How GMS Practice Funding Works: The Global Sum, the Carr-Hill Formula and Weighted Patients

For 2026/27 an NHS GP practice in England is paid £130.07 per weighted patient in core Global Sum funding, and the Carr-Hill formula is what converts a raw registered patient list into the weighted patient count that price is multiplied by. That single mechanism is why two practices of identical size can be funded very differently. The Statement of Financial Entitlements sets out what is paid for what, and the GMS, PMS and APMS contracts differ in who sets the terms, who is allowed to hold the contract and where the payment rules are written down.

The Global Sum is practice trading income, not a partner's salary, so the money has to travel through the practice's costs and the profit-sharing agreement before any of it is yours. The detail of how that profit is then taxed and split is in our GP partnership tax complete guide and our page on GP partnership profit sharing and tax planning.

Where an NHS GP practice's money actually comes from (the income lines)

A GP practice is not paid a single fee. Its income is built from several distinct streams, and understanding them separately is the first step to reading your own accounts:

• The Global Sum, the core per-weighted-patient payment that covers essential and additional services. This is the largest core line for most practices.
• The Quality and Outcomes Framework (QOF), a voluntary, points-based quality scheme that sits alongside the Global Sum. We cover it in full in QOF income explained.
• Enhanced services, optional extra income on top of the core, including nationally directed schemes and locally commissioned services. See enhanced services income and tax.
• Primary Care Network (Network Contract DES) funding, including the Additional Roles Reimbursement Scheme, which flows through networks of practices.
• Dispensing income, where the practice is a dispensing practice.
• Premises reimbursement (notional or cost rent) and any private income the practice earns.

Hold onto one principle throughout. All of this is practice trading income. It belongs to the partnership, not to any individual partner.

For a typical dispensing-free practice, the Global Sum is by far the biggest single line, and the variable income (QOF and enhanced services) is smaller but more discretionary, because the practice has to earn or opt into it. Premises reimbursement is a pass-through, not profit, since it offsets a real premises cost the practice carries. And reimbursements such as locum cover for parental or sickness leave are exactly that, reimbursements, not a windfall. Knowing which lines are core and automatic, which are variable and earned, and which are simply covering a cost is the first habit of reading practice finances well, and it sits at the heart of good GP practice management.

The three NHS GP contract types: GMS, PMS and APMS

Before the money mechanics, it helps to know which contract a practice holds, because the contract sets the framework the payments hang off. There are three contract types for NHS primary medical care in England.

GMS (General Medical Services)

GMS is the default national contract. It is negotiated nationally between NHS England and the General Practitioners Committee of the BMA, governed by the GMS contract regulations (the National Health Service (General Medical Services Contracts) Regulations 2015, SI 2015/1862) and paid under the Statement of Financial Entitlements.

PMS (Personal Medical Services)

PMS is a locally agreed variant. Historically it carried a locally negotiated baseline instead of a purely national formula, but it uses broadly the same funding building blocks as GMS. The difference is that PMS is a local agreement with the commissioner, not a national contract, so the precise terms can vary between PMS practices.

APMS (Alternative Provider Medical Services)

APMS contracts are made with alternative providers, which can include companies and other organisations, not only a traditional GP partnership. They are typically time-limited and locally commissioned, used where a commissioner wants a different delivery model for a particular population.

Whichever contract a practice holds, the core per-patient funding logic, a weighted list driving a core payment, comes from the same family.

The Global Sum: the core per-patient payment

The Global Sum is the main core funding payment. It is designed to cover the essential and additional services a practice provides to its registered patients. Mechanically, it is calculated as a national price per weighted patient multiplied by the practice's weighted list size, and it is paid monthly by the commissioner.

For 2026/27 the figure is £130.07 per weighted patient. That is not a commentator's estimate: it is stated at paragraph 3(4) of the General Medical Services Statement of Financial Entitlements Directions 2026, which came into force on 1 April 2026. The same paragraph adds a London Adjustment of £2.18 for every registered patient whose postcode falls inside the Greater London Authority area, so an inner-city London practice is funded slightly above the national rate before any weighting is applied.

The per-weighted-patient amount is uplifted annually as part of the contract settlement. Treat £130.07 as date-tagged to 2026/27, not permanent: it moves every April, and the current Directions are always the figure to confirm against, never last year's carried forward.

