Most GP partners draw a profit share every month but have never actually seen how the money arrives. The cash lands in the practice account, the practice manager reconciles it, and the partners take their drawings. This guide opens up the engine room of NHS GP income. It explains the Global Sum as the core per-patient payment, the Carr-Hill formula that turns a raw patient list into weighted patients (so two practices of identical size can be funded very differently), the Statement of Financial Entitlements that governs it all, and where the GMS, PMS and APMS contracts diverge.

The whole point is to connect that funding structure to what a partner actually takes home, because the Global Sum is practice trading income, not a partner's salary. If you want the detail of how that profit is then taxed and split, this guide links you to our GP partnership tax complete guide and our page on GP partnership profit sharing and tax planning rather than re-teaching them here.

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 and the main subject of this guide.
  • 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. A partner is taxed on their share of practice profit, not on their drawings, a point we explain in full in our GP partnership tax complete guide. The funding lines in this article are the source of that profit; the tax mechanics are downstream of them.

It is worth getting the proportions right in your head. 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 rather than 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. Because GMS is the standard nationally regulated contract, it is the worked example used throughout this guide.

PMS (Personal Medical Services)

PMS is a locally agreed variant. Historically it carried a locally negotiated baseline rather than 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 rather than 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 rather than 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. This guide uses GMS as the example because it is the national default and the clearest illustration of how the Global Sum and Carr-Hill formula work together.

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.

The per-weighted-patient amount is uplifted annually as part of the contract settlement and is set in the Statement of Financial Entitlements. To illustrate only, for 2025/26 it was uplifted to around £123 per weighted patient (the figure rose from the prior year). Treat that purely as a date-tagged illustration, not a permanent fact: it changes every year, and you should always confirm the current figure in the latest Statement of Financial Entitlements rather than carrying forward last year's number.

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 rather than 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, rather than 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. The precise weightings the formula applies are technical and are not something a practice sets, so we describe them qualitatively here rather than inventing multipliers. 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.

It is worth being clear about what the weighting does not do, too. 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 (kept brief and neutral)

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 rather than settled fact, and it is not advice. We note it only so that you understand the formula is a model with known limitations, not a perfect mirror of need. 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)

This is the section that ties the funding structure back to your bank account. 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. Partners take drawings against their expected share through the year, and the position is trued up at the year-end once the actual profit is known. The single most important point to internalise is that a partner is taxed on their profit share, not on their drawings. So in a strong year where profit is retained for working capital, you can be taxed on more than you actually drew. 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.

A worked illustration makes the gap between funding and take-home concrete. Suppose the Global Sum and the other NHS lines bring a meaningful sum into the practice in a year. From that, 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 rather than 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.

Because the truing-up happens after the year-end, a sensible practice holds back a portion of profit through the year rather than drawing it all out. That reserve does two jobs: it funds the working capital the practice needs to operate, and it covers each partner's tax, which (since tax follows profit share) can exceed what a partner drew in a weak cash year. Setting the reserve is one of the practical things a specialist medical accountant models from each partner's projected share.

On VAT, one line is enough here: 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.

The catch that catches people out is the company route. A limited company cannot hold a GMS or PMS contract, and company income is not NHS-pensionable. So income taken as dividends from a company builds no NHS pension at all. That is why any decision to incorporate private work has to be modelled with the pension-accrual loss in view, never on the tax saving alone. We do not re-teach incorporation here; for the detail see our guides to GP corporation tax and GP pension contributions and tax relief.

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. The Global Sum should appear as the core NHS funding line within practice income, with QOF, enhanced services, PCN funding, any dispensing income and premises reimbursement broken out alongside it. Below income sit the practice's expenses, and the difference is the profit allocated to partners.

Seeing the funding map onto the accounts is what lets a partner ask sensible questions: is the core funding line tracking the expected weighted-list figure, are the variable lines (QOF, enhanced services) where they should be, and is the profit allocation consistent with the agreement. 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.

How we help GP practices

As specialist medical accountants, much of our work with GP practices starts exactly here, with the funding. We help practices reconcile the Global Sum and the other NHS income lines against what the Statement of Financial Entitlements says they should receive, present those lines clearly in the practice accounts, and connect them to each partner's profit share and tax reserve. We also model how a change in the list, a merger or a partner entry or exit moves the funding and the profit allocation. The aim is straightforward: partners who understand where their income comes from, can read it in their own accounts, and are not caught out at the year-end. This is general information rather than advice for your specific circumstances, and the figures move every April, so the current Statement of Financial Entitlements is always the figure to check. If you would like to talk through your own practice's funding and accounts, you are welcome to get in touch.