The DDRB 3.5% Pay Award 2026/27: What It Actually Means for GP and Dental Practice Finances

In March 2026, the Review Body on Doctors’ and Dentists’ Remuneration published its 54th Report, recommending a 3.5% increase to pay ranges and the pay element of contracts from 1 April 2026. The recommendation covers resident doctors and dentists, consultants, SAS doctors, locally employed doctors, contractor GPs, and salaried GP pay ranges across all four UK nations. The government accepted the recommendation in full, and the pay award took effect from 1 April 2026.

For GP practices and dental practices across England and Wales, the DDRB award is simultaneously welcome news and a significant financial management challenge. It is welcome because it provides the basis for a meaningful increase in take-home pay for GPs and dentists after years in which real earnings have been eroded by inflation. It is a challenge because the obligation to implement the pay award — including passing it on to all salaried practice staff — arrives at the same time as the April 2026 employer NIC rate increase to 15%, the secondary threshold drop to £5,000, and the National Living Wage rise to £12.21 per hour. These changes compound each other in their impact on practice finances, and the headline 3.5% pay award does not arrive in isolation.

This guide explains what the DDRB award means in practice for GP surgeries and dental practices — how the pay uplift flows through the contract and payment mechanisms, what the obligation to pass on the award to all practice staff actually costs, whether the contract funding uplift covers the full cost, and what the gap analysis looks like for a typical practice. It also covers how to account for the pay award correctly in your practice accounts and what cash flow planning steps are needed in 2026/27.

What the DDRB Is and How Its Recommendations Work

The Review Body on Doctors’ and Dentists’ Remuneration is an independent advisory body that makes annual recommendations to the government on the pay of NHS doctors and dentists. Its recommendations are based on evidence submitted by NHS employers, the BMA, the BDA, DHSC, HM Treasury, and other interested parties. The government is not legally obliged to accept DDRB recommendations but has accepted the 2026/27 recommendation of 3.5% in full.

The 3.5% award applies to the following groups relevant to GP and dental practice finances:

For GP practices:

• Contractor GPs — the pay element of the GMS/PMS contract, reflected in the Global Sum uplift
• Salaried GP pay ranges — the minimum and maximum of the salaried GP pay scale
• All other practice staff — the award creates an expectation that practices pass on equivalent pay rises to non-clinical and clinical support staff funded by the practice

For dental practices:

• NHS dentists working under GDS and PDS contracts — reflected in the UDA value and contract value uplifts
• Salaried dentists in Community Dental Services — direct pay scale adjustment
• Dental associates — indirectly through the UDA rate, which affects the income from which associate percentages are calculated

Key Point: The DDRB recommendation is not simply a pay rise for GPs and dentists personally. For practices that employ salaried staff, it carries an explicit expectation from NHS England that the funding uplift will be used to deliver equivalent pay increases to all practice staff — receptionists, healthcare assistants, practice nurses, administrators, and managers — not just the clinical staff covered directly by the DDRB. The NHS Primary Care Bulletin confirmed that practices are expected to pass on pay rises to all practice staff in line with this funding uplift. ICAEW This is where the financial challenge becomes most acute.

How the 3.5% Award Flows Into GP Practice Finances

For GP practices, the DDRB award manifests primarily through two mechanisms: the Global Sum uplift and the salaried GP pay range adjustment.

The Global Sum uplift:

The GMS Statement of Financial Entitlements for the 2026/27 GP contract has been published, with Global Sum payments increased from 1 April to £130.07 per weighted patient, reflecting the DDRB recommendations and enabling a 3.5% pay uplift for salaried and contractor GPs. PwC Tax Summaries

For a GP practice with 8,000 weighted patients, the increase in Global Sum income from the 2025/26 rate to £130.07 per weighted patient represents a meaningful uplift in the most stable and predictable element of NHS income. However, the Global Sum uplift is designed to fund the pay award for contractor GPs — the partners — not to separately fund pay rises for all employed practice staff on top. The expectation that practices pass on the award to all staff creates a cost that must be funded from the combined contract uplift, not just from a dedicated staff pay element.

The salaried GP pay range adjustment:

The minimum and maximum of the salaried GP pay range have both been uplifted by 3.5% from 1 April 2026. A salaried GP previously at the top of the pay range now has a new contractual minimum that is 3.5% higher. For practices employing salaried GPs — an increasingly common arrangement as the traditional partnership model has given way to employed GP models in many areas — this is a direct and immediate payroll cost increase that must be implemented from April 2026.

