The 2026/27 practice-level reimbursement scheme will land roughly £47,000 in the average practice’s budget for the year. At the maximum claimable hourly rate, that funds just under 10 hours of GP time per week. The number most partners’ meetings have not yet put on the whiteboard is the one that comes next: 10 GP hours per week is not, on its own, the answer to the same-day urgent access mandate the scheme is funding practices to meet.
The scheme funds clinical capacity. The contract obligation requires clinical capacity plus the access throughput to reach it. Those are two budget decisions, made together, funded separately. This post is about the second one.
What the Scheme Is, in Plain Terms
The 2026/27 GP contract repurposed £292 million from the PCN-level Capacity and Access Payment into a practice-level GP reimbursement scheme. The scheme is funded at £4.57 per adjusted patient, which against the Contractor Population Index of 10,295 produces an average claim of £47,048.15 per practice.
The funding is ring-fenced. It is available to practices to recruit additional GPs or fund additional sessions from existing GPs to support clinical same-day urgent access in general practice. The Capacity and Access Support Payment and Capacity and Access Improvement Payment that previously sat at PCN level have been removed from the Network Contract DES.
The mechanics: practices submit reimbursement claims via the CQRS Local system used by ICBs to administer claims and payments for primary care providers. Claims can be made from 1 April 2026 until 31 March 2027, and the funding will remain within the core GP contract recurrently beyond 2026/27. This is not a one-off. It is a structural reallocation.
Two rules from the SFE amendment that practice managers should hold in mind. Funding cannot be used to cover short-term sickness absence of GPs, on the basis that this cost is currently met by the employer. And funding does not cover locum work in the usual sense. The scheme is built around employment and contracted sessions, not flexible cover.
What the Money Actually Buys
The number that matters most for the budget conversation is not £47,000. It is the number of GP hours that £47,000 delivers.
The maximum hourly rate claimable under the scheme is £90.61 per hour, including on-costs and London weighting. At that maximum rate, £47,000 funds just under 10 hours per week of GP time across the year. Practices may struggle to recruit a salaried GP for less than 2.5 sessions per week.
Ten GP hours per week is meaningful capacity. It is roughly 2.5 four-hour sessions, which translates to a reasonable add to most practices’ clinical rota if the recruitment market allows for it. The maximum reimbursement ceiling increases from approximately £106,000 in 2025/26 to £152,900 nationally and £155,698 in London for 2026/27, which gives practices that are using the scheme to top up existing GP contracts a clear annual envelope.
But ten GP hours per week is not the same-day urgent access answer. It is one input into the same-day access answer. And the gap between those two statements is where most partners’ meetings end up, once the maths is on the whiteboard.
Before getting to where the gap sits, it is worth being precise about how the urgent access mandate actually behaves operationally, because the funding only makes sense in the context of the demand it has to meet.
What the Same-Day Mandate Actually Asks Of the Practice
The 2026/27 contract requires practices to provide a same-day response for all urgent patient requests. Practices may not ask patients to contact the practice at a later date. The clinical urgency determination remains with the practice.
For a 10,000-patient list, the inbound demand profile that has to be assessed for urgency on any given morning is a known number: 400 to 500 calls in the first two hours, with the routine and the urgent mixed together in the same queue. The work the contract is asking the practice to do is twofold. First, get every patient through the access gateway fast enough that the urgent ones are identified within the working day. Second, have the GP capacity available to respond to those urgent ones on the day.
The second part is what the £47,000 funds. The first part is not what it funds. And the first part is what determines whether the second part actually works.
A practice that adds 10 GP hours per week of clinical capacity but cannot triage its inbound demand fast enough has not solved the access mandate. The new GP sessions get filled with whatever reached the front of the queue, urgent or not, and the patients who never got through the access gateway are the ones the contract is designed to protect.
The Half-Problem Framing
The £47,000 buys half the answer. It buys GP capacity. It does not buy access throughput.
Access throughput is the capacity to get patients through the gateway: phone answering, triage, identification of urgent need, routing to the right clinical pathway, and either a same-day appointment or a clear safe alternative. The practice’s existing reception team and the practice’s existing telephony are the access throughput layer. The scheme does not fund anything that improves this layer.
This is the half of the problem that determines whether the new GP sessions actually deliver same-day access or whether they get absorbed by demand that would have got through any access pathway, urgent or not. Practices that have done the maths on this honestly are now making two budget decisions in parallel: one funded by the scheme (GP capacity), one funded from core contract uplift or operational budget (access infrastructure).
