MAKING SENSE OF THE NUMBERS
Medical Newsletter AUTUMN 2026
INTRODUCTION Welcome to our Autumn Newsletter As autumn arrives, general practice continues to operate in an environment of constant change. From proposed neighbourhood contracting arrangements and the ongoing review of the Carr-Hill funding formula, to the financial realities facing practices and PCNs, there is no shortage of developments demanding attention. In this edition, we explore some of the biggest issues currently shaping the future of primary care, including what the proposed neighbourhood contract models could mean for practices, and why the review of the Carr-Hill formula could have significant implications for future funding allocations. We also look ahead to Best Practice Birmingham 2026, where we’ll be sharing practical insights to help practices make sense of the numbers behind funding announcements, the financial reality and financial planning. Alongside these sector updates, we have included some lighter reading. As Christmas begins to appear on the horizon, we share some timely reminders on tax-efficient ways to reward your team. We’re also delighted to introduce our newest team member, Laura, whose unique healthcare and accountancy background makes her a fantastic addition to the medical team. And in the first instalment of his memoirs, Jim reflects on his journey into specialist medical accountancy and the many changes he has witnessed across NHS finance over the years. I hope you find this edition informative, practical and enjoyable. As always, if any of the topics discussed raise questions for your practice, PCN or organisation, please get in touch. We’re always happy to help.
SARAH EDWARDS
Partner
BEST PRACTICE BIRMINGHAM 2026: LET’S MAKE SENSE OF THE NUMBERS!
We are heading back to Best Practice Birmingham next month and are looking forward to catching up with familiar faces, meeting new people and spending a couple of days talking all things general practice and primary care. The event takes place on 7–8 October 2026 at the NEC Birmingham and is always a useful opportunity to hear what is happening across primary care, share ideas and pick up practical insight from across the sector.
sense of the numbers - From funding uplifts to financial reality on 7 October 2026, 11:15–11:45, in the Business Service Hub. If you are attending Best Practice Birmingham, we would love to see you there. Whether you are planning ahead, looking for fresh ideas or simply want to talk things through, come and say ‘hello’ at Stand J20.
You’ll find us on Stand J20, so if you are going along, please do pop by for a chat. We’ll be happy to talk through any questions you may have and discuss how we can support you and your practice. We know there is a lot for practices and PCNs to think about at the moment, and events like this are a great chance to step back, compare notes and have useful conversations about what is working well and what might need a bit more planning. Sarah Edwards and I will also be back on stage, following the success of our previous session. Join us for Making
IWONA SILVÉRIO Director iwona.silverio@albertgoodman.co.uk
CARR-HILL UNDER REVIEW:
WHAT GP PRACTICES NEED TO KNOW
The Government’s decision to review the Carr-Hill formula marks one of the most significant developments in general practice funding for over two decades. While many practices are familiar with the term, fewer understand exactly how the formula works, where its assumptions originate, and why the current review could result in substantial changes to the distribution of core funding across England. The formal review was launched in October 2025 and a 6 month review period was started. Recommendations from the review were expected this Spring/Summer with formal consultation to follow. To date, no findings or recommendations have been released.
WHAT IS THE CARR-HILL FORMULA? Introduced alongside the new GMS contract in 2004, the Carr-Hill formula is used to calculate the weighted patient population for GP practices and forms the basis of the Global Sum allocation, which remains the largest single element of core contract funding for many practices. The principle behind the formula is relatively straightforward. Rather than funding practices solely according to their registered patient numbers, it attempts to estimate the workload associated with those patients and the unavoidable costs of delivering services in different locations. The result is a “weighted list size” that differs from a practice’s actual registered population. For example, two practices with identical list sizes may receive different levels of funding because one serves an older population, experiences high patient turnover, or is located in a rural area with higher operating costs.
WHAT FACTORS ARE INCLUDED? The current formula is based on data that is now over 20 years old, but at the time was designed to recognise drivers of workload and unavoidable costs using the following factors: 1. Patient Age and Sex Different age groups are considered to generate differing levels of GP workload. Older patients require more consultations and management of long-term conditions, while younger adults typically generated less activity. The formula therefore applies weighting according to age and sex profiles. 2. Additional Needs Adjustment This element attempts to account for differences in health status and expected workload. The data underpinning these adjustments was derived from a self-reporting patient Health Survey in the 1990’s! 3. List Turnover Practices experiencing high levels of patient movement receive additional weighting with newly registered patients considered to require more consultations and administrative activity during their first year. 4. Rurality The formula is meant to recognise that delivering services in rural and dispersed populations can increase costs. The distance to the nearest practice and population density are incorporated into this weighting calculation.
