Following the release of details of the 2026/2027 GP Contract, one recently-retired practice manager correspondent gives their views and feelings on this latest contract and its measures - some well-publicised and others less so.

The opinions and statements in this article are those of the independent author and do not represent the opinions of FPM Group

The 2026/27 GP contract, taking effect from 1 April 2026, marks the second consecutive year of unilateral imposition by NHS England. It offers a modest financial uplift but introduces significant operational expectations that will reshape day‑to‑day general practice.

As ever, the headlines look simple, but the real story is buried in the detail. And this year, several clauses have been slipped in with minimal fanfare, each one tightening oversight, increasing data extraction, and blurring the boundaries between practices and commissioners.

For many this will seem like a contract that gives with one hand, takes with the other, and quietly expands oversight.

A New Requirement: Mandatory Sharing of Staff Details with the ICB

One of the most striking — and barely mentioned — additions is a requirement for practices to mandatorily provide the ICB with the names and contact details of all staff for surveys, engagement exercises, and workforce planning.

On paper, this sounds harmless. It represents a significant shift in the relationship between practices and commissioners.

What practices must now provide

• Full names of all staff
• Job roles
• Contact numbers or emails
• Updates every time someone joins or leaves

This applies to every role — clinical, administrative, managerial, and support.

Why this matters

This is not a routine administrative request. It is a new level of visibility and potential influence over:

• Staffing levels
• Skill mix
• Roles and responsibilities
• Perceived “gaps”

The NHS/ICBs are not the employer. They have no HR responsibility, no contractual relationship with staff, and no legal basis to shape internal staffing structures. Yet this requirement gives them the data to do exactly that.

This “big brother” approach has been attempted before — by PCTs, CCGs, and now ICBs. Each time, the justification is “workforce planning.” But the reality is:

• It invites interference
• It creates assumptions
• It increases administrative burden
• It raises data‑protection concerns
• It feels like data collection for future contractual leverage

Staff will rightly ask why a commissioner needs their personal contact details. The contract seems to offer no clear safeguards.

This clause gives ICBs unprecedented visibility into practice staffing — seemingly without justification, without safeguards, and without acknowledging that practices, not ICBs, are the employers.

Other Hidden or Under‑Discussed Changes

Several other clauses have been quietly inserted or reframed. They deserve attention because they may collectively increase oversight and reduce autonomy.

1. ICBs gain new powers to “review” practice capacity and workforce models

The contract states that ICBs will use new access and demand data to:

• “identify practices requiring support”
• “understand workforce deployment”
• “ensure capacity aligns with demand”

This sounds supportive, but in practice it gives ICBs a mandate to scrutinise:

• GP session numbers
• Skill mix
• Appointment models
• Staffing ratios

This is a significant expansion of commissioner oversight, seemingly introduced without discussion.

2. Accountability for access, shifts from PCNs to individual practices

Previously, PCNs carried responsibility for access improvement plans.

Now, individual practices are accountable for:

• same‑day urgent care
• access data
• demand management
• patient experience

This exposes practices to direct performance management, without the buffer of the PCN structure.

3. Digital control quietly centralised

The contract includes a sleeper clause requiring practices to use digital tools “as specified by NHS England.”

This gives NHS England the power to mandate:

• specific telephony systems
• specific online consultation platforms
• specific data‑sharing tools
• specific reporting dashboards

This is a quiet but powerful centralisation of digital control.

4. New “data quality” obligations

To support the new data extraction, practices must ensure:

• accurate coding
• consistent triage categorisation
• standardised appointment types
• clean appointment books
• correct mapping of online requests

This could be a major administrative burden, introduced without funding and seems to assume that “one hat fits all.”

5. “Support” language that means intervention

The contract repeatedly says ICBs will “support” practices struggling with access.

In NHS England language, “support” often means:

• mandatory improvement plans
• regular monitoring meetings
• external reviews
• performance oversight

In my view this is performance management by another name.

6. Financial Uplift: 3.6% headline, 1.4% real‑terms

NHS England has confirmed a £485 million uplift — a 3.6% cash increase, translating to 1.4% real‑terms growth.

This includes an assumed 2.5% staff pay rise. Minimum wage has risen by 4.1%, yet the contract only funds 2.5%.

For practices with reception and admin teams on minimum wage, this is another unfunded cost.

7. End of the PCN Capacity and Access Payment (CAP)

CAP — a £292m performance‑based PCN payment — is abolished.

The money is redistributed to practices.

New scheme:

• Average £47,000 per practice
• Can fund GP sessions or recruitment
• Practices with high GP‑to‑patient ratios must apply via ICB

Many would say this is welcome in principle — but £47k does not stretch far. It will not transform access.

8.  Same‑Day Urgent Care Requirement

Practices must provide a same‑day response to all clinically urgent requests. Patients cannot be asked to call back another day.

Patients will love this — because everything feels urgent when you are unwell.

But where is the extra capacity coming from? This risks undermining triage and inflating expectations.

9 Advice & Guidance (A&G) Becomes Core

A&G is now mandatory before or instead of referral.

A&G:

• increases workload
• shifts responsibility
• can delay care
• can confuse patients
• requires meticulous documentation

Useful in theory, but in my experience - burdensome in practice.

10. QOF Changes

Eighteen new points, with new indicators for:

• childhood vaccinations
• diabetes
• obesity
• heart failure

The Obesity Enhanced Service is retired. Positive direction — but small compared to wider pressures.

11.  ARRS Flexibility

PCNs can now hire experienced GPs under ARRS. More flexibility, but risks competition for a limited GP workforce.

12. PCN DES Clarifications

Tightened expectations around:

• vaccinations
• cancer screening
• continuity
• neighbourhood geography

13. Pharmacy Integration

More signposting to pharmacy expected.

Some pharmacies say the funding does not cover their workload. If pharmacy capacity falters, practices will have to absorb the fallout.

14.   Data Collection & Demand Monitoring

NHS England will extract detailed access and demand data from every practice.

This increases scrutiny, invites comparisons, and may drive future contract levers.

It also adds indirect workload through coding and data‑quality requirements.

What This May Mean for Practice Managers

The contract is a blend of modest financial relief and significant operational tightening.

The ‘hidden’ clauses — especially around staffing data, digital control, and workforce oversight — represent a quiet but meaningful shift in power.

Practices will need to:

• strengthen triage
• prepare for increased scrutiny
• ensure data accuracy
• manage patient expectations
• protect staff from unnecessary commissioner intrusion

Once again, practices are expected to deliver more with less — and with less autonomy than before.

References

1. NHS England – GP Contract 2026/27 documentation (24 Feb 2026)
2. NHS Confederation – “Summary of the 2026/27 GP Contract” (24 Feb 2026)
3. Pulse Today – Coverage of contract uplift, CAP changes, same‑day care, QOF updates (24–25 Feb 2026)
4. Health Service Journal (HSJ) – Reporting on ARRS changes and contract implications
5. NHS England – PCN DES 2026/27 updates