The two decisions are linked but they are not the same decision, and confusing them is how the same-day mandate ends up unmet despite the additional clinical capacity being in place.
The Honest Comparison: Three Ways to Spend the GP-Capacity Side
For the £47,000 side of the decision, there are three realistic deployment models that practices are choosing between in the partners’ meetings happening now.
Additional sessions from existing GPs. The scheme covers additional sessions from GPs already in the practice, and a partner or salaried GP can be reimbursed for up to 9 sessions per week. The advantage is that the practice knows what it is buying. The clinician knows the practice, the patients, the systems, and the protocols. There is no recruitment risk and the capacity goes live immediately. The constraint is whether the existing clinical team has the personal capacity to take on additional sessions sustainably, and whether the partnership is comfortable with the additional intra-practice income concentration that this creates.
Recruitment of an additional salaried GP. The scheme funds GP recruitment up to the maximum reimbursement ceiling. At £47,048 against the maximum hourly rate of £90.61, the funding supports just under 10 hours per week, and practices may struggle to recruit a salaried GP for less than 2.5 sessions per week. For practices below the 3,000-patient-per-GP ratio, recruitment is the route that builds long-term clinical capacity into the practice. For practices over the 3,500 threshold, ICB engagement is required before the recruitment can proceed under the scheme.
Topping up an ARRS-funded GP through the new pathway. The ARRS rules have been amended to allow PCNs to recruit a broader range of GPs, with the maximum reimbursement increased to reflect that recruited GPs will not only be those who have recently qualified. Some practices are using ARRS for the foundation GP role and the practice-level scheme for additional sessions, which gives a combined funding pathway across both budgets. This requires PCN coordination but maximises the total capacity per pound.
Each route ends with the same outcome on the GP-capacity side: roughly 10 hours per week of additional GP time, funded sustainably from 2026/27 onwards, available to absorb same-day urgent demand.
What none of these routes does is improve how patients get through the access gateway to those 10 GP hours.
The Parallel Decision: What Funds the Access Pathway
The access pathway question is the budget decision practices are making alongside the CAP question, from a different funding source. It is not within scope of the scheme, but it determines whether the scheme delivers the access outcome the contract is asking for.
The honest list of what the access pathway requires, in operational terms, is short. Inbound calls answered fast enough that urgent presentations are identified within the working day. Triage that distinguishes urgent from routine consistently and safely. Routing that delivers urgent demand into the available GP slots without losing it in the queue. Reception team capacity that is not entirely consumed by the 8am surge, so that the urgent cases the triage layer identifies actually reach the GP rota.
Practices currently absorb this pathway work with fixed reception headcount, existing telephony, and whatever digital triage tools the practice has deployed. The constraint is that the access pathway competes with everything else the reception team does for the same fixed hours: prescription processing, care navigation, document handling, outbound patient contact, and the front-desk presence the building requires.
The infrastructure decisions practices are making to address the access pathway side fall into three categories.
Online triage and digital front door. Tools that move a subset of patients off the phone channel and into a structured digital request. Effective for the digitally confident segment of the list. Not effective for the patients without smartphones or digital confidence, who remain on the phone channel and continue to call.
Reception team expansion. Adding receptionist headcount. This is the historically default answer to the access pathway problem and remains an option, but it is funded from core contract uplift, not from the scheme. The 2026/27 contract delivers 3.6% cash growth or 1.4% real-terms growth, which constrains how much additional reception headcount is realistic against everything else the core budget has to fund.
AI voice as concurrent reception capacity. Voice-based AI that answers the phone alongside the existing reception team, absorbs the routine call volume, and routes complex or sensitive calls back to the team with full context. The reception team remains in place and continues to handle the work that benefits from a human. The AI removes the routine volume that was bottlenecking the queue and consuming the morning. The result is access throughput that is not gated by the reception team’s queue capacity.
The Auxilis deployment at Park Street Surgery in Liverpool gives a live reference point on this third option. Over the first eight weeks: 1,200 calls handled, 81% of inbound demand absorbed by the AI layer, 91.1% completion rate, zero missed safety indicators, 51 hours of reception time recovered and redirected to the rest of the team’s work. The Greensand Surgery rollout is showing the same operational pattern: 816 calls handled and 26 hours of reception time saved in the early weeks.
The point in this post is not which of the three infrastructure options a practice chooses. The point is that one of them has to be chosen, and the budget for it sits outside the scheme.
The Combined Picture
The same-day access mandate is met when the GP-capacity decision and the access-pathway decision both produce capacity that aligns with the contract obligation.