Registered list versus weighted list

This is the distinction that confuses most people the first time they see it. The registered list is the raw headcount of patients on the practice list. The weighted list is that same population adjusted by the Carr-Hill formula. The Global Sum is paid on the weighted population, not the raw one. So a practice with 8,000 registered patients does not simply receive 8,000 multiplied by the per-patient price; it receives its weighted patient count multiplied by that price, and the weighted figure can be meaningfully higher or lower than the headcount.

How the Global Sum is paid and reconciled

The Global Sum arrives as a monthly payment through the commissioner. As patients join and leave, list changes feed through into the weighted figure and the payment adjusts. A well-run practice does not simply bank what arrives; it reconciles what it receives against what it expects, because list adjustments, weighting changes and timing differences can all move the monthly figure. Checking that the core funding line is correct, month on month, is a basic financial-control discipline for a practice. It is also one of the most common places where money quietly goes missing if nobody is watching.

There is a second reason the monthly figure moves that often surprises partners. The Global Sum runs on a quarterly list-cleaning cycle: the weighted list used for payment is refreshed periodically, not on the day a patient registers or leaves, so there is a built-in lag between a change on the ground and a change in the payment. A practice that is growing its list will, for a time, be paid on a slightly stale, lower weighted figure, and a practice that is shrinking will briefly be paid on a higher one. Neither is an error; it is the cadence of the system. The discipline is to know the cadence so that a normal timing lag is not mistaken for an underpayment, and a genuine underpayment is not waved through as a timing lag.

It also helps to keep the Global Sum mentally separate from the things that look like it but are not. A practice receives a single remittance covering several streams, and it is easy to treat the whole figure as core funding. In reality the remittance bundles the Global Sum with QOF aspiration, enhanced-service payments, reimbursements and adjustments. Breaking the remittance back out into its component lines, every month, is what lets the practice see whether the core funding itself is right, instead of judging the total in aggregate and hoping it nets off.

The Carr-Hill formula: how a raw list becomes weighted patients

The Carr-Hill formula is the national weighting system that converts a raw registered list into weighted patients. Its purpose is to make funding follow relative workload and need rather than paying a flat rate per head. A flat per-head payment would over-fund a young, healthy, stable population and under-fund an older, sicker, more mobile one. The formula is an attempt to correct for that.

The factors

The recognised Carr-Hill factors adjust the raw list for:

• Age and sex of patients, since workload varies considerably across the age range.
• Additional needs, reflecting morbidity and mortality in the population.
• List turnover, because newly registered patients tend to generate more work in their first year.
• A nursing and residential home factor, reflecting the additional work of patients in such settings.
• A rurality and geography adjustment, recognising the cost of serving more dispersed populations.
• A staff market-forces (cost) adjustment, reflecting that staff costs vary by location.

These are the recognised Carr-Hill factors. A practice does not set the weightings, and the coefficients behind them are not published in a form anyone outside the calculation can usefully apply. What matters for understanding your funding is the direction each factor pushes, not a precise coefficient.

Why two same-size practices are funded differently

Consider two practices with an identical registered headcount. Practice A serves an older population with higher morbidity and high list turnover (think a town centre with a transient population and several care homes). Practice B serves a younger, stable, lower-need population (think a settled suburb). Even with the same raw headcount, Practice A weights up across several factors and Practice B weights down, so Practice A receives a larger Global Sum.

The figures here are purely illustrative, but the principle is solid: a like-for-like comparison of two practices by headcount alone tells you very little about their core funding. This is also why a partner moving between practices, or a practice merger, can produce a very different funding picture from what the raw patient numbers would suggest.

The same logic has a sharp edge for anyone buying into a partnership. A practice that looks healthy on raw list size may be carrying a list that weights down (younger, more stable, lower need), so its core funding per head is lower than the headcount implies. Conversely, a practice with a modest headcount but an older, higher-turnover, higher-morbidity population can weight up substantially. An incoming partner who reads only the patient count, and not the weighted list and the funding it drives, is reading the wrong number. We set this in the wider context of a buy-in decision in our guide to the financial implications of becoming a GP partner.

