Over the past few years, general practice has been caught between rising demand, shrinking workforce numbers, and a constant stream of policy initiatives designed to “fix” the problem. The latest of these is the GP Reimbursement Scheme, introduced in May 2026 as part of the updated GP contract. On paper, it looks like a practical way to increase GP capacity. But it may raise as many questions as it answers.

Like many NHS workforce schemes, it seems well‑intentioned. But the detail reveals a set of practical drawbacks that practices must navigate carefully.

1. What the GP Reimbursement Scheme Is Supposed to Do

The scheme was created to help practices:

• recruit new salaried GPs
• retain existing GPs
• increase the hours of part‑time GPs
• stabilise practices that previously relied on PCN‑funded GP roles

Practices can claim reimbursement per session, up to a capped amount, for a GP who is:

• newly hired
• increasing their hours
• returning from a break
• previously funded through ARRS or PCN schemes

In theory, this should help practices expand clinical capacity at a time when demand continues to rise.

2. The Reality: Reimbursement Does not Cover the True Cost

This is the most significant issue. The reimbursement rate simply does not match the actual cost of employing a GP.

In many practices the actual cost of a salaried GP is around:

• £10,500 per session per year, plus pension, NI, indemnity, CPD time.

By contrast, the reimbursement scheme typically pays:

• £8,000–£9,000 per session per year.

That leaves a substantial shortfall of £1,500–£2,500 per session, or £12,000–£20,000 per year for a full‑time GP.

For smaller practices, this gap is simply too large to absorb. The scheme helps, but it does not make a GP “affordable” in real terms.

3. Short‑Term Funding, Long‑Term Commitments

The scheme is funded year by year, but GP employment contracts are not.

This creates a structural problem. Practices take on a permanent salary commitment, but the funding is temporary and subject to annual review.

For practices already operating on tight margins, this is a major risk. Many simply cannot commit to a long‑term cost based on short‑term funding.

4. Administrative Burden and Monitoring Requirements

As with many NHS schemes, the administrative load is heavy. Practices must:

• submit detailed claims
• provide evidence of hours worked
• complete monitoring returns
• undergo audits
• justify any changes in working patterns

For overstretched practice managers, this is yet another layer of bureaucracy. Some practices have already said privately that the admin outweighs the benefit.

5. The Risk of Clawback

If a GP leaves, reduces hours, moves to another practice, or goes on long‑term leave, then NHS England can claw back the funding.

This creates uncertainty and makes practices cautious. No practice wants to be left with a bill because a GP resigns or circumstances change.

6. How This Links to the ARRS GP Role

The GP Reimbursement Scheme is closely tied to the winding down of GP‑related roles under the Additional Roles Reimbursement Scheme (ARRS). Under ARRS, PCNs could employ certain types of GPs with 100% reimbursement, including salary and on‑costs.

When ARRS funding for GP roles began to taper off, practices were left with:

• GPs whose posts were fully funded by PCNs.
• no ongoing funding to keep them.
• no mechanism to transition them into substantive practice roles.

The new reimbursement scheme was introduced partly to absorb these GPs and prevent sudden job losses. But the reimbursement rate is significantly lower than ARRS, leaving practices to carry the financial burden.

In effect, the scheme shifts:

• fiscal responsibility from PCNs to practices
• employment risk from networks to individual partners
• long‑term liability onto organisations already under strain

It is a replacement for ARRS GP funding — but not a like‑for‑like one.

7. The Employment‑Law Problems No One Talks About

Alongside the financial pressures, the scheme creates a series of employment‑law risks that practices must manage carefully.

TUPE risk

If a GP was previously employed by a PCN or hosted under ARRS, TUPE may apply, meaning:

• their terms and conditions transfer automatically.
• continuous service carries over.
• the practice inherits liabilities, grievances, and disputes.

Sick pay, holiday entitlement, and training obligations

Once a GP becomes your employee, the practice must provide:

• statutory or NHS sick pay
• holiday entitlement based on continuous service.
• protected CPD time
• training and supervision

These obligations remain even if reimbursement stops.

Unfair dismissal risk

If funding ends, the practice must follow a full redundancy process. Failure risks an unfair dismissal claim.

Constructive dismissal risk

If the practice changes duties, hours, pay, or training time, the GP may argue fundamental breach of contract.

Redundancy rights — even after only 6 months

Redundancy rights apply from day one. Redundancy pay applies after two years. So, a GP employed for six months can still be made redundant — and can still challenge the fairness of the process.

Clawback vs employment rights

If NHS England withdraws funding because a GP reduces hours or takes maternity leave, the practice must still honour the contract.

Continuity of service complications

GPs moving from PCN roles may bring NHS continuous service, affecting maternity pay, sick pay, and notice periods.

Inherited ARRS expectations

ARRS roles often included protected development time and structured supervision. If the practice cannot replicate these, the GP may argue detrimental change.

In short:

The scheme shifts legal liability from PCNs to practices — without providing the stability needed to manage that risk safely.

8. Larger Practices Benefit More Than Smaller Ones

Bigger practices can absorb financial risk, manage the admin, and recruit more easily. But smaller practices — often the ones most in need — struggle to find GPs, take on risk, manage the paperwork, cover unfunded costs

This widens the gap between stable and struggling practices.

9. A Scheme That Helps — But Only Up to a Point

The GP Reimbursement Scheme is not a bad idea. It is simply not enough.

It provides some financial support, but not enough to transform recruitment. It offers flexibility, but not enough to offset the risks. It recognises the need for more GPs but does not address why so many are leaving.

Like many NHS workforce initiatives, it is a sticking plaster on a much deeper wound.

A Scheme That Needs More Than Good Intentions

From my own experience in general practice, I have seen how schemes like this land in the real world. They arrive with optimism, but the detail often reveals the same familiar pattern: short‑term funding, long‑term risk, and a failure to address the underlying pressures that drive GPs away.

The GP Reimbursement Scheme will help some practices, particularly larger ones with the capacity to manage the admin and absorb the financial gap. But for many, it will feel like yet another initiative that does not quite match the reality on the ground.

General practice does not need more schemes — it needs stability, manageable workload, and a workforce plan that recognises the complexity of modern primary care. Until that happens, even the best‑intentioned policies will struggle to deliver the change the NHS so urgently needs.

Selected References & Sources

• NHS England (2026). General Practice Contract Arrangements 2026/27. Guidance outlining the introduction of the GP Reimbursement Scheme and transitional arrangements following ARRS changes.

• NHS England (2025). Additional Roles Reimbursement Scheme (ARRS) Guidance. Details the scope, funding rules and 100% reimbursement model for PCN‑employed roles.

• GMC (2026). Workforce Report to the Health and Social Care Committee. Highlights GP burnout, workload pressures, and the “leaky bucket” effect of GPs leaving faster than they can be replaced.

• House of Commons Health and Social Care Committee (2025–2026). Evidence on General Practice Workforce Pressures. Includes testimony from the GMC, BMA and NHS England on retention, workload, and the limitations of existing schemes.

• BMA (2025). Salaried GP Handbook. Guidance on employment rights, redundancy, sick pay, TUPE, and contractual obligations.

• NHS Employers (2024–2026). Model GP Employment Contracts and Terms & Conditions. Covers continuous service, maternity rights, sick pay, CPD entitlement and contractual protections.

• ACAS (2024). Redundancy, TUPE, and Employment Rights Guidance. Clarifies redundancy rights, constructive dismissal, and employer obligations.

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