The GP-capacity decision is funded by the £47,000. The honest output is roughly 10 GP hours per week, structured as additional sessions or recruitment. This sits inside the scheme.
The access-pathway decision is funded from core contract uplift, operational budget, or in some cases by reducing other spend categories. The output is access throughput: the capacity to identify urgent demand and route it cleanly into the available GP capacity, without losing patients in the queue or absorbing all the urgent presentations into routine reception workload.
Practices that are treating these as one decision are at risk of underfunding either side. Practices treating them as two parallel decisions, made together but funded separately, are the ones likely to deliver on the access mandate in operational terms.
The framework most useful for the partners’ meeting is the following.
What is the practice’s current GP-hour shortfall against same-day urgent demand. The scheme answers this side, up to roughly 10 hours per week.
What is the practice’s current access throughput bottleneck. Is it phone answering capacity at the 8am surge. Is it triage routing accuracy. Is it reception team capacity being consumed by routine call volume. This question is answered from a different budget, and the answer determines whether the new GP hours funded by the scheme actually deliver same-day access or get absorbed by demand that would have been seen anyway.
Both questions need an answer for the access mandate to be met. The scheme funds one of them.
If you want to understand what the access-pathway side looks like operationally before making the parallel budget decision, the Auxilis team runs 20-minute demos using real call recordings from the Park Street and Greensand deployments. The four-week pilot is free, runs on existing telephony, and produces live data from the practice’s own patient list to support the budget conversation.
Book a demo at auxilis.ai
Frequently Asked Questions
What exactly does the 2026/27 practice-level reimbursement scheme fund?
The scheme funds GP recruitment or additional sessions from existing GPs to support clinically urgent same-day access. Funding is £4.57 per adjusted patient, producing an average claim of approximately £47,000 per practice. It cannot be used for short-term sickness cover or locum work in the usual sense, and it cannot be used for non-clinical roles, access infrastructure, or digital tools.
How many GP hours does £47,000 actually fund?
At the maximum claimable hourly rate of £90.61, including on-costs and London weighting, £47,000 funds just under 10 hours per week of GP time across the year. That is approximately 2.5 four-hour sessions, which is meaningful additional capacity but is not, on its own, the answer to the same-day access mandate.
Can the scheme money be used to fund AI voice technology or reception team expansion?
No. The scheme is ring-fenced to GP recruitment or additional sessions from existing GPs. Reception team capacity, digital triage tools, AI voice technology, and access infrastructure investments must be funded from core contract uplift or other operational budget. This is the parallel budget decision practices are making alongside the scheme spend.
What is the access pathway problem the scheme does not solve?
The contract requires practices to provide a same-day response to all urgent patient requests. The scheme funds the clinical capacity to respond. It does not fund the access throughput required to identify which inbound presentations are urgent and route them cleanly to the available GP capacity. For most practices, the access pathway bottleneck is the 8am call surge consuming the reception team’s morning, which is a different problem from the GP-capacity shortfall.
How does AI voice support the reception team rather than replace it?
The deployment model that has produced the strongest live results positions AI voice as concurrent capacity on the phone channel, sitting alongside the existing reception team. The reception team continues to handle complex, sensitive, and relationship-based calls. The AI absorbs the routine volume that was bottlenecking the queue. At Park Street Surgery, the reception team remained fully employed throughout the deployment, and the 51 hours of recovered time was redirected to prescription processing, care navigation, and outbound patient contact.
What happens to practices over the 3,500 patient-to-GP ratio threshold?
Practices with a high patient-to-GP ratio (more than 3,000 to 3,500 depending on local interpretation) need to engage with their ICB before accessing the scheme. The ICB conversation is about justifying the ratio and confirming the recruitment plan. PCN finance leads can usefully identify which practices in their network are over the threshold and prompt the ICB conversation early, so it runs alongside the claim rather than delaying it.
When does the funding window run and is the scheme recurrent?
Claims can be made from 1 April 2026 until 31 March 2027. The funding remains within the core GP contract recurrently beyond 2026/27, which means this is a structural reallocation rather than a one-off payment. Practices building their budget on the scheme can plan on the funding continuing in subsequent years, subject to future contract negotiations.
What is the single most useful question for the partners’ meeting?
What is the practice’s current access pathway bottleneck, and does adding 10 GP hours per week of clinical capacity actually clear it. If the bottleneck is GP capacity, the scheme is the answer. If the bottleneck is access throughput (phone answering, triage routing, reception team capacity), the scheme funds half the answer and the other half has to come from somewhere else. The partners’ meeting that names both decisions explicitly is the one that produces an operational plan, not just a recruitment plan.