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BIRMINGHAM — Primary care practices could boost income by reviewing list sizes and performance on key indicators, according to experts at The Primary Care Show 2025.

Speaking at the event, Katy Drew, a chartered accountant and head of primary care development at specialist medical accountancy firm Sandison Easson, and Claire Houston, a primary care management consultant for Practice Index, explained the impact of funding changes in the 2025-2026 General Practice (GP) contract. 

They also offered strategies to practice managers for maximising income.

Understanding the Global Sum

Drew explained that the General Medical Services Statement of Financial Entitlements details the various ways that primary care practices receive funding. Key components include the global sum Quality and Outcomes Framework (QOF) targets, provision of direct enhanced services (DES), and reimbursements for services such as vaccinations. 

Drew, a former practice and business manager, said: “If you want to maximise your global sum, you need to be looking at your list size.” However, she cautioned those new to practice management finance that they could not simply multiply the number of patients on their list by the sum allocated per patient (£121.79 for 2025-2026). 

This is because the money needs to be weighted according to the global sum allocation formula, also known as the Car-Hill formula. This takes into account factors such as the age and sex of the patient population; any additional needs relating to morbidity or mortality, such as the presence of a chronic condition requiring regular care; the number of patients being added to or removed from the list (i.e., list turnover); the nursing and residential homes index (NARHI); and unavoidable costs of running the practice, such as market forces and the rurality index. 

While fixed factors such as patients’ age and sex cannot be influenced, others like list turnover and the NARHI can.

Managing List Size and Turnover

“If you are being proactive with your list size, or you've got a list dispersal happening in your area, that will give you an additional weighting on your global sum,” said Drew.

She gave the example of gaining 2000-3000 patients from a new local housing development. For the first 12 months, these patients would carry an additional rating of 1.46, boosting funding. However, that uplift falls the following year, which could lower the global sum.

“So, it's something to log away at the back of your mind if you're ever in that situation”, Drew advised. 

She also urged practices to check NARHI coding regularly and update patient registers ahead of quarterly reporting deadlines. Accurate coding can improve global sum payments. “Month-by-month, you're benefiting from that,” Drew said. She advised checking lists every few months and not to miss any patients when registering them. 

“Do it a couple of weeks before your quarter end, so that you've done your coding, it's all set, and then you benefit from that for the next quarter,” she added.

Financial Pressures Persist

Houston said that financial planning had become challenging for many practices recently. “I don't think that anything there has changed, but I think it feels much, much harder now than it has done in years gone by.”

Houston noted some optimistic signs. “This is first time in quite a few years that we haven't had an imposed contract, which I think is great news,” she said. 

However, she noted that rising staff costs, including for parental leave, sick leave, prolonged study leave, and suspensions, continued to stretch budgets. Staffing typically accounted for at least 44% of practice spending but “doesn't go anywhere near touching the sides of what your actual staff costs are”. 

QOF Points: More Value, Fewer Available

In 2025-2026, the value of a QOF point has risen by 2.2% to £225.49. However, the maximum number of available points for achieving QOF targets has been reduced from 635 points in the previous financial year to 564 points this year.

Houston said this change could reduce a practice income by up to £13,000 annually. “If you’ve got an expert in your practice, that is really helpful,” added Drew.

Some QOF funds have been redirected into the global sum and to raise the Item of Service payment for childhood vaccinations. But Houston warned that shifting funds between streams could have unpredictable effects.

Some QOF funds have been redirected into the global sum and to raise the Item of Service (IoS) payment for childhood vaccinations. Houston noted: “One of the problems that we're seeing is when we move money from one pot to another. Sometimes it works out well for us in practice; other times not so much.”

Focus on Cardiovascular QOFs

Houston advised practices to carefully examine their disease prevalence before modelling QOF income. 

She noted that QOF points were only valuable if they could be obtained. The cost per QOF “being bandied about” is based on an average practice with a list size of 10,184 patients and “an average prevalence” of the QOF in question, according to NHS England estimates. 

“If your practice is smaller, or you have less disease prevalence, you aren't looking at £225 per QOF point at all,” she said. “So, when you're looking at your modelling, that's a really important thing to think about”.

Houston said there were 141 QOF points achievable from meeting cardiovascular disease (CVD)-related targets, worth an estimated £198 million across the UK overall. 

“If you are hoping to achieve QOF this time round, go home, look at your practice prevalence versus the national average in terms of your cardiovascular disease [indicators], because the amount of money you will get at the end of the year from QOF is going to be the most singularly affected by that,” Houston advised.

She also recommended checking related QOF indicators, such as diabetes, as “there is significant shifting in terms of pointing at cardiovascular disease within other disease areas”. 

Practice Managers Share Experiences

Kay Keane, a practice manager for Urban Village Medical Practice in Manchester, said that general practices operated on fixed budgets. 

“We're given an envelope of money, and that's what we have to work with,” she told Medscape News UK. However, she acknowledged that while the money available varied across practices based on the age and likely medical needs of the patient population and the services offered, there were ways in which more money could be leveraged. 

Keane observed: “General practice is the most cost-effective part of the NHS” as it is run by the GPs themselves.

Robyn Clark, a practice manager and managing partner for Kingswood Health Centre in Bristol, also highlighted the value of general practice, telling Medscape News UK that it generates £14 for every £1 spent that can be reinvested back into the health system. However, it receives only 7% of the NHS budget. 

Clark questioned the relevance of the Car-Hill formula, saying it is “almost irrelevant” to modern patient needs. 

For example, “there isn't an extra level of weighting for people whose English isn't their first language. We often find inner city practices with a higher level of non-white British population really struggle because the weighting doesn't meet the actual needs of the patients”, Clark said. 

To address funding gaps, Clark recommended making use of DES, including vaccination services and diagnostics like ECGs.

Drew is an employee of specialist medical accountancy firm Sandison Easson, and Houston is an employee for Primary Care Management company Practice Index. Keane and Clark are directors of the Institute of General Practice Management, an independent body for practice managers in the UK. 

Sara Freeman, BSc, MSc, is a freelance medical journalist based in London, UK. She has been reporting for specialist healthcare news organisations for more than 20 years.