The following table sets out the revenue spend categories for the specified services commissioned by NHS England and clinical commissioning groups, now integrated care boards, using audited figures between 2015/16 to 2024/25:

Notes:

1. delegated specialised commissioning has been included within the specialised commissioning line as well as directly commissioned spec comm to remain consistent with previous years; and
2. prescribing and delegated pharmacy/ophthalmology/primary and secondary dental all sit within the ‘other’ category.

Information for 2025/26 is unvalidated and not quality assured. In-year data is not routinely reported on with the breakdown of spend used for this answer and would be subject to material change between plan and outturn as a result.

75% of NHS England commissioned social services are within the community services line.

The GP Contract requires all practices to enable patients to telephone or visit their practice in person to make appointments. Online tools must always be provided in addition to, rather than as a replacement for, other channels for accessing a general practitioner, and practice receptions should be open so that patients without access to telephone or online services are in no way disadvantaged.

To support patients who depend on telephone bookings, recent contractual changes require all general practices to offer online booking throughout core hours, from 8:00am to 6:30pm. This is designed to ease pressure on phone lines by allowing those who prefer online booking to do so at any time, freeing up phone lines, reducing long phone queues, and improving the experience for those reliant on telephone bookings.

We recognise that the uneven distribution of general practitioners (GPs) is a longstanding, generational challenge which successive administrations have sought to overcome. As we consider future interventions we are looking carefully at lessons from previous approaches, such as Medical Practices Committees, whilst taking account of the current workforce position and contracting landscape within General Practice.

We acknowledge the urgent challenge of ensuring practices facing particular workforce pressures have the resources to continue serving their patients. To address this, we are taking steps to increase capacity in GPs and ensure every practice has the necessary workforce to provide integrated, patient-centred services.

Following stakeholder feedback from the 2026/27 GP Contract consultation, we have introduced a practice-level GP reimbursement scheme using £292 million of repurposed funding from the current Capacity and Access Payment. This funding is available to practices to hire additional GPs or to fund additional sessions with existing GPs to improve access in practices. This aims to strengthen capacity, access, and improve patient satisfaction.

We have also increased flexibility of the Additional Roles Reimbursement Scheme (ARRS) by removing the restriction that ARRS funding can only be used for recently qualified GPs, increasing the maximum reimbursement amount for GP roles to reflect experience, and enabling primary care networks to recruit a broader range of ARRS roles, where agreed with the commissioner.

We recognise the importance of ensuring funding for core GP services is distributed fairly between practices across the country and we know that the current distribution formula is considered outdated. The first phase of a review of the Carr-Hill formula concluded in May and the recommendations are with the Department for consideration.

We are grateful to Parliament for their scrutiny of the Health Bill and look forward to debating any amendments in due course.

General practices (GPs) are independent business that hold contracts with the National Health Service to perform essential services to the public. We require practices to provide online consultation tools. From 1 October 2025, GPs have been required to offer access to online services throughout core hours, 8:00am to 18:30pm, bringing online access in line with walk-in and phone access. This change aims to improve patient access, reduce long phone queues, and help GPs manage demand more effectively.

NHS England collects data on GP appointments, online consultation submissions, and cloud-based telephony. This data shows that 99% of practices have reported having an online consultation system in place. Where a practice does not comply with these contractual requirements, it may be in breach of contract. Patients who have concerns should contact their practice in the first instance, or raise the matter with their local integrated care board.

We welcome the findings from the Royal College of General Practitioners’ report, Tackling the GP workload crisis. Many of the recommendations align closely with our ongoing commitment to fixing the front door of the National Health Service by cutting red tape and ensuring general practitioners (GPs) can spend more time treating patients.

The 10-Year Health Plan sets out our commitment to delivering the recommendations of the Red Tape Challenge, including making improvements at the interface between primary and secondary care. These recommendations also highlight our ambition to improve customer service and experience through better patient communication, support, and navigation, as well as strengthening underpinning infrastructure.

The report also mentions simplifying incentives such as the Quality Outcomes Framework (QOF), which, for the 2025/26 GP Contract year, was streamlined significantly, with 32 out of the 76 indicators retired to reduce administrative burden for practices. For the 2026/27 GP Contract year, QOF remains streamlined, with 43 indicators.

We are continuing to work across the Government to better understand where additional burdens are being placed on GPs and, where possible, to remove unnecessary requirements and improve ways of working.

The purpose of the elective Single Point of Access (SPoA) is to ensure patients and practices receive rapid specialist assessment and a clear next step, using modern referral and triage approaches. This is not about using specialist advice as a way to reject or refuse referrals from general practice (GP). It is important to emphasise that the clinical threshold for a referral remains unchanged.

GPs, and other primary care referrers, remain professionally accountable for making appropriate clinical decisions. The use of SPoA and specialist advice requests does not override those responsibilities or place GPs in conflict between contractual and professional obligations. SPoA does not change the clinical threshold for referral to specialist care, and GPs should continue to make a clinical decision to refer for specialist care where that is in the patient’s best interests, and to request specialist advice where it is needed. NHS England continues to support clinicians through guidance, pathway design, and local governance arrangements to ensure these arrangements are used safely, proportionately, and in a way that preserves clear clinical accountability.