The ARRS funding interaction:

For practices using ARRS funding to employ GPs under the new GP Reimbursement Scheme, the reimbursement rate covers salary at the top of the salaried GP pay range including employment on costs. The 3.5% uplift to the salaried GP pay range means the ARRS/GP Reimbursement Scheme reimbursement should also increase to cover the higher salary. Practices should confirm with their ICB that reimbursement rates have been updated to reflect the new salaried GP pay range from April 2026 — if the reimbursement is still based on the old pay range, the practice is absorbing the pay award cost without receiving the corresponding uplift in reimbursement.

The Obligation to Pass On the Award to All Practice Staff

This is the aspect of the DDRB award that is most often misunderstood or underestimated in practice financial planning. The expectation is not simply that GP partners receive more through the Global Sum and salaried GPs receive a pay range uplift. It is that the entire practice workforce receives a pay increase consistent with the 3.5% award.

For a GP surgery with a team of twelve employed staff across reception, administration, healthcare assistance, and practice nursing, passing on 3.5% to each employee from 1 April 2026 generates a specific and calculable additional payroll cost. Let us model this precisely.

Worked Example — GP Surgery Pay Award Cost:

A GP surgery employs twelve staff with the following salary structure:

• 1 practice manager at £42,000
• 1 senior receptionist at £28,000
• 4 receptionists at £24,000 each
• 2 healthcare assistants at £25,000 each
• 1 practice nurse at £36,000
• 1 social prescriber at £30,000
• 1 administrator at £23,000
• 1 pharmacist at £55,000

Total current payroll: £42,000 + £28,000 + (4 × £24,000) + (2 × £25,000) + £36,000 + £30,000 + £23,000 + £55,000 = £335,000

3.5% pay award cost on £335,000 payroll: £335,000 × 3.5% = £11,725 per year in additional salary

Additional employer NIC on the pay increase at 15%: £11,725 × 15% = £1,759 per year

Total additional cost of passing on the DDRB award to all staff: £13,484 per year

This £13,484 must be funded from the contract uplift. For a practice of this size — approximately 8,000 to 9,000 patients — the GP contract funding uplift is approximately £7,800 per year on the Global Sum alone. The pay award cost therefore exceeds the core contract income increase by approximately £5,700 before any other cost increase is considered.

When the April 2026 employer NIC changes are added — the rate increase to 15% and the secondary threshold drop to £5,000 generating approximately £4,676 of additional NIC on the existing payroll as modelled in our NIC changes guide — the total additional employment cost in 2026/27 versus 2025/26 for this practice approaches £18,000. Against a contract income increase closer to £7,800 from the Global Sum uplift alone, the funding gap is material and requires active financial management rather than assumption that the contract uplift covers the cost.

How the 3.5% Award Flows Into Dental Practice Finances

For dental practices, the DDRB award mechanism is different from GP practices because most NHS dental income flows through UDA values rather than a per-patient Global Sum.

The UDA value uplift:

The 3.5% DDRB award is reflected in an uplift to NHS dental contract values from 1 April 2026. For a dental practice with a Negotiated Annual Contract Value of £400,000, the 3.5% uplift adds approximately £14,000 to the annual contract value — expressed through a higher UDA value or a higher NACV depending on how the contract is structured.

However, this uplift must be read alongside the April 2026 NHS dental contract reforms — the mandatory 8.2% unscheduled care requirement, the introduction of complex care packages from June 2026, and the recall interval quality improvement programme. The contract value uplift and the structural reform of how UDAs are earned and paid interact in ways that make it very difficult to treat the 3.5% DDRB award as simply adding 3.5% to practice income. The reformed contract changes the mix of activity required to earn the full NACV, which affects cash flow even if the headline value increases.

Associate pay implications:

Most dental associates are paid as a percentage of the NHS UDA income and private fees they generate — typically 40% to 50% of UDA income. A 3.5% uplift to UDA values automatically flows through to associate earnings at the same percentage rate, meaning associates benefit proportionally from the DDRB award without any separate negotiation required. For practice owners, this means a portion of the NACV uplift is automatically distributed to associates — reducing the amount available to the practice owner as retained income.

Salaried dental staff:

Dental practices that employ salaried dental nurses, hygienists, receptionists, and managers face the same obligation as GP practices to pass on the DDRB award to their employed workforce. The 3.5% expectation applies to all NHS-funded dental staff. A dental practice with six employed support staff at an average salary of £26,000 faces an additional payroll cost of approximately £5,460 per year from the pay award, plus additional employer NIC of approximately £819 — a total of £6,279 per year before the NIC changes on the existing payroll are factored in.

