Additionality tanks are on the lawn. Is there money for extra GPs?
It’s a classic headline question to which the answer is ‘no’ 1 . Not just a ‘no’, it’s ‘cut your existing funding no’. There’s no surprise that trumpeted real terms rises aren’t quite what they seem but this also represents a stark policy shift. I do thank Andy Pow for noticing the sleight of hand.
If you manage GP or PCN finances you’ll need to read on to understand the new constraints on your budget. If you are staff in a PCN or GP practice but you’re not in ARRS, or you are not a GP, then look away now. Seriously, don’t read this.
NHSE’s letter from Dr Amanda Doyle 2 proudly states the budget is a 1.4% increase in real terms with the attention grabbing “new practice-level GP reimbursement scheme to enable practices to recruit new GPs or increase the number of sessions from GPs”.
That repurposed £292 million of funding is currently allocated to the Primary Care Network (PCN) Capacity and Access Payments (CAP). It’s 2.1% of the total £13,863m new GP contract, but bear in mind the new contract is a 1.4% increase in real terms. So NHSE are relying on that repurposing that £292m to get the budget to a real terms increase. But what if the £292m hasn’t been repurposed?
Let’s unpack the spin….
The first sleight of hand is that the £292m comes from abolishing the CAP part of the PCN contract. The rationale is that this will move money to GP Practices, hence it is extra. Currently PCNs get CAP payments for meeting various targets, then NHSE pay cash to the PCN, and then the PCN can pass the CAP cash to the practices. Sometimes practices choose to leave some of the CAP cash in the PCN pot for shared activities. The point is that the CAP cash already goes to practices.
The change in how the money is routed looks something like this:
| Current distribution (2026-27 values) | New distribution (2026-27 values) | ||
|---|---|---|---|
| GP Contract | £13,571m | £13,863m | GP contract increases by 2.2%, ie 1.4% real terms |
| CAP | £292m | – | |
| Total | £13,863m | £13,863m | Overall no difference |
| Total | £13,863m | £13,863m | Overall no difference |
This is the equivalent of Wes Streeting taking your dinner out of the oven, then ringing your doorbell and proudly announcing he’s giving you a free meal. It’s a bit silly but at least we still get our money, right?
It gets worse…..
The existing CAP funds are unrestricted so they become part of the general practice income to help pay the bills, employing doctors, employing people who are not doctors and all the other costs of a business.
The problem is that NHSE have added a condition that the new GP reimbursement funds can only be used for reimbursing extra GP sessions (the NHS jargon is “additionality”).
This means the £292m jumps into a different category and the funding distribution now looks like this:
| Current distribution (2026-27 values) | New distribution (2026-27 values) | ||
|---|---|---|---|
| GP Contract | £13,571m | ||
| CAP | £292m | – | |
| Funds for existing GP activities | £13,863m | £13,571m | Additionality reduces funding for existing services by 2.2%. |
| Extra GP Sessions | £292m | ||
| TOTAL | £13,863m | £13,863m | 0.0% change |
Yes, you read that correctly, changing how the cash is allocated results in 2.2% less cash to pay the existing staff and bills. So the headline 1.4% real terms increase is actually 0.8% cut in real terms for existing services.
This time Streeting has come to your house and taken your dinner from your oven but the food can now only be eaten by friends you invite to join your family. You can’t touch your own food. This has been portrayed as good thing.
So what happens next?
- CAP funding has come to an end so practices need to consider if/how they want their PCN to keep funding those shared activities. The combination of a reimbursement scheme and the additionality rule will prevent practices using internal transfers to balance the missing CAP funds with the extra GP money.
- Practices will need to balance their budgets for a 0.8% cut in real terms, let alone the greater than inflation rises for utilities and other costs.
- The additionality rules mean existing GPs are safe. ARRS staff are in a different funding pot, albeit a funding pot with its own set of problems.
- NHSE’s zeal for ringfence funding and reimbursement schemes means the burden to make savings will fall on non-doctor and non-ARRS staff.
- Also announced recently, the NHS Pay Review Board has recommended a 3.3% pay review for Agenda for Change staff that will cause other problems. 3
To draw this to a close, my overall thoughts are that this is a fairly stark move by DHSC to push additionality & reimbursement into the GP Contract. I’ve not seen any commentators or think tanks highlight the impact of the additionality reimbursement mechanism. The BMA GPC “cautiously welcomed … the creation of a £292m GP employment reimbursement scheme”. They might need to revisit that 4.
Additionality reimbursement was seen as a quirk of of the PCN ARRS scheme but now the additionality reimbursement tanks are parked on the GMS lawn.
- https://en.wikipedia.org/wiki/Betteridge%27s_law_of_headlines ↩︎
- https://www.england.nhs.uk/long-read/changes-to-the-gp-contract-in-2026-27/ ↩︎
- https://www.nhsemployers.org/news/nhs-prb-pay-award-announcement-2026 ↩︎
- https://www.bma.org.uk/news-and-opinion/gps-left-reeling-over-plans-for-same-day-urgent-care ↩︎