The Government’s actual cash uplift to general practice under the GP contract 2025/26 for England represents an increase of just £4.69 per patient per year, practice managers have said.
The Institute of General Practice Management (IGPM) has responded to the details of the contract, unveiled last week, highlighting that much of the value of the £889m headline figure is ‘significantly reduced’ after factoring in funds that have been rebadged and rising staff costs.
The negotiated agreement between the BMA and Government – the first in four years – will see 32 QOF indicators axed. And around £100m of QOF money will be diverted into the global sum to fund a rise to the Item of Service fee for routine childhood vaccinations and locum reimbursement payments under the Statement of Financial Entitlements.
The £889m pot is being put into the core practice contract and the Network Contract Directed Enhanced Service, taking the combined total estimated contract value to £13,176m.
The IGPM said with £100m not being new and the fact that practices in England will have to stump up an estimated £440m (£70k per practice on average), to cover national insurance and National Living Wage rises, ‘the actual uplift is significantly reduced, equating to just £4.69 per patient per year’.
‘This will consume most of the uplift that this contract provides and will not help increase access to GP service,’ it directors have also said.
Overall, the IGPM said it welcomed measures such as the reduction of QOF indicators that ‘cut red tape without compromising patient care’, and the inclusion of practice nurses in the ARRS. It also described the requirement for all practices to keep online access systems open during core hours from October as ‘a step forward’.
However, it outlined key concerns, particularly on how practices will absorb National Insurance hikes, announced in the 2024 autumn budget and due to come into force from this April.
Last week the House of Lords voted to exempt GP practices from having to pay increased National Insurance contributions (NICs) so they would continue to contribute 13.8% rather than the new rate of 15%.
And the IGPM said: ‘We urge the House of Commons to support the House of Lords’ vote to exempt GP practices from NI increases, given the financial pressures already facing the sector’.
Other concerns highlighted by the IGPM are:
- While the 2025/26 agreement will see an increase to GP locum reimbursement rates (payments to cover GPs on parental leave, sickness absence, prolonged study leave and more) increased, there is no similar recognition for the wider practice team, including practice managers and administrative staff.
- The higher upper thresholds for CVD QOF indicators create a significant workload increase, which may further disadvantage practices in deprived areas (see table below).
- Practices should be trusted to allocate resources based on their needs, rather than being restricted by controlled funding under ARRS. While ARRS funding has expanded to include newly qualified GPs and practice nurses, these are not new roles to general practice, the IGPM points out.
- Many practices still lack the physical space to accommodate additional staff. Without investment in estates, workforce expansion remains impractical for many practices.
- Digital inequalities need to be addressed in policy implementation. For example, the IGPM explains, rural areas face significant barriers in implementing digital booking systems due to poor telecoms infrastructure.
- Practices should be trusted to allocate resources based on their needs, rather than being restricted by controlled funding.
The IGPM also said it welcomes the opportunity to contribute to the new patient charter, which will be publicly available and set out the standards a patient can expect from their practice, to ‘ensure it reflects both practice realities and patient expectations’.
The organisation added: ‘The IGPM remains committed to supporting practices through these changes by providing guidance, best practice sharing, and advocating for fair, practical solutions. We call on the Government to ensure that these reforms lead to tangible improvements for both patients and healthcare professionals.
‘And as discussions continue towards a reformed 2026/27 contract, we urge policymakers to consider long-term, sustainable investment that supports the entire general practice system.’
The 2025/26 upper thresholds and points for CVD prevention indicators under QOF
| Indicator | Lower threshold 2025/26 (remain unchanged) | Upper threshold 2025/26 (figure in brackets is for last year ) | QOF points (figure in brackets is for last year) |
|---|---|---|---|
| CHOL003 Percentage of patients on the QOF Coronary Heart Disease (CHD), Peripheral Arterial Disease (PAD), Stroke/ Transient Ischaemic Attack (TIA) or Chronic Kidney Disease (CKD) Register who are currently prescribed a statin, or where a statin is declined or clinically unsuitable, another lipid-lowering therapy | 70% | 95% (unchanged since last year) | 38 (14) |
| CHOL004 Percentage of patients on the QOF Coronary Heart Disease (CHD), Peripheral Arterial Disease (PAD), or Stroke/Transient Ischaemic Attack (TIA) Register, with the most recent cholesterol measurement in the preceding 12 months, showing as ≤ 2.0 mmol/L if it was an LDL (Low-density Lipoprotein) cholesterol reading or ≤ 2.6 mmol/L if it was a non-HDL (High-density Lipoprotein) cholesterol reading. | 20% | 50% (35%) | 44 (16) |
| HYP008 The percentage of patients aged 79 years or under with hypertension in whom the last blood pressure reading (measured in the preceding 12 months) is 140/90 mmHg or less (or equivalent home blood pressure reading) | 40% | 85% (77%) | 38 (14) |
| HYP009 The percentage of patients aged 80 years or over, with hypertension, in whom the last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less, (or equivalent home blood pressure reading) | 40% | 85% (80%) | 14 (5) |
| STIA014 The percentage of patients aged 79 years or under, with a history of stroke or TIA, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/90 mmHg or less (or equivalent home blood pressure reading) | 40% | 90% (73%) | 8 (3) |
| STIA015 The percentage of patients aged 80 years or over, with a history of stroke or TIA, in whom the last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less, (or equivalent home blood pressure reading) | 46% | 90% (86%) | 6 (2) |
| CHD015 The percentage of patients aged 79 years or under, with coronary heart disease, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/90 mmHg or less, (or equivalent home blood pressure reading) | 40% | 90% (77%) | 33 (12) |
| CHD016 The percentage of patients aged 80 years or over, with coronary heart disease, in whom the last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less, (or equivalent home blood pressure reading) | 46% | 90% (86%) | 14 (5) |
| DM036 Note that DM036 replaces DM033 from last year. The percentage of patients with diabetes, on the register, aged 79 years and under without moderate or severe frailty in whom the last blood pressure reading (measured in the preceding 12 months) is 140/90 mmHg or less (or equivalent home blood pressure reading) | 38% | 90% (78%) | 27 (10) |
| Source: NHS England |
