How Will Practices Fund GPs Previously Supported by CAIP?

How Will Practices Fund GPs Previously Supported by CAIP?

CAIP has not so much disappeared as moved house, but the new practice-level reimbursement scheme does not behave like the old payment. The cap, the additionality test, and the rule against funding locum cover mean practices that treat the change as a like-for-like substitute will find a gap where the money used to be.

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How Will Practices Fund GPs Previously Supported by CAIP?

The simplest way to describe what has happened to the Capacity and Access Improvement Payment is to say that it has not so much disappeared as moved house. The money is, broadly, still there. From April 2026, CAIP and its larger sibling CASP have been removed from the Network Contract DES, and the funds (around £292 million in total) have been repurposed into a new practice-level GP Reimbursement Scheme. On paper, the principle is uncontroversial. Money that previously flowed to PCNs to support access and improvement now flows to individual practices to recruit or retain GP capacity. Control returns to where most clinicians believe it should sit. The framing in the contract letter is, in effect, that this is a quiet correction to where the money lives.

In practice, the move is rather more involved than the framing suggests. The mechanics have changed in ways that will reward practices that plan carefully and penalise those that assume the new scheme is a like-for-like substitute. For practices that have already used CAIP funds to recruit a salaried GP, increase sessions, or shore up rotas, the question is now operational. How do you actually fund those posts going forward without leaving yourself exposed?

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The shift from improvement to reimbursement

The CAIP design rewarded PCNs for meeting access and improvement targets across patient experience, ease of access, demand management, and the accuracy of appointment book recording. It was, by design, a payment for hitting performance criteria. The new scheme is not a performance payment. It is a reimbursement scheme, and the distinction matters more than it first appears.

Under the new arrangement, practices claim back against actual costs of new salaried GPs or additional sessions provided by existing salaried GPs. NHS England reimburses the lower of actual cost or a capped maximum: around £152,900 per FTE salaried GP (£155,698 with London weighting), or £90.61 per additional hour (£92.27 in London). Funding is capped at £4.57 multiplied by adjusted practice population. The five access metrics that previously underpinned CAIP performance are now data-collection only, used to understand demand rather than to gate payment.

That sounds tidier than it is. Three things follow that practices should think about hard.

First, the cap on reimbursement is below what some salaried GPs already earn. In tight labour markets, especially outside London, practices that have agreed competitive packages to attract and retain experienced salaried GPs may find themselves reimbursed at less than the full cost. The difference falls on the partnership. In a market where salaried GP pay has had to move quite a long way upwards to compete with locum rates and ARRS roles, this gap is not hypothetical.

Second, the scheme cannot be used to cover an absent GP performer. That single sentence in the rules carries a lot of weight. Practices that have used CAIP and CASP flexibly to fund locum cover for sickness, maternity, parental leave, or sabbatical will not be able to do so under the reimbursement scheme. If part of how you stayed afloat last year was a portion of CAP money quietly underwriting locum bills, that route is now closed. Locum spend has to be funded elsewhere or designed out.

Third, the additionality principle bites in subtle ways. The scheme is intended to support genuine expansion or preservation of GP capacity, not the absorption of existing roles into a new funding line. For posts originally created with CAIP funding, transition into the new scheme is provided for, but practices need to be confident the post evidences additionality against their established baseline. What counted as "baseline" GP capacity in the year that has just ended is going to become a small but important administrative artefact.

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The locum question

The audience that ought to think hardest, and is sometimes least directly addressed in the formal guidance, is the locum constituency and the practices that rely on them. The reimbursement scheme is fundamentally a salaried GP scheme. Sessions delivered by self-employed locums sit outside it, except where those sessions are now being delivered by salaried GPs whose hours have been increased.

That has two consequences. For locums, the structural incentive in the system is again being nudged towards salaried employment. Practices with capped reimbursement and an inability to claim against locum invoices will look harder at whether the locum hours they have been buying could be converted into a salaried session pattern. For some locums, that is welcome. For others, particularly those who have built portfolio careers across multiple practices, it could erode the demand that has supported a flexible career. Practices that need locum cover for legitimate reasons will not stop using it, but the financial calculus has shifted.

For practice leaders, the implication is that the locum line in the management accounts needs to be examined separately and honestly. If locum cover is structural rather than incidental, the question is whether converting some of those hours into a salaried role recovers reimbursement that is now available, and whether the resulting predictability of cover is worth the change in working pattern. For some practices the answer will be yes. For others, where the locum population is genuinely covering peaks and troughs that a salaried role would not flex around, the honest answer is no, and that cost has to be carried elsewhere.

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Cash flow, modelling and the £47,000 myth

The £292 million divided across roughly 6,200 practices in England produces an arithmetic average of around £47,000 per practice. It is tempting to use that figure as a planning assumption. Almost no practice will receive exactly that. The cap is set against adjusted population, and the distribution of GP cost across the country is not uniform. A practice with a large list, a competitive labour market, and a salaried GP earning close to the cap is in a very different position from a smaller practice with a lower-cost workforce.

There is also the matter of timing. Reimbursement, by definition, follows expenditure. Practices need to fund the salary or session first, then claim. For practices already running tight on working capital, especially those that had become used to monthly CASP payments as part of their cash position, this represents a meaningful shift. A short modelling exercise should answer two questions before any new commitments are made. What is the maximum the practice can claim under the cap? And what is the gap between that claim and the actual cost of the GP capacity the practice intends to keep, including any on-cost differential between salaried and locum delivery?

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The ARRS lever sitting next to it

The ARRS expansion sits alongside this and should not be considered in isolation. The restriction that limited GP employment through ARRS to those within two years of CCT has been removed, and PCNs can now use ARRS funding to recruit GPs more broadly. For practices, that is a second route to GP capacity, with its own additionality rules and PCN-level decision making. Most practices will need to think about the two routes together rather than separately, because the choices they make in one affect what is sensible in the other. A practice that has already secured additional GP capacity through the reimbursement scheme may have less appetite or scope to push for ARRS-funded GP recruitment at PCN level, and vice versa. The two levers can be complementary, but only if they are actively coordinated rather than pulled in parallel by different people without reference to each other.

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A useful moment to be deliberate

A practical view of the change is this. The new scheme returns funding control to practices, which is a good thing in principle, but it does so through a mechanism that requires more financial discipline than the old PCN-routed payment ever did. PCNs took on a certain amount of administrative friction on behalf of their member practices. Some of that friction is now transferred back. Practices that respond by treating the new scheme as a passive replacement will probably find that what they assumed was £47,000 of secured funding is rather less, after the cap, the additionality test, and the inability to recover locum cover have been applied.

Practices that respond by actively modelling their workforce against the new rules, and that revisit the boundary between salaried, locum, and partner sessions with the new economics in mind, are more likely to come out ahead. The direction of travel in the contract is clear enough. It is intended to push general practice towards employed GP capacity at the practice level, and away from at-scale or flexible delivery. Whether one agrees with that direction or not, treating it seriously and modelling for it now is more useful than waiting for the first quarter's claims to make the gaps visible.

The transition from CAIP to the new scheme is not, in the end, primarily a funding question. It is a workforce planning question dressed up in a funding letter. The practices that answer it well will be those that recognise the change for what it is, and that build the new constraints into how they think about GP employment, locum reliance, and the structure of their working week.

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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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