2026: a new year with challenges in the world of primary care

As advisors, we need to be constantly aware of the changing dynamic, and I look below at some of the challenges we are currently seeing:

In many ways conspicuous by their absence in the 10-year plan but of course very much a part of the current primary care environment, but how will these evolve in 2026?
The direction as we well know is new neighbourhood contracts and working at a much larger scale.

PCNs are in a perfect position to win new neighbourhood contracts but they will need to take some preparatory action now to make sure they are at the right scale. Without this, they and member practices run the risk of losing some of their current funding streams.

Both PCNs and GP Federations are arguably the best choice to take on both single neighbourhood provider and multi neighbourhood provider contracts, respectively. These, we hope, they will be able to take on alongside the existing GMS, PMS and APMS contracts held mainly by practices.

In my opinion, practices will need both contract income streams, as there is a very real likelihood that much of the commissioning of current enhanced services will need to go through these neighbourhood contracts. Without maintaining enhanced service levels, GP practices will not be able to survive as these income streams form a significant amount of their core income per patient. We look towards a model where PCNs and GP Federations put themselves in a position to win these contracts and subcontract much of the work down to member practices.

A single PCN, in most instances, is not going to be large enough, so we need to look at the amalgamation of a group of PCNs into a much bigger entity, probably a corporate structure, to win such contracts and deal with the bulk of the administration and management issues, leaving practices, on a subcontract basis, to concentrate on the clinical operations side. PCNs would then, after management costs, share resources based largely on patient list size. This could leave some choice to practices perhaps preferring not to partake in all elements of the contract and others to capitalise on areas of strength across a wider population. The detail of the available contracts remains to be clarified but details should be with us very soon.

PCNs, not as yet entering into preparations in this way, should now do so at speed to take advantage of the opportunity that, without action, will prove to be a very real risk. There will of course be a variety of approaches applicable to differing areas and population types but a call to action, in whatever direction, is needed.

GP Federations will be better suited to the multi-neighbourhood contracts, leaving PCNs to deal with the single neighbourhood provider contracts. Without action, I think we run the risk of Foundation and Community Trusts taking these contracts, which, without doubt, will cause a loss of income to practices.

In terms of preparation, we need to be encouraging and joining these conversations, ensuring that structures are set up in the best way and that the skills are there within them to manage and operate, both financially and operationally. Smaller PCNs coming together will need support, with the accounting and financial management of what will become much larger organisations. We should also ensure that current PCN records and accounts are fully up to date and tidy, with decisions around deferred income and monies due to practices all fully resolved and transparent as of 31 March 2026, thus allowing the enlarging momentum to gain pace without legacy issues.

We will be looking at this huge area in webinars and at the annual conference, but there are two key pointers for current awareness:

• GP premises values continue to fall quite dramatically, in a number of instances. Large reductions in value have huge ramifications for partners’ property equity, partnership ability to borrow and the attraction of new property-owning partners. The key here is to encourage all clients to make sure that at any property transaction, even if no new borrowing is required, that the property valuation is up to date and fair and reasonable to all partners. It is of course imperative that specialist qualified surveyors are used in this regard, even though this comes at a cost. Without this, we run the risk of very real inequity for retiring and new property-owning partners. It is a very contentious area, leading to many partnership disputes, which will serve to be costly and destabilising to practices. Values are being affected by a number of issues, including market forces, surveyor approach to risk, areas such as restrictive covenants and the frequent loss of lease contracts, particularly in respect of the closure of onsite pharmacies.
• NHS grant terms need to be understood very carefully. There is, without doubt, a swing here in terms of the requirement for charges over GP premises in exchange for development grants. This is coupled with quite harsh terms in respect of the claiming of capital allowances on the non-funded part of any spend. It is important that we advise clients in respect of the ramifications of these terms so that they can make informed decisions, and so that lenders and clients together can look at the proposed position in advance of the grant funding being received and fully understand the interaction of first and second charges held over properties. Doubtless this will evolve, but please be very aware.

Not for partnerships at this stage, but don’t forget any single handers, as MTD will apply from 2026/27.

The former is still not received by all pension scheme members, and these will continue to arrive.

These should now be available and, if not yet received, clients should be requesting. They may not be available where a pension record is still not fully up to date, but clients, with our help, should be trying to resolve historic issues with PCSE and NHSBSA. For those clients where RPSS McCloud remedy work has been carried out, there should be no reason why the 2023/24 PSS should not be available, assuming the 2023/24 certificates are fully processed. The 2023/24 PSS enables us to finalise any changes that may be needed to 2023/24 tax returns and, if appropriate, Scheme Pays elections. Ideally this can be done prior to 31 January, when the amendment window remains open.

These should now be available for non-Type 1 performers, and most clients should have received these in time for the tax return preparation. Many of these are showing some negative growth and it is important to note that negative growth can be offset against positive growth in another scheme in year, but not to be carried forward if any negative excess remains.

Happy New Year! We shall see how 2026 evolves.