The Carr-Hill weighting changes how much core Global Sum the practice receives; it does not change a patient's entitlement to care or the practice's clinical obligations. Two patients with very different weightings receive the same NHS service. The weighting is a funding mechanism designed to push resource towards practices doing more work, not a rationing tool. Keeping that distinction clear avoids the common misreading that a low-weighting practice is somehow under-serving its patients.

Known criticisms of the Carr-Hill formula

The Carr-Hill formula is widely discussed in health policy, and a recurring criticism is that it may not fully capture deprivation as a driver of workload. That is a live policy debate, not settled fact, and it is not advice. Any change to the formula would flow through the Statement of Financial Entitlements in the usual way.

The Statement of Financial Entitlements (SFE): the rulebook for the money

If the regulations create the GMS contract, the Statement of Financial Entitlements (the SFE Directions) is the document that sets out exactly how much is paid for what. It governs the detailed payment entitlements, including the Global Sum, QOF and the various enhanced and other payments. It is reissued and amended over time, and the per-patient and per-point values within it are uplifted in line with the annual contract settlement.

The practical consequence for a partner is simple but important. Your practice's core funding line moves every April as the new settlement takes effect, which is precisely why "last year's figure" is never the safe figure to budget on. If you are modelling next year's income, or sense-checking what the practice has received, the current SFE is the source of truth. The published SFE Directions on gov.uk, supported by NHS England's annual GP contract guidance, is where to confirm the live numbers.

GMS funding is practice income, not your pay (how it reaches a partner)

The Global Sum, and every other NHS income line, lands in the practice as trading income. From that income, the practice meets its expenses: staff salaries and employer pension, premises costs, clinical supplies, IT, locum cover and all the running costs of the surgery. What remains after expenses is profit.

That profit is then shared between the partners under the partnership's profit-sharing agreement, and a partner is taxed on their profit share, not on their drawings. The mechanics of that, and how shares are agreed, are covered in our GP partnership tax complete guide and in GP partnership profit sharing and tax planning.

The gap between the funding figure and take-home pay is wide. Out of the Global Sum and the other NHS lines the practice pays its staff (usually the largest cost by far), its premises costs, its clinical supplies, its IT and systems, locum and registrar costs and the rest of the running overhead. Only what is left is profit, and only the partner's share of that profit is theirs. So a large headline funding figure is not a large income; it is the top of a funnel that narrows considerably before it reaches any one partner. Partners who anchor on the funding figure instead of the profit share consistently over-estimate what the practice can sustainably pay out, which is why drawings should be set against projected profit, not against turnover.

Core NHS GMS income is outside the scope of VAT, so the Global Sum carries no VAT and does not count towards the registration threshold. Where a practice has a genuine VAT question, it is usually about non-NHS work, and we cover that in our guide to GP VAT registration.

The pension angle: Global Sum profit is pensionable, dividends are not

Because the Global Sum (and the rest of the NHS income) feeds the partnership's profit, it also feeds a partner's NHS pension. As a Type 1 medical practitioner, a GP partner's pensionable earnings derive from net NHS-derived profit, certified each year through the Annual Certificate of Pensionable Profits via PCSE.

Income routed through a company is not NHS-pensionable, so dividends build no NHS pension at all. That trade-off is set out in full in our guide to PCN clinical director payments and tax, and the wider incorporation question in our guide to GP corporation tax.

What this means for reading your practice accounts

Once you understand the income lines, a set of GP practice accounts becomes much easier to read. Ask for these to appear as separate lines inside practice income, because each one answers a different question:

• Global Sum. Divide it by the practice's weighted population for the year and the answer should land on £130.07 for 2026/27, before the London Adjustment and after any minor surgery or out of hours deduction. If it does not, either the weighted list moved or a payment is wrong.
• QOF, split between the aspiration paid through the year and the achievement balance settled afterwards. A large year-end balancing entry usually means aspiration was set badly, not that the practice underperformed.
• Enhanced services. This is earned, opted-into income, so it is the line to weigh against the clinical time spent generating it.
• Network Contract DES receipts. Money that reaches the practice through its PCN, which is why it does not track the practice's own list size the way the Global Sum does.
• Premises reimbursement, notional or cost rent. A pass-through, so it should sit against a matching premises cost and never read as profit.
• Reimbursements such as SFE locum cover for parental or sickness leave. Also matched to a cost, and never a windfall.
• Dispensing income and any private income, which carry their own cost bases, and in the case of private work a possible VAT question.