Worked Example — Dental Practice Pay Award vs Contract Uplift:

A mixed NHS/private dental practice has a NACV of £350,000. The 3.5% DDRB uplift adds approximately £12,250 to the NACV.

The practice employs six salaried staff at an average of £26,000. Total payroll: £156,000. 3.5% pay award cost: £156,000 × 3.5% = £5,460 Additional employer NIC on the pay increase: £5,460 × 15% = £819 Total pay award cost for employed staff: £6,279

Two associates each generating 45% of NHS income from their UDA work. Combined UDA income attributable to associates from the uplift: £12,250 × 45% × 2 associates proportional share = approximately £5,513 flowing to associates automatically.

Net NACV uplift retained by the practice after associate share and staff pay award: £12,250 − £5,513 (associates) − £6,279 (staff) = £458 net benefit to the practice

This worked example — deliberately simplified — illustrates that the DDRB award is not a windfall for dental practice owners. For many practices, the combination of the associate percentage structure and the obligation to pass on pay rises to employed staff means the net financial benefit to the practice owner from the 3.5% contract uplift is very small, while the gross cost increase is substantial.

Accounting for the Pay Award: What Needs to Change in Your Books

The DDRB award creates several specific accounting adjustments that should be made from April 2026 in both GP and dental practice accounts.

1. Update payroll from April 2026

The most immediate action is ensuring all affected employees receive their 3.5% pay increase from 1 April 2026. For employees on monthly payroll, this means the April 2026 payroll run — which will be processed in late April or early May — should already reflect the new salaries. If your payroll has not yet been updated, this needs to be corrected immediately with appropriate backdating to 1 April. Delayed implementation of the pay award creates a liability — the practice owes back pay to affected employees from 1 April regardless of when the payroll system is updated. Our payroll for healthcare team can implement the pay award update and calculate any back pay liability for practices that have not yet applied the increase.

2. Update the staff cost budget for 2026/27

Your 2026/27 practice budget should reflect the full-year cost of the pay award from April 2026 — not just the incremental increase over the 2025/26 payroll. If your budget was set in January or February 2026 before the DDRB report was published, it will need to be updated to incorporate the 3.5% uplift on all staff salaries plus the additional employer NIC on the increased salaries. A budget that understates staff costs will generate misleadingly optimistic profit projections throughout the year and may lead to partner drawings or dividend decisions based on incorrect assumptions.

3. Update management accounts to reflect the new salary levels

Your bookkeeping system should be posting staff costs at the new salary levels from April 2026. If management accounts are being prepared using the old salary levels — either because payroll has not been updated or because the bookkeeper has not been notified of the change — the accounts will understate staff costs and overstate profit. This is a straightforward but important update that should be confirmed with your bookkeeper or accountant before the April management accounts are finalised.

4. Accrue the Global Sum uplift from April 2026

For GP practices, the Global Sum at £130.07 per weighted patient should be accrued as income from April 2026. If your practice has been accruing Global Sum income at the 2025/26 rate, update the accrual immediately. The difference between the old and new Global Sum rate, multiplied by your patient list size, is additional income that should appear in your April 2026 management accounts — not simply when the first payment at the new rate arrives from NHSBSA.

5. Treat the dental NACV uplift correctly in income recognition

For dental practices, the 3.5% contract uplift changes the monthly advance payment from NHSBSA from April 2026. The new advance payment level should be the baseline for income accruals from April. If your UDA delivery and the deferred income liability calculation were based on the old NACV, update both the income accrual and the deferred income balance to reflect the new contract value from April 2026.

The Net Financial Position: Is the Funding Enough?

This is the question that every GP practice manager and dental practice owner is asking — and the honest answer is that for many practices, the DDRB award creates a net cost increase rather than a net financial improvement in 2026/27.

The funding gap analysis for GP practices:

The 3.5% Global Sum uplift provides additional income. But it must fund the 3.5% pay award for all practice staff — including those not directly covered by the DDRB recommendation — plus the additional employer NIC on those higher salaries at the new 15% rate. As the worked example above demonstrates, for a typical mid-sized practice the pay award cost can exceed the Global Sum uplift by several thousand pounds per year before the NIC increase on the existing payroll is even considered.

