What the New GP Reimbursement Scheme Really Means for Practices and Locums

What the New GP Reimbursement Scheme Really Means for Practices and Locums

The new £292m GP reimbursement scheme is being framed as a win for practices. Read more closely, it is a structural redrawing of how GP work gets paid for, with real consequences for partners, salaried GPs and the locum market.

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When NHS England confirmed that £292 million of what had been Capacity and Access Payment funding would move from primary care networks to individual practices in April 2026, the framing was tidy. Practices would have direct control of funding to recruit additional GP capacity, and the long-standing restriction limiting reimbursement to recently qualified GPs was being lifted. Headlines wrote themselves around the idea that GPs were, at last, being put back at the centre of the funding model.

What did not get the same headline treatment is the more uncomfortable substance of the change. The new practice-level GP reimbursement scheme, sitting alongside the continued expansion of ARRS, is not simply a top-up. It is a structural redrawing of how GP work is paid for, and it will reshape the staffing decisions practices make, the careers locums can build, and the bargaining position of partners against the wider market. It is worth pausing on what the scheme actually does, and what it quietly assumes about how practices will respond.

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A short, important history

To understand the shift, it helps to remember how we got here. The 2019 GP contract created the Additional Roles Reimbursement Scheme to fund 20,000 additional patient-facing staff through primary care networks. It worked in the narrow sense that the recruitment numbers were met. It also produced something nobody quite anticipated: a hiring environment in which the funded roles (pharmacists, paramedics, physiotherapists, social prescribers and the rest) were always cheaper to a practice than a GP, and so the GP came last in the queue when sessions needed to be added.

That perverse incentive was finally acknowledged. In late 2024 a separate "GP Sum" was opened up to recruit GPs within two years of CCT through ARRS, with a fixed pot and tight rules. In 2025/26 the cap on the number of ARRS GPs was removed and the reimbursable rate was lifted in line with the BMA salaried scale, although the recently qualified restriction stayed in place. The 2026/27 contract then went further. It moved the £292 million previously funnelled through the Capacity and Access Payment into a practice-level scheme designed specifically to fund GP capacity, and removed the two-year post-CCT rule. Experienced GPs are now in scope, and the maximum reimbursement is the top of the salaried GP pay range plus employer on-costs.

That is a real change, and on the face of it a welcome one. It is also a quietly destabilising one.

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The temporary money problem

The first thing every practice considering the new scheme should sit with is this: the funding is currently guaranteed only until 31 March 2027. The contract has been written that way. There is no commitment beyond that point, and the joint review of ARRS that was promised in 2025/26 is still hanging over the entire architecture.

This matters because the natural use of the money is to recruit a salaried GP, and salaried GPs come with employment contracts. Those contracts do not switch off when a funding stream does. A practice that hires confidently on the assumption that the scheme will continue is taking on a permanent liability against a temporary income line. A practice that hires on a fixed-term contract to mitigate the risk will struggle to attract good candidates, because the salaried GP market is already nervous about exactly this kind of exposure.

There is no comfortable answer here. The honest position is that practices should be modelling at least three scenarios: the scheme continues in its current form, the scheme is restructured into something narrower or with strings attached, and the scheme ends. The financial difference between those scenarios over a three to five year horizon is significant, and it should be on the table when any new appointment is being discussed at a partners' meeting. Build break clauses where you can. Look hard at existing partner sessions before assuming new salaried capacity is the right answer. Where the scheme funds an increase in sessions from a GP already in the practice, that is materially less risky than funding a new permanent post, and the contract specifically allows for this.

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What it does to locums

The locum side of this picture deserves more attention than it has received in the official communications. The earlier iterations of ARRS, particularly through 2024 and 2025, did real damage to the locum market. Practices, understandably, preferred to spend funded money on funded roles, and locum work dried up in many parts of the country at the same time as salaried vacancies became heavily oversubscribed. Newly qualified GPs who had planned to spend a few years locuming found themselves squeezed from both directions, and experienced locums saw their day rates fall and their booking diaries thin.

The 2026/27 scheme does not undo any of that. In some ways it formalises it. Locums can be funded through the practice-level scheme, but only if they take an employment contract for the relevant additional sessions, in which case they are no longer locums in any meaningful sense. The implicit message is that the locum-as-career model, the GP who deliberately keeps their portfolio flexible across multiple practices, is being designed out of the funding architecture.

For locums reading this, the practical question is whether to accept that direction of travel or to resist it. Accepting it means looking seriously at salaried or part-salaried arrangements, possibly across more than one practice if portfolio working still matters, and negotiating session terms that protect the flexibility you valued in the first place. Resisting it means accepting that the practices most able to pay you well are now incentivised to do so only through a salaried frame, and that the unfunded market for locum work will be thinner and more concentrated than it was. Neither option is obviously right, but the worst response is to assume the locum market will revert to where it stood in 2022. It will not.

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What it does to partnerships

There is a quieter effect on the partnership model. When experienced GPs can be reimbursed at the top of the salaried scale through a practice-level scheme, the calculus that has long held the partnership model together starts to wobble. A senior GP weighing partnership against salaried employment used to be choosing between drawing profit share and accepting fixed pay. Increasingly, they are choosing between drawing profit share, which the partnership may or may not generate, and accepting fixed pay that the practice has been handed the money to offer. The relative attractiveness of partnership now depends on what the practice actually earns above the reimbursement ceiling, and on whether the partner role carries enough non-financial reward, in autonomy, ownership and longevity, to compensate for the risk.

Partners need to think hard about this. If your succession plan assumes the next cohort of GPs will want partnership in the same way you did, the funding environment is now actively working against that assumption. The conversations you have with salaried colleagues, including the salaried colleagues funded by the new scheme, will matter more than usual. So will the way you describe the partnership opportunity, particularly its long-term financial arc, when you advertise.

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Cashflow, claims and the unglamorous reality

Two operational points are worth landing before any decision is made. First, the scheme pays in arrears. Claims for GP reimbursement are submitted after the spend has occurred, and practices carry the timing risk between paying the salary and receiving the reimbursement. For larger practices this is a manageable working capital question. For smaller practices, particularly those that already run a tight monthly position, it is a real constraint, and the scheme should not be assumed to be cash neutral from day one.

Second, practices with more than 3,500 patients per GP need to contact their ICB before drawing on the scheme. This is not a small administrative footnote. It introduces a discretionary check at exactly the point where the practices most stretched by demand might most want to use the funding, and the relationship with your ICB on this point is worth getting ahead of rather than discovering when you submit a claim.

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The shape of the next two years

If there is a single argument to take from all of this, it is that the new reimbursement scheme is not best understood as funding. It is best understood as policy. NHS England is using money to nudge practices towards a particular staffing model, salaried GP employment paid for centrally, against a backdrop of constrained partner numbers and a diminishing locum market. Practices that engage with the scheme on those terms, knowing what is being asked of them and what is being assumed about them, are more likely to make decisions they will not regret in 2028.

The most important thing to avoid is treating the scheme as the answer to a workforce problem. It is one possible response, with its own trade-offs, written with one eye on the next negotiation and one eye on the political weather. The practices and locums who do best out of the next two years will be the ones who read it that way, and plan accordingly.

The above article is intended for information purposes only and you should seek professional advice prior to acting on any of its contents.

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‍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.

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