the contract.
Key Reflections from the IGPM
- Information has been slow to emerge. Specifications and further details are still awaited, with practices and PCNs expected to plan quickly for major system changes.
- Digital mandates risk widening health inequalities if not carefully implemented — we urge NHSE to consider rural practices, digital exclusion, and IT infrastructure disparities.
- There is a lack of clarity on funding impact per practice, particularly for those with lower QOF earnings or who may not be able to fully engage with new services.
- The operational burden on practice managers remains high. Any new service, incentive or access requirement must come with realistic implementation timelines and recognition of the workload placed on administrative and management teams.
Implementation Timeline
- April 2025: Funding uplift takes effect; new QOF indicators; Advice & Guidance service launches.
- October 2025: Online consultations must be open during core hours; GP Connect enabled.
- Throughout 2025/26: PCNs implement continuity metrics; practices to monitor evolving service specifications.
We welcome the progress made through negotiations with community pharmacy, particularly the expansion of services available to patients. However, there remains little recognition of the administrative burden this may place on general practice teams, particularly in ensuring the electronic patient record remains accurate and up to date.
We would also like to highlight the significant and ongoing financial pressures facing dispensing practices, many of which operate in rural and isolated communities. Their challenges are distinct and require dedicated consideration. We strongly urge that future discussions continue to involve and support this vital group within general practice
The IGPM will continue to support its members to interpret and implement these changes — but we call on NHS England to engage more meaningfully with non-clinical leaders in primary care to ensure reforms are practical, sustainable, and reflective of frontline reality.
We stand ready to work in partnership to deliver improvements that benefit both staff and patients, but that partnership must include a stronger voice for practice management at every level. The IGPM can facilitate this.