5. Market Forces Factor This factor was included to address geographical variations in staffing costs and should reflect differences in local labour markets across England.
WHY HAS THE FORMULA BECOME CONTROVERSIAL? The formula has been widely criticised for not reflecting the reality of modern general practice. Demographics have changed over the last 20 years and the formula does not adequately reflect GP workload for increasing multimorbidity, deprivation and service demand. For example, recent studies suggest that practices serving the most deprived areas receive on average 10% less funding than more affluent areas.
WHAT DOES THE REVIEW MEAN FOR PRACTICES?
populations may benefit if deprivation becomes an explicit funding factor. However, rural practices and those that currently benefit from existing weightings will be looking carefully at the detail of any proposed reforms.
WHAT PRACTICES SHOULD DO NOW Practices should review their current demographics, deprivation indicators and understand the factors influencing their current weighted patient calculation. For most practices the patient weighting information is available on the monthly NHS Statements from PCSE. Practices should keep a keen eye on updates from the government review and consider financial modelling the impact of any proposals. As always, please do get in touch if you would like support with financial reviews and how this might impact practice strategy.
For most practices, the biggest single income stream is the global sum payment which is currently £130.07 per weighted patient. Therefore, practice funding could be substantially impacted by any changes to the Carr-Hill formula used to determine patient weighting. The review could simply update existing calculations using more recent data, it could add factors such as the IMD deprivation score, or it could overhaul the formula completely with a new allocation methodology. Without an increase to the total global sum funding, simply changing the allocation of funding alone would create a new set of winners and losers. Practices serving highly deprived
SARAH EDWARDS Partner sarah.edwards@albertgoodman.co.uk
Festive Cheers Without Tax Tears Whether you’re ready to hear it or not, Christmas is now less than 100 days away.
This is where the trivial benefits exemption comes in. A benefit can usually qualify if:
With that in mind, many practices are looking for ways to thank their staff for the hard work this year, without falling foul of any tax rules. The good news is that HMRC offer two valuable exemptions that can help you to reward employees without creating an unexpected tax bill.
It costs no more than £50 per employee, including delivery fees.
Annual Events
If all above conditions are satisfied, there is no tax or national insurance to pay, and no requirement to report the benefit to HMRC.
Trivial Benefits Making the most of the £150 Annual Events Exemption The festive season is a perfect opportunity to thank your employees and bring colleagues together, something HMRC recognises through the annual events exemption. Provided certain conditions are met, employers can hold annual social events, such as Christmas parties or a summer barbecue, without creating a taxable benefit for employees. To qualify: The event must be annual in nature. Open to all employees, or all employees based at one location. The total annual cost must not exceed £150 per head. This is inclusive of VAT and any associated costs, such as catering, entertainment, transport and accommodation. It is important to remember that the £150 limit is an exemption, not an allowance. If the cost per head exceeds £150, the exemption is lost entirely. It’s always worth keeping an eye on the total in the year before upgrading the drinks package!
Is not a cash or a voucher convertible to cash. It is not a reward for work or performance. It isn’t in the terms on their contract.
Trivial benefits are not just a festive favourite. They can be a useful way to show appreciation throughout the year, from winter wellness support to celebrating key personal milestones. A word of caution: if the same benefit appears too regularly, HMRC may start to see it less as a thoughtful gesture and more as something employees have come to expect. At that point, it could become a contractual entitlement and fall outside the exemption. A final festive thought The festive period is a great opportunity to thank your team and celebrate the successes of the last twelve months. With a little planning, you can make the most of the available tax exemptions, reward your employees and keep the celebrations firmly in the “festive cheers” camp rather than the “tax tears” one. If you’re unsure whether a planned event or gift qualifies for an exemption, we would be happy to help walk your through the rules to ensure you make the most of these exemptions.
Trivial benefits: Small rewards, big impact Has the summer barbecue already taken a generous bite out of the £150 exemption? Don’t put the Christmas wrapping paper away just yet — a small tax-free gift may still be an option.
