Where the Capacity and Access money went

Written by the Virtual Pharmacist clinical team

From 1 April 2026 the Capacity and Access Payment stopped arriving at network level. NHS England confirms that the payment, covering both the Capacity and Access Support Payment and the Capacity and Access Improvement Payment, has been removed from the Network Contract DES, and that the £292 million involved has been repurposed into a practice-level GP reimbursement scheme aimed at recruiting new GPs or increasing sessions from GPs already working in the practice.

For most networks this is the single most consequential change of the year, because it changes who holds the money and what it is for.

What the money used to do

The Capacity and Access Payment was network money. A network could look at its own access position, decide where the pressure sat, and put shared capacity behind it. In practice that often meant capacity that no single practice would have funded alone: a shared clinic, a shared team covering several sites, or a workstream that took a category of work off every practice at once.

Medicines work suited that shape particularly well. Prescription queries, discharge letters, monitoring recalls and medication reviews are all high volume, all similar across practices, and all cheaper to run once for the network than five times for five practices.

What the money does now

The replacement scheme sits at practice level and is pointed at GP capacity specifically: recruiting new GPs, or increasing sessions from GPs already in the practice. That is a legitimate and useful thing for the money to do. It is simply a different thing from what the network money did.

Two consequences follow.

• The network has less discretionary capacity. Anything the network was funding from this pot needs another source, a smaller scope, or a decision to stop.
• The new money buys GP time, not team time. A practice that takes up the scheme gains GP sessions. The medicines workload sitting underneath those sessions does not reduce, and some of it will now be handled by the most expensive clinician in the building.

The gap this opens, and where it shows up

The work funded by network money did not disappear when the money moved. It went back to wherever it sat before, which is usually a practice manager’s list and a GP’s screen.

The places it tends to surface first:

• Prescription and medication queries. High volume, arriving daily, and the first thing to back up when shared capacity stops.
• Discharge and clinical letters. Time-critical, and the backlog is invisible until something is missed.
• Monitoring recalls. High-risk drug monitoring quietly slips when nobody owns the search.
• Structured medication reviews. Usually the first thing deprioritised, because the consequence is slow rather than immediate.

None of these are GP-only tasks. Most of them are pharmacy tasks that reach a GP because there is nobody else holding them.

Three responses networks are taking

Reduce the network’s scope deliberately. Decide what the network is genuinely for now that it holds less money, resource that properly, and hand the rest back to practices with a clear statement that it has been handed back. Networks that do this cleanly avoid the worst outcome, which is a shared service that still exists on paper but no longer has the capacity to deliver.

Reallocate within ARRS. The ARRS allocation is still network money. Some networks are rebalancing it toward the workstreams the Capacity and Access Payment used to cover. This needs a deliberate decision early in the year, because the GP option within ARRS became considerably more expensive in 2026/27 and will absorb allocation quickly if it is taken up without planning. Our ARRS budget planning guide sets out a working method.

Buy the workstream rather than the headcount. Where the need is a defined body of work rather than a person in a chair, some networks commission the workstream itself: the discharge letters, the monitoring recalls, the review backlog. The advantage is that capacity flexes with the work and does not carry recruitment lead time. We describe how that model works in outsourced clinical pharmacist support.

A practical way to size what you have lost

Before deciding what to do, it helps to know the number. A straightforward approach:

1. List everything the network funded from the Capacity and Access Payment in 2025/26.
2. For each item, mark whether the work stopped, moved to practices, or is still running on another budget.
3. For anything that moved to practices, estimate the hours it now takes per practice per week.
4. Multiply out across the network. That total is the gap, expressed in hours rather than pounds, which is the more useful unit when you go looking for a replacement.

Most networks that run this exercise find the number is larger than expected, because work that was invisible while it was being absorbed becomes visible once it is spread across several practices.

What good looks like by the end of the year

A network that handles this well can say three things by March: what it stopped doing and told practices it had stopped, what it kept and how that is funded, and what the medicines workload actually costs now that it sits where it sits. Networks that cannot answer those three tend to be the ones where a backlog builds quietly and surfaces in an inspection or a significant event.

If you want a view on which parts of your medicines workload are worth holding at network level, talk to us.

Figures in this article are taken from NHS England’s published 2026/27 GP contract and Network Contract DES material, read in August 2026. Check the current NHS England publication before relying on a figure for planning.