GP services in care homes: NHS responsibilities and retainer fees

Do care homes have to pay GP retainer fees? Not for services already covered by NHS contracts. However, GP practices may charge for genuinely additional services provided to a care home organisation.

Care England’s guidance helps care providers in England understand which GP services should already be NHS-funded, review existing retainer arrangements and challenge charges where necessary.

Download GP retainer templates

Use these free, editable resources to review your current agreement or seek clarification about NHS commissioning responsibilities.

What GP services should care homes receive through the NHS?

Care home residents have the same entitlement to NHS primary medical services as patients living in their own homes. GP practices remain responsible for clinically necessary assessment, treatment, prescribing, referrals and home visits, subject to their contractual obligations and clinical judgement.

Under the Enhanced Health in Care Homes (EHCH) arrangements, participating Primary Care Networks (PCNs) also have responsibilities for coordinating healthcare in aligned care homes. These include:

• A named clinical lead.

• Weekly care home rounds for residents requiring review.

• Multidisciplinary working between healthcare professionals.

• Personalised assessment and care planning.

• Structured medication reviews, prioritised according to clinical need.

These services are supported by existing NHS contractual and funding arrangements. A weekly care home round does not mean that the same GP must visit every week or that every resident must be seen.

When can a GP practice charge a care home?

Separate fees may be appropriate where the practice provides services to the care home organisation that fall outside NHS-funded responsibilities.

Examples include bespoke staff training, independent advice on organisational clinical governance and additional administrative or management reporting commissioned by the provider.

However, services described as weekly GP visits, named GP support, medication reviews or care planning should be examined carefully before separate charges are accepted. These activities may already fall within NHS contractual responsibilities.

The deciding factor is whether the service is genuinely additional to what the NHS is already funded to provide.

How should care providers review GP retainer fees?

Where a care home already pays a retainer, Care England recommends reviewing the agreement with the GP practice before making changes.

1. Check your agreement. Identify the services covered, annual cost, renewal arrangements and notice provisions.

2. Request a breakdown. Ask what services are included, who provides them, what has been delivered over the previous 12 months and how the charges are calculated.

3. Compare NHS responsibilities. Establish whether the services are already covered by GP, PCN or other local NHS contracts.

4. Agree the next steps. Discuss whether the retainer should continue, be amended or cease to cover particular services.

The aim is to agree fair arrangements for the future, rather than pursue historical repayments or damage established relationships with GP practices.

What if a GP practice disputes the charges?

Where the practice and provider disagree about which services are NHS-funded, the first step should be to seek clarification from the practice and aligned PCN.

If the position remains unresolved, providers can contact their ICB’s primary care commissioning team using Care England’s ICB commissioning clarification letter.

The ICB can clarify NHS commissioning and contractual responsibilities, although it does not ordinarily determine private contractual disputes between a practice and care provider.

Providers should check their contractual obligations before changing or withholding payments. Residents’ access to NHS healthcare must continue without interruption.

NHS England and BMA guidance

For further information on GP contractual obligations, NHS funding and the EHCH framework, see:

• NHS England: Enhanced Health in Care Homes framework

• NHS England: Network Contract Directed Enhanced Service

• NHS England: GP contract and funding arrangements

• BMA: NHS primary medical services in care homes

• BMA: What GP practices can and cannot charge for

This guidance applies to adult care homes in England and reflects the 2026/27 contractual arrangements. It provides general information rather than individual legal advice. Providers should review any private agreement against its own contractual terms.