RORY GRANT Manager rory.grant@albertgoodman.co.uk
SERIES INTRODUCTION
JIM DUGGAN
Memoir
Over the years, I have been fortunate to experience a variety of careers, challenges and opportunities that have shaped my life as a medical accountant. In this series I will share personal recollections, reflections and stories from those experiences from different chapters of my life. Although many of the experiences took place what feels like a long time ago, the lessons they taught, adapting to change, learning from others, and making the most of unexpected opportunities, remain just as relevant today as they were then. When I was younger, I was fascinated by medicine and pretty much anything connected to it. So when I missed the entry requirements by just one point, I honestly thought that was it, my chance of working in the medical world was gone. Instead, I ended up going into accountancy, a subject I had always been pretty good at in school. After years of training, I moved into auditing. It was interesting enough, but if I’m honest, I never really found it fulfilling. Then, in April 2000, I spotted an advert for a medical accountant and that changed the direction of my accountancy career completely. I quickly realised that GP finance was far more complicated than I had expected, and that specialist medical accountants play a really important role. When I first started working in specialist medical finance, the NHS was 52 years old and already on its eighth 10-year plan. That was when it really hit me: the one constant in NHS finance is change. Strangely enough, that constant movement is also what makes GP finance so interesting, at least to an accountant. One example was fundholding, which was introduced in 1991 and abolished in 1998. It allowed certain general practices to hold a fixed government budget to pay for community services, prescription drugs and routine hospital care for their patients. Fundholding was a big shift in how general practice was funded in the UK. It moved things away from a centralised system of fees and allowances and helped lay the groundwork for the funding structures we see today. By the time it was abolished, though, it had created a two-tier system with clear winners and losers, especially for patients. Starting any new job is difficult, but taking on a specialist role in a subject you are still getting to grips with brings a whole new kind of challenge. As accountants, we are not trained in the quirks of NHS funding or the complications of the supposedly simplified NHS pension scheme. Without the patience and support of people who knew the system well, my learning curve would have been much steeper. That is why I have always believed in helping those who are willing to learn. The guidance and encouragement I received early on taught me the value of passing that support on to others, a principle that would shape many of the opportunities and decisions that followed in my life.
JIM DUGGAN Director jim.duggan@albertgoodman.co.uk
NEIGHBOURHOOD CONTRACTS: What GP Practices Should Be Thinking About Now
Following the close of NHS England’s consultation, practices should start considering how the proposed neighbourhood contracting models could affect future funding, service delivery and local collaboration. The proposals do not change core GP contracts, but they could influence how practices, PCNs and local partners work together in the years ahead. NHS England’s consultation on new neighbourhood contracting models closed on 10 September 2026. While the next steps are still awaited, the proposals give an important indication of how local health and care services may be organised in future. At their heart is a clear ambition: to support more joined-up care, delivered closer to patients, with services built around local communities rather than traditional organisational boundaries. The consultation focused on two potential new contract types: the Single Neighbourhood Provider (SNP) contract and the Multi-Neighbourhood Provider (MNP) contract. A neighbourhood would typically cover a population of around 50,000 people, although local areas would have flexibility to agree what works best for their communities. In broad terms, an SNP contract would cover one neighbourhood, while an MNP contract could cover several neighbourhoods and coordinate services across a wider area. For GP practices, the most important point is that the consultation did not propose changes to core GMS, PMS or APMS contracts. However, that does not mean the proposals can be ignored. If taken forward, they could influence how enhanced services, current PCN arrangements and other locally commissioned services evolve over time. The SNP model has been described as building on PCNs, rather than acting as an immediate replacement for them, but practices will want to understand how this might work in their own local area. Local commissioners may have a range of options available to them. Some areas may continue with existing PCN DES arrangements, possibly with local variations. Others may explore an SNP contract for a single neighbourhood, or an MNP contract to bring together services across several neighbourhoods. The consultation suggests that a PCN
DES and an SNP contract would not normally be expected to operate for the same population at the same time, so practices should keep a close eye on how local systems interpret and develop the proposals. There is potential for the changes to be positive if they are designed and implemented well. Neighbourhood contracts could help general practice, community services, mental health, social care, local authorities and voluntary sector partners work more closely around shared local priorities. This could support earlier intervention, reduce duplication and make better use of available funding. For patients, the aim is a simpler and more coordinated experience. For practices, there may be an opportunity to help shape local services and strengthen the role of integrated neighbourhood teams. There are, however, important questions still to be answered. Practices will want clarity on whether funding will genuinely move into community and primary care settings, how financial and operational risks will be shared, and how GP leadership will be protected within larger provider models. There are also practical, legal and tax issues to work through, including governance, workload, subcontracting, employment responsibilities, VAT and the interaction with existing PCN structures. Now that the consultation period has closed, the immediate priority for practices and PCN leaders is to stay engaged. This is a good time to review current PCN arrangements, consider where practices add most value within local neighbourhood working, and make sure general practice has a strong voice in local discussions. If you would like to discuss what the proposals could mean for your practice or PCN, please get in touch with a member of the team.
