GP Reimbursement scheme 2026/27: what partners should do

GP Reimbursement scheme 2026/27: what partners should do

The 2026/27 GP contract has quietly shifted the financial architecture around partnership. The new reimbursement scheme funds salaried GP sessions but excludes partners, even where they are picking up the same urgent same-day work. Here is what to model, what to revisit, and what to decide before the neighbourhood contracts land.

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There is a sentence buried in the supplementary guidance to the 2026/27 GP contract that very few partners have read closely enough. The new £292 million practice-level GP reimbursement scheme, designed to fund additional same-day clinical capacity, reimburses the cost of salaried GPs and locums who convert to salaried contracts for the additional sessions. It does not reimburse partner sessions. A partner doing the same clinical work, in the same room, on the same day, generates no claim against the £4.57 per adjusted patient that has now landed in your practice's CQRS Local account.

That is not a drafting oversight. Read alongside the wider direction in the 10-Year Plan, the neighbourhood provider contracts being commissioned by ICBs from 2026, and the BMA's own warning that general practice is being asked to anchor neighbourhood reform without a substantive new GMS contract, the message becomes harder to dismiss. The financial architecture around the partnership model has quietly shifted. The question for partners is no longer whether the model survives in the abstract. It is what to do, this year, when the practice's biggest new income stream rewards a workforce structure that does not include you.

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What has actually changed in the money flow?

For the last several years, the Capacity and Access Payment sat at PCN level. Practices argued, often correctly, that the money rarely translated cleanly into clinical hours on the ground. From 1 April 2026, NHS England has moved that £292 million to practice level. On average it is around £47,000 per practice, although the actual ceiling is £4.57 multiplied by your adjusted registered population at 1 January 2026. For a list of 10,000, that is roughly £45,700. For 14,000 it is over £63,000. It is real money, claimed monthly through CQRS Local, and confirmed to sit recurrently within the core contract beyond 2026/27.

What it pays for is narrower than the headline suggests. The reimbursement covers either a new salaried GP, additional sessions from an existing salaried GP up to nine per week, or a locum who enters a salaried employment contract with the practice for those additional sessions. Reimbursement is capped at the lower of actual employment cost or £152,900 a year, £155,698 in London, inclusive of employer National Insurance and pension. A practice with more than 3,500 patients per GP has to discuss the position with the ICB before claiming, although the guidance is clear this is intended to be supportive rather than a barrier.

What it explicitly does not cover is partner sessions, however many extra hours a partner picks up to meet the new same-day urgent access requirement. The clinical work is the same. The financial treatment is not.

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Why does this create such a sharp incentive?

The same-day access requirement is not optional. Practices must provide an immediate clinical response to all urgent requests, with five new metrics being collected at practice level by NHS England to monitor performance. Most practices will need additional clinical sessions to deliver this safely. The contract gives you £47,000 or so to fund them, provided the person doing the work holds a salaried contract.

If a partner picks up two extra urgent care sessions a week to plug the gap, the practice carries the cost of that time through reduced profit share. There is no reimbursement claim. If a salaried GP picks up the same two sessions, the practice claims the cost back, up to the cap. Over a year, on two sessions a week at typical salaried rates, the difference can sit comfortably in the £15,000 to £25,000 range depending on seniority and on-costs. Multiply that across the partners doing extra to keep the practice afloat, and the cumulative effect on partnership drawings is material.

In conversations with practice managers over the last couple of months, I am finding the same calculation being run quietly around the table. Some are concluding that the cheapest way to deliver the new contract is to convert a partner role to salaried, claim the reimbursement, and either bring in a new partner for a share of the residual profit or run a smaller partnership with fewer profit-sharing mouths. That is a real conversation, not a hypothetical one, and the scheme's design rewards exactly that response.

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Is the partnership model finished?

It is too soon to say that, and the loudest commentary on the subject often gets ahead of itself. The 2026/27 contract does not, on its face, replace the partnership model. NHS England's national director for primary care has been explicit that there is no aim to do so. The Health Foundation's read on the contract is that it is incremental rather than transformative. The traditional partnership still offers something that no salaried structure has reliably replicated: ownership, financial discipline, continuity of care, and the kind of practice culture that produces better patient satisfaction.

But two things are happening at once. The reimbursement scheme tilts the marginal economics against partner-delivered sessions. And the neighbourhood provider contracts, which ICBs will start commissioning from 2026, allow trusts, federations and primary care collaboratives to hold contracts covering populations of 30,000 to 50,000 in single neighbourhood form, and 250,000 plus in multi-neighbourhood form. Wesleyan's recent poll found 61 per cent of GPs considering partnership are now worried about increased financial risk and liability, and the BMA has been blunt about the existential pressure on the model. Whatever the formal position, the financial environment around partnership has become less hospitable, and partners need to make decisions about structure on that basis rather than on assumption.

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What should partners be doing in the next twelve months?

The first thing is to model your reimbursement entitlement properly. Take your adjusted list size at 1 January 2026, multiply by £4.57, and that is your annual ceiling. Then look at how the additional sessions required by the same-day access duty are actually being delivered. If partners are absorbing that work, you are leaving reimbursable income on the table. If the workforce mix is wrong for the funding mechanism, the question is whether to recruit, whether to convert, or whether to restructure how sessions are allocated. None of these decisions should be taken in isolation from the partnership deed.

The second is to revisit the partnership agreement itself. Most agreements I see were written for a different financial era. They predate ARRS, the practice-level reimbursement scheme, and the looming neighbourhood contracts. They often do not address what happens when a partner moves to a partly salaried arrangement, when premises liability needs renegotiating because a partner is retiring early, or when the practice considers entering a collaborative bid for a neighbourhood provider contract. A clearly drafted deed that addresses decision-making, capital, premises, succession and dispute resolution is the difference between a practice that can move quickly when the neighbourhood contracts arrive and one that gets stuck in internal negotiation while ICBs commission around it.

The third is income extraction and tax. With dividend tax rates higher and thresholds frozen, the balance between salary, dividends and pension contributions in a personal services company, or the comparable choices within a traditional partnership, deserve a proper look this tax year rather than next. The partners I work with who are most settled about the changes are the ones who have already stress-tested two or three scenarios: practice carries on as is, practice restructures workforce mix, practice joins a multi-neighbourhood bid. Each has different tax consequences, different liability exposures and different requirements from the deed.

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A point on tone, finally

There is a temptation, when the financial environment shifts against an established model, to read every policy change as part of a coordinated plan to dismantle it. Sometimes that reading is accurate. More often the changes are the product of multiple departments pulling in slightly different directions, and the cumulative effect is harder to spot than the individual decisions. The 2026/27 contract is not a deliberate attempt to end the partnership model. But the scheme's exclusion of partner sessions, combined with the arrival of neighbourhood provider contracts and the BMA's own position that the GMS contract is not currently fit for the strategic role being asked of it, means that partners who do nothing this year will find themselves on the wrong side of the marginal economics next year.

The model is worth preserving where it works. The question is whether your particular practice is structured to make it work under the new rules, or whether it is being slowly squeezed by them while the partners hope the policy direction changes. It probably will not, at least not in time.

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DISCLAIMER: This article has been prepared for information purposes only. Formal professional advice is strongly recommended before making decisions on the topics discussed in this release. No responsibility for any loss to any person acting, or not acting, as a result of this release can be accepted by us, or any person affiliated with us.