Two checks follow from that layout. First, the core funding line divided by the weighted population should reconcile to the SFE price, month on month. Second, staff costs as a share of total practice income is the single ratio that moves profit most, so an unexplained shift in it is worth a question before the year-end. For the bookkeeping detail behind those lines, see our GP accounting guide and our GP bookkeeping guide. If you are weighing up partnership in the first place, our guide to the financial implications of becoming a GP partner sets the funding in the context of buying in.

What is a GMS contract, and how does it differ from PMS and APMS?

A GMS contract is the standard national contract under which a practice provides NHS primary medical care in England. It is made under the National Health Service (General Medical Services Contracts) Regulations 2015 (SI 2015/1862), its payment terms sit in the Statement of Financial Entitlements, and its core funding line is the Global Sum. The three differences that matter when you are reading a set of practice accounts are who sets the terms, who is allowed to hold the contract, and where the payment rules are written down.

NHS primary medical care contract types in England, 2026/27

Contract	How the terms are set	Who can hold it	Where the payment rules sit
GMS	Negotiated nationally between NHS England and the General Practitioners Committee of the BMA	A GP, a GP partnership, or a company limited by shares meeting the qualifying-shareholder conditions in section 86(3) of the NHS Act 2006. An ordinary personal service company does not qualify	The GMS Statement of Financial Entitlements Directions 2026, in force 1 April 2026
PMS	Agreed locally with the commissioner, on a local baseline	A GP, a GP partnership, or a company limited by shares whose shareholders all qualify. An ordinary personal service company does not qualify	The local agreement, built on the same funding blocks as GMS
APMS	Commissioned locally, typically for a fixed term	Alternative providers, which can include companies and other organisations	The terms of the individual contract

A GMS contract cannot be changed at will on either side. A variation has to follow the requirements in the 2015 Regulations, and where it is reasonably practicable the variation takes effect no earlier than 14 days after the notice is served. That is the answer to a question partners ask when core funding moves unexpectedly: the price per weighted patient changes through new Directions each April, and the contract itself changes through a served variation, so an unexplained monthly movement is almost always a list or timing effect instead.

How is the Global Sum calculated, and what comes off it?

To see how to calculate the Global Sum for your own practice, follow the route the Directions take. They start from your Contractor Registered Population, the raw registered list at the quarter date. They then apply the Global Sum Allocation Formula, which is the Statement of Financial Entitlements' own name for the Carr-Hill weighting, to produce your Contractor Weighted Population for that quarter. That weighted figure is multiplied by £130.07 for 2026/27, and a London Adjustment of £2.18 is added for each registered patient whose postcode sits inside the Greater London Authority area.

The Carr-Hill variables that move a weighted population are the six factors set out above, and the one worth naming precisely is the nursing and residential home adjustment, because it is the reason a practice with several care homes on its patch weights up on a headcount that looks ordinary. Age and sex, additional needs, list turnover, rurality and local staff costs do the rest of the work.

Deductions then come off the initial Global Sum Monthly Payment where the practice does not deliver certain services. Not providing minor surgery reduces it by 0.6%, and not providing out of hours services reduces it by 4.70%, both under the Table at paragraph 3(6) of the 2026 Directions. Check which of the two applies to your own contract before you compare your statement with anyone else's, because a practice that has kept a service and a practice that has handed it back are paid different amounts on the same weighted list.

What is a 9,000 weighted patient practice worth on GMS in 2026/27?

Take Dr K, a partner in an illustrative English practice outside London that does not provide out of hours services. Its Contractor Weighted Population for the quarter is 9,000, a rounded figure chosen to keep the arithmetic clean. At the 2026/27 price of £130.07 per weighted patient, the initial annual Global Sum is 9,000 x £130.07 = £1,170,630. Because out of hours services are not provided, 4.70% comes off: £1,170,630 x 4.70% = £55,019.61, leaving £1,115,610.39. A London practice would add £2.18 for every registered patient inside the Greater London Authority area on top. The weighted population is the only input that moves during the year, so a quarterly reweighting changes the answer while the price holds until the next April uplift.

What is not covered by the Global Sum?

