Practice manager Pete Woodward analyses the latest contract deal and warns of hidden dangers

Over the years, we’ve all seen a range of different GP contracts being released, with very mixed implications for primary care.

And yet the one just announced for 2026/27 by the Government may seem reasonable at first glance, but when you get into the detail, the story is very different…

So what are the risks?

The headline figure of the announcement is a 3.6% increase to the global sum (including a 1.4% ‘real’ increase, and 2.2% accounting for inflation).

However, in my practices, the removal of the Advice and Guidance enhanced service payments (£20 per submission) and Weight Management enhanced service combined account for roughly 0.5% of the increase, so this is just giving with one hand and taking away with the other.

Inflation (CPI) was also actually 3.0% in the last 12 months, not 2.2%. Not only that, but wage inflation in the last year was closer to 4.2%. In many practices, wages are a massive part of our overall costs- in mine, it’s over 80%.

So for us, this new contract represents a funding cut, which puts more pressure on already overworked teams and means that the quality of the service we provide for our patients will suffer.

The increasing reliance on advice and guidance risks shifting liability from secondary into primary care. Advice and guidance primarily exists to reduce waiting lists and demonstrate Government’s progress against targets, but means that liability for dealing with a patient waiting for secondary care often stays squarely with the practice.

Not only that, but a hospital is not incentivised to deal with these requests in a fashion that is efficient and practical for the GP. For example, consultants might recommend more reviews in both depth and/or frequency that go well beyond what primary care is commissioned and funded to provide. It could also mean an increase for primary care in the number of blood tests and other diagnostics, which would normally be the hospital’s responsibility.

The removal of PCN Capacity and Access monies generates additional risk for practices. In many practices, this money was a valuable source of additional income to support general activity to improve access. While it is claimed the money will be put into a dedicated pot to support practice recruitment of GPs (what seems like a practice-level ARRS scheme), this creates a number of issues. The estates crisis hasn’t been addressed, and many practices simply don’t have additional clinical rooms to accommodate extra GPs. The risk is that practices won’t be able to spend this money on alternatives to improve patient care. As always, the devil will be in the detail, and we will need to have that detail very soon to be able to put sensible plans in place.

Most of the changes to QOF seem routine. While the introduction of points for ‘improvement’ in uptake of childhood immunisations are somewhat helpful, it doesn’t address the fundamental issue of having unrealistically high targets or the fact that many practices have a small hardcore of anti-vaccine parents in their population. Because the numbers of eligible patients are relatively small, it only takes one or two parents refusing the vaccine to result in a practice losing thousands of pounds. This undermines our ability to invest in and improve our services, and again, feels like a money saving initiative by the government.

One of the most difficult parts for many practices is the provisions on access, specifically around being required to see patients on the same day. While practices retain the decision on what is deemed to be clinically urgent, practices will need to review their triage models to make this viable, and look increasingly at solutions which allow automation, or possibly even change working patterns. It’s a huge change for some practices with hardly any notice to implement it. It is difficult to see how this can be sensibly put in place without creating an administrative burden for practices through hundreds of additional coding requirements in every practice, every day.

Practices will be required to pass patient information to Lung Cancer Screening . While we can all agree this is a positive, it raises questions about information governance. If the practice is the data controller but doesn’t have a choice on what data to share, it retains all of the risk and liability but has no control on mitigating it.

Similarly, the contract raises a number of additional bureaucratic tasks to complete – such as being part of the NHS Staff Survey. While the aim of this is well intentioned, it duplicates work already happening in many practices and just increases the number of ICB and NHS England deadlines we have to manage, effectively taking us away from actually running our surgeries and attempting to improve the quality of services to our patients.

Overall, my opinion is this is by far the worst contract I’ve seen in my five years working in primary care. It’s now for practices to be as prepared as possible for the changes ahead, think carefully about wage structures, and to retain as much flexibility as possible in our financial plans to deal with the constant chipping away of funding and undermining of primary care by this Government – to try to survive.

Pete Woodward is managing partner at Cheadle Medical Practice and Alvanley Family Practice in Stockport, as well as running Woodley Village Surgery on a consultancy basis.