Investment in Northern Ireland’s general practice services reached £435.055 million in 2025-26, representing a 5.55% increase on the previous year, according to new figures published by the Department of Health. However, when adjusted for inflation, the real-terms increase amounts to just 2.04% — significantly below the headline figure and raising questions about whether this investment is sufficient to address the mounting pressures facing GP services.
The publication marks the seventh time the Department has released these statistics, following the discontinuation of the UK-wide series by NHS England due to non-comparable data across the four nations. The figures include reimbursement for drugs dispensed in general practices as well as core contract funding.
What the figures show
The 2025-26 investment breaks down as follows:
- Total investment: £435.055 million (up from £412.168 million in 2024-25)
- Nominal increase: 5.55%
- Real-terms increase: 2.04%
- GP pay uplift: 4.0% (following DDRB recommendation)
- Practice staff expenses uplift: 4.0%
- Other expenses uplift: 4.1%
- Total uplift investment: £11.717 million
The Department notes that general practice played a key role in the Covid-19 pandemic response, which is reflected in higher investment levels during 2020-21 and 2021-22. However, the latest figures show investment has not maintained that trajectory in real terms.
Context: A system under strain
While the Department highlights percentage increases, the raw figures reveal a more complex picture. The 2024-25 investment of £412.168 million represented a 6.16% nominal increase on 2023-24, but only a 2.01% real-terms rise. The 2023-24 figure of £388.248 million, meanwhile, represented a real-terms decrease of 2.48% compared to 2022-23 — the first such reduction since 2007-08.
This pattern of modest real-terms growth follows years of tension between the Department and GP representatives. In May 2025, the British Medical Association (BMA) in Northern Ireland rejected a proposed contract and took collective action, with 99.6% of voting GPs opposing the Department’s offer. The BMA had sought an additional £80 million for the 2025-26 contract but received £1 million, leading to an imposed contract and ongoing dispute.
The Department’s own figures show general practice receives approximately 5.4% of the health budget — significantly below the 9% in England and 6.6% in Wales. Yet according to NIAO analysis, Northern Ireland has the highest number of GP practices per 100,000 patients in the UK (15.6), and the second-highest number of GPs per 100,000 registered population (72, behind Scotland’s 76).
Workforce pressures persist
The investment figures do not capture the full scale of workforce challenges. According to the Department’s own General Medical Services statistics published in June 2026, the number of active GP practices in Northern Ireland fell to 304 in 2025-26 — down from 305 the previous year and 348 in 2014. The average number of registered patients per practice has risen by 24% since 2014, from 5,500 to 6,838.
While headcount figures show 1,505 GPs (excluding locums) in 2025-26 — a 28% increase since 2014 — these numbers do not account for working patterns. The Royal College of General Practitioners Northern Ireland has noted that whole-time equivalent (WTE) GP numbers have actually fallen, mainly due to reduced partner sessions. A 2025 survey by the RCGP found that 73% of GPs believe patient safety is being compromised by excessive workload.
The Northern Ireland Audit Office reported in 2024 that per capita investment in general practice has traditionally been lower than elsewhere in the UK, with GP earnings correspondingly lower. The Audit Office also found that around one in eight practices were at risk of contract handback due to workforce issues, retirement without succession planning, sickness, inability to recruit, or financial problems.
Questions about comparability and transparency
The discontinuation of the UK-wide series means Northern Ireland’s figures can no longer be directly compared with England, Scotland, and Wales. The Department states this is due to “changes to general practice contractual arrangements in each country,” but this leaves patients and policymakers without a clear benchmark for assessing whether Northern Ireland’s investment levels are adequate.
The 2025-26 uplifts of 4.0% for GP pay and practice staff expenses, and 4.1% for other expenses, follow DDRB recommendations. However, according to the BMA’s report “Report into the Failings of the Pay Review Process for Doctors and Dentists,” the association has criticised the pay review process as no longer truly independent, citing government interference through remit letters, delayed publications, and ignored recommendations. For 2026-27, the DDRB recommended a 3.5% uplift — described by the BMA as “not acceptable” and failing to address years of pay erosion.
What this means for patients
The modest real-terms investment increase comes as demand continues to grow. The patient population registered with GP practices reached 2.079 million in 2025-26, with Belfast alone accounting for 443,000 registrations. The Department’s figures show average payment per registered patient was £184 in 2024-25 — just £2 higher than the previous year, and still below 2021-22 levels when adjusted for inflation.
The Public Accounts Committee, in a November 2025 report, found “significant difficulties” in patient access to GPs and called for urgent strategic action. The Committee’s survey attracted over 15,000 respondents — an unprecedented response highlighting public concern.
Key questions for policymakers
- Given that real-terms investment growth has averaged around 2% annually since 2023-24, is this sufficient to maintain service quality amid rising patient complexity and demand?
- Why does Northern Ireland continue to invest a smaller proportion of its health budget in general practice than England or Wales, despite having more practices per capita?
- How will the Department address the disconnect between rising GP headcount and falling whole-time equivalent numbers, which suggests GPs are working fewer hours?
- What assessment has been made of whether the 4.0% pay uplift matches actual DDRB recommendations for 2025-26, given past disputes about full implementation?
- With the UK-wide comparison series discontinued, how will the Department demonstrate that Northern Ireland’s investment levels are adequate relative to need?
What to watch
The Department has committed to prioritising future pay awards at the start of the financial year, following delays in implementing the 2025-26 uplift. However, the BMA remains in dispute over both the 2025-26 and 2026-27 contracts, with collective action continuing. The Department’s promise of “new funding into core GMS in 2026-2027” — made to secure GP representatives’ return to negotiations — has yet to materialise, according to the BMA.
The next investment figures, covering 2026-27, will reveal whether the Department has delivered on this commitment — and whether investment is finally rising at a pace that matches the pressures on Northern Ireland’s GP services.
The full report and data tables are available on the Department of Health website.