Recently, four members of the Robson Laidler team headed down to Daventry for the annual AISMA conference 2026 – A flagship training event from the Association of Independent Specialist Medical Accountants (AISMA), which provides crucial updates on NHS GP funding, pensions, tax and financial strategies for General Practice.
Here are a few of our takeaways from the event:
Change is KEY
The rising demand in volume and complexity, workforce pressures, flat or constrained funding, increased expenses and expectations to deliver more with less, is having a significant impact on General Practice.
These pressures are also being added to, by the 10-year health plan and the introduction of the neighbourhood frameworks.
With Multi-Neighbourhood Contracts, Single Neighbourhood Contracts and GMS/PCN Des contracts – practices need to be thinking about how they will integrate and keep needed services within General Practice.
Rural areas will find these changes more impactful, however it is possible to succeed.
Start with a plan
What does that mean for you?
- Think about how you can control the contract / review potential opportunities available for primary care. Can services currently being funded by secondary care, be serviced in primary care / reducing overall pressure and giving more structure.
- Consider your legal structure and governance (especially PCNs). Who can hold a contract.
- Tax advice as tax and VAT will be difficult to navigate.
- Beware of legal restriction in sub-contracting, pensions, indemnity, CQC etc.
Contract updates:
Although 99% of voters, were against the changes to the 26/27 contract for England, it came into force on 1 April 2026.
Some of the key things to remember:
- Funding – Global sum funding uplift and redistributions – 1.4% real-terms growth.
- GP Scheme – moved from capacity and access funding.
- Access – Same-day urgent care (as defined by the practice), no call-back rule.
- ARRS – Newly qualified restrictions removed and ceiling raised.
- Carr-Hill formula – Under NHSE review – could redistribute global sum from 2027/28.
- PCN Cap – Capacity and access funding withdrawn from PCNs now direct to practices.
- QOF – Higher points available but new more complex competencies, to achieve.
Employment contracts / National Minimum wage (NMW)
Care needs to be taken to ensure that practices have the right processes in place to ensure employment contracts and National Minimum Wage calculations are correct.
The Fair Work Agency, who enforces employment law, protects workers’ rights and ensures a level playing field for businesses, have been looking into the healthcare sector more.
Employment contracts
You need to ensure these are worded correctly to ensure legal compliance, prevent costly disputes and legally protect the practice interests like client confidentiality.
It is a legal requirement to provide a ‘written statement of employment particulars’ from day one.
Missing or vague core terms like pay, hours and holiday, violate this requirement and may lead to financial penalties.
Clear expectations can also prevent misunderstandings, can aid in avoiding tribunal claims and protect the business assets.
National Minimum Wage (NMW)
We all understand that there is a National Minimum Wage that employees should be paid, however were you aware that some payroll deductions could mean employees are paid below the required minimum and this could have major impacts.
Many business are caught out not by deliberately paying a low hourly rate, but by making technical errors.
If you are deducting any of the following from your employee’s salary, you need to ensure they still comply with NMW regulations:
- Job related cost – Uniform deductions, administrative fees, mandatory training or tools needed for the job.
- Salary sacrifice schemes – Cycle to work, gym membership, green car leases – employers must cap a sacrifice, if this deduction would bring the gross below the NMW.
- Mandatory staff meal – Deductions for food provided at work.
Businesses that fail to pay the National Minimum Wage (NMW) face strict enforcement action, if underpayments exceed £500 the practice could be publicly ‘named and shamed’ by the government, even if it was a genuine mistake.
You would also need to pay back any arrears to affected workers at the current NMW rate and could face penalties up to 200% of the total underpayment.
Staffing is one of the major expenses within your practice, you need to ensure you are getting this right.
How can we help?
The challenges facing General Practice aren’t getting any simpler. From contract reform and neighbourhood working to tax, pensions, employment compliance and financial sustainability, practices need trusted advisers who understand both the technical detail and the wider healthcare landscape.
At Robson Laidler, our specialist accounting healthcare team works alongside GP practices, Primary Care Networks and other healthcare providers to help them navigate change with confidence. Whether you’re reviewing your practice structure, planning for future contracts, managing rising costs or ensuring compliance with complex tax and employment regulations, we’re here to provide practical advice tailored to your practice.
If you’d like to discuss how these changes could affect your practice, or explore opportunities to strengthen your financial position for the future, get in touch with one of our specialist healthcare advisers. We’d be delighted to help you build a clear plan for whatever comes next.
This article is for general information only and does not constitute advice. Please do not take or refrain from action based on its contents. Information is based on our understanding of legislation at the date of publish and may change in future.