The practices that are most exposed are those with large employed workforces — practices with employed salaried GPs in addition to partners, practices with practice-employed nurses and pharmacists, and practices with extensive non-clinical support teams. For these practices the pay award obligation is proportionally larger relative to the contract income uplift.

The funding gap analysis for dental practices:

For NHS dental practices the position is further complicated by the associate percentage structure and the April 2026 contract reforms. A straightforward comparison of NACV uplift versus staff pay award cost does not capture the full picture because a significant proportion of the NACV uplift automatically flows to associates, reducing the net amount available to the practice owner to fund other cost increases.

Mixed NHS/private dental practices have some ability to adjust private fees to compensate — but pure NHS practices face the same structural constraint as GP practices: the income is fixed by the contract and cannot be adjusted to reflect actual cost increases.

What practices should do about the funding gap:

The first step is to quantify the gap precisely for your practice using the methodology set out in this guide. The second step is to review all other variable costs — discretionary expenditure, locum usage, consumables — to identify any offsets available. The third step is to model partner drawings or director dividend levels for 2026/27 based on the realistic net profit position after all cost increases are applied — not based on prior year profit levels or assumption that the contract uplift fully covers the increased costs.

Our GP practice accounting team and dental practice accounting team are conducting 2026/27 net financial position reviews for all practice clients, modelling the combined effect of the DDRB pay award, employer NIC changes, NLW increase, and contract uplift on practice profitability. If you have not yet had this modelling done for your practice, the sooner it is completed the better — decisions about partner drawings and staffing made now without this analysis may need to be unwound later in the year.

Partner and Associate Earnings: What the Award Means Personally

Beyond the practice-level financial impact, the DDRB award has direct personal income implications for GP partners and dental practice owners as individuals.

GP partners — contractor pay element:

For contractor GPs, the 3.5% uplift to the contractor pay element is reflected through the Global Sum increase. However, the net effect on individual partner earnings depends entirely on how much of the Global Sum uplift remains as distributable profit after all practice costs — including the staff pay award — are met. As the worked examples above demonstrate, the distributable profit increase per partner may be substantially less than 3.5% of their current drawings, and in some practices may be negligible or negative if the funding gap is not managed carefully.

Salaried GPs:

For salaried GPs, the pay award is more straightforward — the DDRB recommendation translates directly into an increase in contractual salary within the updated pay range. A salaried GP at the midpoint of the 2025/26 scale should see a 3.5% increase in their base salary from 1 April 2026. If your practice has not implemented this increase, the salaried GP is entitled to back pay and the practice has a growing liability. Our GP practice accounting team can confirm the updated pay ranges and ensure your payroll reflects them correctly.

Dental associates:

For associates paid on a percentage of UDA income, the 3.5% uplift to UDA values flows through automatically — the associate’s earnings increase in proportion to the contract value without any separate negotiation. The practice owner should be aware that this automatic flow-through reduces the net benefit of the NACV uplift to the practice, as modelled in the worked example above.

The personal tax implications:

For GP partners, the increase in distributable profit — however modest after practice costs — increases their taxable income from the partnership. Partners who are already above the £50,000 MTD threshold should ensure their quarterly MTD submissions reflect the updated income level. Partners whose income approaches the £100,000 personal allowance taper threshold should review whether the additional income from the pay award — on top of the dividend tax increase and other 2026/27 changes — pushes them into the taper zone, which would trigger a 60% effective marginal rate on the affected income. Our personal tax team works with GP partners and dental practice owners on exactly this type of whole-income tax planning at the start of each new tax year.

The Business Tax Position: Corporation Tax for Incorporated Dental Practices

For dental practices and private clinics operating as limited companies, the DDRB award and its cost implications feed through to the corporation tax position.

Additional salary paid to employed staff as a result of the DDRB award is fully deductible against corporation tax at 25% — reducing the company’s taxable profits by the full amount of the pay increase. The additional employer NIC on those higher salaries is also deductible. The net cost of the pay award to an incorporated dental practice after corporation tax relief is therefore:

Additional salary: £5,460 Additional employer NIC: £819 Total additional cost: £6,279 Corporation tax relief at 25%: (£6,279 × 25%) = £1,570 Net cost after tax: £4,709This means the effective cost of passing on the DDRB award to employed staff is reduced by the corporation tax deduction — but only if the company is profitable and paying corporation tax. A practice that is loss-making or below the small profits rate threshold does not receive immediate tax relief on the additional cost. Our business tax team can model the corporation tax impact of the pay award for your incorporated practice and ensure the deduction is correctly claimed in your year-end accounts.