The Global Sum buys essential and additional services, and several of the other lines on a GMS payment statement are outside it entirely. Each has its own rules, and the detail sits elsewhere:

• QOF, the voluntary quality scheme, covered in QOF income explained.
• Enhanced services, including directed enhanced services (DES) and locally commissioned work, covered in enhanced services income and tax.
• Network Contract DES money, most of which is held at Primary Care Network level and sits outside the core contract, although the Network Participation Payment is paid directly to each core network practice, covered in PCN funding and the Network Contract DES.
• ARRS reimbursement for network-employed staff, covered in ARRS reimbursement and employing PCN staff.
• The PCN clinical director payment, covered in PCN clinical director payments and tax.
• Dispensing income, covered in dispensing practice income, accounts and tax.
• Premises reimbursement, whether notional rent or cost rent, covered in notional rent versus cost rent.
• SFE reimbursement of locum cover during parental leave, covered in maternity pay and Maternity Allowance for doctors.

Drawing that boundary is what turns a single monthly figure into something you can check. If the core line looks wrong, the question is whether the weighted population moved, whether a deduction applies, or whether one of the streams above simply landed in a different month.

How do you find out your own practice's weighted list and Global Sum?

Your own figures are published to you every month in PCSE Online. Primary Care Support England, which administers GP payments and records in England, states that "if your global sum payment is calculated by the system, the capitation information can be found on your contractual payment statement under the 'GMS/PMS/APMS Contract value' section", so the capitation and weighting behind the payment are visible to any user at the practice who has been given the statements role. Statements export as PDF or CSV, in an expanded or a collapsed form, which is what makes a month on month comparison practical. The routine for reconciling them is set out in practice income and PCSE statement reconciliation.

For the year ahead, NHS England publishes a "General medical services and primary care network (PCN) income ready reckoner from 1 April 2026" on its GP contract financial information page, which estimates practice and network income under the 2026/27 terms. Between the statement and the ready reckoner you can see what has been paid and what to expect, which is how to find out whether a movement in your core funding is a weighting change or a timing difference.

Is the Carr-Hill formula about to change?

Nothing has changed for 2026/27. On 9 October 2025 the Department of Health and Social Care commissioned a six month review of the Carr-Hill formula from the National Institute for Health and Care Research, announced here, asking it to identify options for a new allocation formula that reflects patient need more accurately. We have not found a published report from that review, and the position in the documents that actually govern payment is unambiguous: the Statement of Financial Entitlements Directions 2026 still applies the Global Sum Allocation Formula, and NHS England's published 2026/27 contract changes make no reference to a replacement. The 2025 announcement describes the current formula as "based on data that is around 25 years old in some cases" and cites Health Foundation evidence that practices serving more deprived areas receive "nearly 10% less funding per patient" than practices in more affluent areas.

Plan on the basis that nothing moves until the Directions move. Any new allocation approach has to be written into the Statement of Financial Entitlements before it changes a single payment, and a redistribution that is cost neutral overall shifts money between practices, so some would gain and some would lose. For the 2026/27 settlement the contract envelope rose by £485 million to £13,863 million, which NHS England describes as 3.6% cash growth or 1.4% real terms growth, and £130.07 per weighted patient is the number a 2026/27 budget runs on.

Checking your own Global Sum against the Directions

The core funding line is checkable to the pound, and three inputs decide the answer: the Contractor Weighted Population for the quarter, the £130.07 price for 2026/27, and whether the 0.6% minor surgery or 4.70% out of hours deduction applies to your contract. Divide the Global Sum in the accounts by the weighted population, allow for the London Adjustment and the deductions, and the result should land on the SFE price. Where it does not, the cause is almost always the quarterly reweighting lag, a deduction that applies and was not modelled, or a stream that landed in a different month.

Two dates set the rhythm. The price changes each April through new Directions, so a figure carried forward from last year is wrong by construction, and the weighted list changes each quarter through list cleaning, so a movement between April uplifts is a list movement. Everything downstream, the profit share, the drawings and the tax reserve, moves with those two.

To go further: PCSE statement reconciliation for the monthly check, the GP accounting guide for how the lines sit in the accounts, and GP partnership tax for what happens to the profit. To talk through your own practice's figures, get in touch.