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GP contract changes for 2024/25

NHS England wrote to all GP practices in England on 28 February, setting out the “final arrangements” for the upcoming financial year. In this blog, I review the proposals and give my thoughts on the offer.

The financial ‘highlights’ of the proposals are as follows:

  • 32 out of the 76 Quality and Outcomes Framework (QOF) indicators will be suspended (and the lost income protected).
  • QOF monthly aspiration payments will increase from 70% to 80%.
  • The Impact and Investment Fund (IIF) indicators will be reduced from five to two.
  • The Capacity and Access Support Payment (CASP) will increase, with funding being recycled from the retired IIF indicators. 70% of the funding will be paid to practices in 12 monthly instalments.
  • The remaining 30% will be paid to practices via the Capacity and Access Improvement Payment (CAIP). To improve cashflow it will now start to be paid once Primary Care Networks (PCNs) confirm that they meet the criteria for payment.
  • The Additional Roles Reimbursement Scheme (ARRS) will now include enhanced nurses (one per PCN, or two if the list size is over 100,000), and caps will be removed on all other direct patient care roles. Enhanced nurses are those holding a level seven or above postgraduate certification, or diploma in one or more specialist areas of care.
  • The mechanism which allows commissioners to redistribute unclaimed funding from the ARRS between PCNs will be removed from the DES.
  • The PCN Clinical Director & Leadership and Management Payment will be rolled into core PCN funding to give PCNs greater autonomy and allow the clinical directors to lead their PCN in the way best suited for their locality.
  • Consideration is being given to the future of recruitment and retention schemes. Perhaps this will mean the return of the New to Partnership scheme? We can but hope.
  • The Weight Management DES will continue, with practices receiving £11.50 per referral (no increase).
  • Any new digital telephone contract must be procured through the national framework and eight metrics are being introduced for 2024/25 that practices must report on, including call volumes, calls abandoned, call times to answer.
  • Core funding in the global sum is increasing by 2%. The suggested breakdown is 1.68% for inflation, and 0.38% for population growth.


The current iteration of the General Medical Services (GMS) contract is twenty years old on 31 March 2024 (how time flies). The five-year framework introduced on 1 April 2019, which saw the introduction of PCNs, also ends on this date. Whilst we all hoped to see a shiny new contract from 1 April 2024, with additional funding being made available for primary care, we instead see an imposed extension of the current contract for a further year.

The inflationary increase of 1.68% is a real kick in the teeth for those managing the front door of the NHS. 

The average practice list size is still to be confirmed, but any increase to this will see a practice with a list size not keeping pace, with the average being financially worse off. To demonstrate this, QOF in 2023/24 was £213.43 per point, increasing from £207.56 in the previous year. The increase equated to an uplift of 2.83%. The national average list size rose from 9,374 to 9,639, also equating to an uplift of 2.83%. Therefore, if your practice list size didn’t increase by at least 2.83%, your income would decrease.

There’s nothing in the letter from NHS England to suggest that other income sources, such as vaccination income, will be uplifted. The payment of £10.06 per vaccine has been in place since April 2020. 

Whilst the “final arrangements” come as no real surprise, we did hope that an inflation-beating increase would be applied to the contract for 2024/25. The reality is that the offer will see a further squeeze on practice profitability, and it’s therefore vitally important that practices always have a complete understanding of their finances.

The specialist medical accounting team at Larking Gowen are ready to assist practices with this, and look forward to working with you in 2024/25. To find out how we can help your practice, call 0330 024 0888 or email

Andrew Burwood


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Larking Gowen


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