IWONA SILVÉRIO Director iwona.silverio@albertgoodman.co.uk
MEET…
LAURA
We’re delighted to welcome Laura to the Medical Team, having joined AG in June this year. With a background in both maternity healthcare and accountancy, she brings a unique combination of knowledge and experience to the role and is already enjoying putting this to good use. Before embarking on her accountancy career, Laura worked at Musgrove Park Hospital and the RD&E Hospital in maternity care. Her role included working on the wards as well as in the community, with GP surgeries providing a base for clinics. In 2017, once her youngest child started school, Laura felt ready for a new challenge and joined a local accountancy firm as a trainee. She completed her ACCA training and became a Chartered Certified Accountant in 2022. Her healthcare background gave her useful skills, such as communication, empathy, organisation and problem-solving, which now help her support clients. In her previous accountancy role, Laura worked with a wide variety of clients, from individuals and small businesses through to larger organisations. She particularly enjoyed working with new start-up businesses, where she had the opportunity to become closely involved and build strong relationships with managers and directors. It was this aspect of the role that prompted her to look for a specialism where she could develop those relationships further. Drawing on her maternity healthcare background, Laura sees clear parallels between supporting new parents and supporting new business owners: both can involve sleepless nights, constant worry and uncertainty about whether they are doing things right. She sees her role as offering reassurance, helping clients feel confident that they are on the right track, and guiding them through each stage. Combining her previous interest and experience in healthcare with her accountancy knowledge, medical accountancy seemed like a natural next step. Since joining AG, Laura has embraced the fast-moving world of NHS and medical accounts with real enthusiasm, bringing curiosity, energy and a fresh perspective to the team. She is excited to keep building strong relationships with clients, getting to know each practice, and using her combined healthcare and accountancy experience to help make the financial side of running a medical practice feel clearer, calmer and more manageable.
AWAY FROM THE OFFICE Life outside work is certainly busy too! Laura lives with her husband, three teenagers and two dogs, so there’s rarely a quiet moment. Laura enjoys running and challenging herself by taking part in races, although she admits that collecting the medals is often the best part. Her greatest achievement so far was completing the Rock Solid Race, a 12-mile extreme obstacle race, after which she says she has only just about recovered from the hypothermia. Laura is an avid grassroots sports fan and can often be found on the sidelines of a cricket ground, rugby or football pitch. Having spent many summers watching the family play at the local village cricket club and not being one to shy away from a challenge, Laura decided that if you can’t beat them, you might as well join them! She joined the newly formed women’s cricket team at Broadway and Horton, who this season won the league. Obviously, the cricket remains an excuse for a couple of G&Ts (although the trophy helps).
EVENTS MAKING SENSE OF THE NUMBERS: Autumn Update for General Practice with Albert Goodman and VWV Tuesday 17th November – 9am – 1pm BRISTOL – AZTEC HOTEL & SPA
MAKING SENSE OF THE NUMBERS: Autumn Update for General Practice with Albert Goodman and VWV Tuesday 24th November – 9am – 1pm TRURO – THE ALVERTON
THINK WE COULD HELP, PLEASE DO CONTACT ONE OF US JADE BROOKS Executive Administrator
DAWN MILLS Manager
jade.brooks@albertgoodman.co.uk
dawn.mills@albertgoodman.co.uk
JIM DUGGAN Director
LISA PARK Assistant Manager
jim.duggan@albertgoodman.co.uk
lisa.park@albertgoodman.co.uk
SARAH EDWARDS Partner
IWONA SILVÉRIO Director
sarah.edwards@albertgoodman.co.uk
iwona.silvério@albertgoodman.co.uk
RORY GRANT Manager rory.grant@albertgoodman.co.uk
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