While advice is being sought or acted on in primary care, the GP remains responsible for the patient’s overall clinical care and risk. The specialist is responsible for the quality and appropriateness of the advice they give, not for ongoing management or follow‑up unless they formally assume responsibility for the patient’s care. Specialists also have clinical responsibility from the point at which a specialist advice request is converted into a referral or if the specialist initiates investigations or treatment directly.

Under this model, requests for specialist advice and referrals are clinically reviewed by a named consultant, with the aim of ensuring patients are directed to the most suitable pathway. Where a local model is already established, or has been agreed between primary and secondary care, that provides timely specialist clinical assessment with clear accountability, this may continue with oversight from a named consultant.

NHS England has published technical guidance to secondary care providers and integrated care boards (ICBs) regarding the SPoA model. This sets out governance, quality assurance, and clinical oversight requirements for SPoA. Existing local processes and structures for quality assurance, performance management, and clinical governance remain in place, for instance through National Health Service trusts and ICBs, including specialty-level clinical leadership and senior oversight to ensure this change is implemented safely and appropriately, and that patients who require specialist assessment are referred without delay.

We are expanding the recruitment of general practice (GP) doctors to improve access to appointments. Since October 2024, we have funded primary care networks (PCNs) with an additional £160 million to recruit recently qualified GPs through the Additional Roles Reimbursement Scheme, preventing over 3,700 GPs graduating into unemployment.

Changes to the 2026/27 GP Contract have removed restrictions so that PCNs can hire more GPs. We introduced a practice level GP reimbursement scheme, worth £292 million, which enables practices to hire additional GPs or fund extra GP sessions with existing GPs. This is intended to help improve access, boost capacity, support GP employment, and continue to improve patient satisfaction. In July 2024, there were 27,735 fully qualified full time equivalent GPs and as of April 2026 there are 30,095, an extra 2,000 GPs. This is the highest number since 2015. This is separate to the passage of the bill.

We are aware that workforce shortages can be greater in some, often deprived, areas. We recognise the importance of ensuring that funding for core GP services is distributed fairly between practices across the country, and we know that the current distribution formula is considered outdated. The first phase of a review of the Carr-Hill formula concluded in May and the recommendations are with the Department for consideration.

The purpose of Advice and Guidance and an elective Single Point of Access is to ensure patients and practices receive rapid specialist assessment and a clear next step, using modern referral and triage approaches. It is important to emphasise that the clinical threshold for a referral remains unchanged.

Where there is clear clinical evidence, the intention is to avoid adding patients to outpatient waiting lists when they can receive timely diagnosis, advice, or management in a more appropriate setting. General practitioners (GPs) should continue to make a clinical decision to refer for specialist care where that is in the patient’s best interests, and to request specialist advice where that is needed. GPs retain responsibility for referral decisions, and this model supports and does not replace or override clinical judgement.

GPs, and other primary care referrers, remain professionally and legally accountable for their clinical decisions, including referring patients to specialist care where this is in the patient’s best interests. Requests for referral or specialist advice will receive a response from a named consultant with clear accountability and oversight.

The 2026/27 GP Contract embeds the previous Advice and Guidance enhanced service funding into core practice funding. Following near universal uptake of the Advice and Guidance Enhanced Service in 2025/26, the focus for 2026/27 is on stability and simplicity. Embedding the specialist advice model within the core contract recognises its role in routine clinical practice, removes annual signups, and provides more predictable funding while supporting consistent patient pathways.

The Government is committed to publishing a 10 Year Workforce Plan to set out action to create a workforce ready to deliver the transformed service set out in the 10-Year Health Plan. The 10 Year Workforce Plan will ensure the National Health Service has the right people in the right places, with the right skills to care for patients, when they need it. This workforce plan will set out how we will deliver that change by making sure that staff are better treated, have better training, more fulfilling roles, and hope for the future.

We are investing £485 million in general practices (GPs) in 2026/27, bringing the total spend on the GP Contract to over £13.8 billion. This builds on the £1.1 billion boost in investment in 2025/26. As part of the 26/27 GP Contract, we are increasing flexibility of the Additional Roles Reimbursement Scheme (ARRS) by removing the restriction that ARRS funding can only be used for recently qualified GPs, increasing the maximum reimbursement amount for GP roles to reflect experience, and enabling primary care networks to recruit a broader range of ARRS roles, where agreed with the commissioner.

Following feedback from the 2026/27 GP Contract consultation, we are introducing a practice-level GP reimbursement scheme which ring-fences and repurposes £292 million of funding from the current Capacity and Access Payment. This funding will be available to practices to hire additional GPs or fund additional sessions with existing GPs to improve access in practices. This aims to strengthen capacity, access, and improve patient satisfaction, whilst also addressing GP unemployment and underemployment.

We know that the way core GP funding is allocated across England is considered outdated and we recognise the importance of ensuring funding for core services is distributed equitably between practices across the country. This is why we are currently reviewing the GP funding formula, the Carr-Hill formula, to ensure that resources are targeted where they are most needed.

The first phase of the review is expected to conclude in March 2026. Subject to ministerial decision, further work would be undertaken to technically develop and model any proposed changes to the formula. Findings from the review will be published in due course by the National Institute for Health and Care Research.

The proposal has been received and Government officials will assess it in the normal manner.