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NHS contract monitoring and clawback in England and Wales

If you hold an NHS contract, your Primary Care Organisation (PCO) will be monitoring your performance, and act on any concerns. Underperformance can lead to financial recovery – also known as clawback.

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Updates are coming

We're aware this advice page needs to be updated to reflect the 2026 contract changes in England and Wales. Due to government delays in confirming crucial details, we are unable to do that just yet. We're pressing for the answers you need and will be publishing updated guidance as soon as possible. Please review your email preferences to make sure you stay in the know.

Overview

Learn more about the points in your contract that your PCO monitors, including standards, staffing, and revenue. We explain how often this is reviewed, what it involves according to your situation, and the actions you are required to take.

The number of UDAs or UOAs you carry out is subject to scrutiny, and you need to be aware of clawback considerations if you don’t meet your targets. Likewise, we cover what to bear in mind and actions to take if you overperform.

Finally, we set out the rights and responsibilities for how and when you can amend or terminate your NHS contract.

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