{"id":24,"date":"2026-02-26T19:27:28","date_gmt":"2026-02-26T19:27:28","guid":{"rendered":"https:\/\/richardhennessy.co.uk\/?p=24"},"modified":"2026-02-26T19:36:55","modified_gmt":"2026-02-26T19:36:55","slug":"additionality-tanks-are-on-the-lawn-is-there-really-money-for-extra-gps","status":"publish","type":"post","link":"https:\/\/richardhennessy.co.uk\/?p=24","title":{"rendered":"Additionality tanks are on the lawn. Is there money for extra GPs?"},"content":{"rendered":"\n

It\u2019s a classic headline question to which the answer is ‘no’ 1<\/a><\/sup> .\u00a0 Not just a \u2018no<\/em>\u2019, it\u2019s \u2018cut your existing funding no<\/em>\u2019. \u00a0\u00a0There’s no surprise that trumpeted real terms rises aren\u2019t quite what they seem but this also represents a stark policy shift. \u00a0I do thank Andy Pow for noticing the sleight of hand.<\/p>\n\n\n\n

If you manage GP or PCN finances you\u2019ll need to read on to understand the new constraints on your budget.\u00a0 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\u2019t read this.<\/p>\n\n\n\n

NHSE\u2019s letter from Dr Amanda Doyle 2<\/a><\/sup> proudly states the budget is a 1.4% increase in real terms with the attention grabbing \u201cnew practice-level GP reimbursement scheme to enable practices to recruit new GPs or increase the number of sessions from GPs\u201d<\/em>.<\/p>\n\n\n\n

That repurposed \u00a3292 million of funding is currently allocated to the Primary Care Network (PCN) Capacity and Access Payments (CAP). \u00a0It\u2019s 2.1% of the total \u00a313,863m new GP contract, but bear in mind the new contract is a 1.4% increase in real terms.\u00a0 So NHSE are relying on that repurposing that \u00a3292m to get the budget to a real terms increase. But what if the \u00a3292m hasn’t been repurposed?
<\/p>\n\n\n\n

Let\u2019s unpack the spin\u2026.<\/p>\n\n\n\n

The first sleight of hand is that the \u00a3292m comes from abolishing the CAP part of the PCN contract. \u00a0The 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.\u00a0 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. <\/p>\n\n\n\n

The change in how the money is routed looks something like this:<\/p>\n\n\n\n

<\/th>Current distribution
(2026-27 values)<\/th>		New distribution
(2026-27 values)<\/th>		<\/th><\/tr><\/thead>
GP Contract<\/strong><\/td>\u00a313,571m<\/td>\u00a313,863m<\/td>GP contract increases by 2.2%,
ie 1.4% real terms<\/td><\/tr>
CAP<\/strong><\/td>\u00a3292m<\/td>–<\/td> <\/td><\/tr>
Total<\/strong><\/td>\u00a313,863m<\/td>\u00a313,863m<\/td>Overall no difference<\/td><\/tr><\/tbody>
Total<\/strong><\/td>\u00a313,863m<\/td>\u00a313,863m<\/td>Overall no difference<\/td><\/tr><\/tfoot><\/table><\/figure>\n\n\n\n

<\/p>\n\n\n\n

This is the equivalent of Wes Streeting taking your dinner out of the oven, then ringing your doorbell and proudly announcing he\u2019s giving you a free meal. It’s a bit silly but at least we still get our money, right? <\/p>\n\n\n\n

It gets worse\u2026..<\/p>\n\n\n\n

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.<\/p>\n\n\n\n

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 \u201cadditionality\u201d).\u00a0\u00a0\u00a0<\/p>\n\n\n\n

This means the \u00a3292m jumps into a different category and the funding distribution now looks like this:<\/p>\n\n\n\n

<\/th>Current distribution
(2026-27 values)<\/th>		New distribution
(2026-27 values)<\/th>		<\/th><\/tr><\/thead>
GP Contract<\/td>\u00a313,571m<\/td><\/td> <\/td><\/tr>
CAP<\/td>\u00a3292m<\/td>–<\/td> <\/td><\/tr><\/tbody>
Funds for existing GP activities<\/strong><\/td>\u00a313,863m<\/strong><\/td>\u00a313,571m<\/strong><\/td>Additionality reduces funding for existing services by 2.2%.<\/strong><\/td><\/tr><\/tfoot><\/table><\/figure>\n\n\n\n
Extra GP Sessions<\/td> <\/td>\u00a3292m<\/td> <\/td><\/tr><\/tbody>
TOTAL<\/td>\u00a313,863m<\/td>\u00a313,863m<\/td>0.0% change<\/td><\/tr><\/tfoot><\/table><\/figure>\n\n\n\n

<\/p>\n\n\n\n

Yes, you read that correctly, changing how the cash is allocated results in 2.2% less cash to pay the existing staff and bills.\u00a0 So the headline 1.4% real terms increase is actually 0.8% cut in real terms for existing services.<\/p>\n\n\n\n

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. <\/p>\n\n\n\n

So what happens next?<\/p>\n\n\n\n