PCTs' failure to cut acute care costs threatens to derail GP commissioning and could lead to 'disastrous' primary care cuts, the GPC has warned.
PCT clusters are battling to achieve 'extremely demanding' savings via the Quality, Innovation, Productivity and Prevention (QIPP) programme to stop clinical commissioning groups (CCGs) inheriting shortfalls in April.
But board papers reveal many are concerned that acute care costs remain unsustainable as the NHS seeks to save £20bn over five years.
In NHS Bedfordshire Cluster, acute and specialist care costs were £11.2m over budget, mainly due to 'slippage on QIPP savings targets'. These costs had been 'mitigated by underspends elsewhere', including on primary care and medicines management.
The Arden Cluster board in Warwickshire said that overspending in 2011/12 related 'primarily to acute contract over performance and under delivery of QIPP schemes'.
The performance of some hospitals in NHS Greater Manchester Cluster was deemed 'totally unacceptable', according to minutes from a February meeting. These revealed how GPs were asked to 'deflect' referrals to alternative providers, while patients were moved to private providers to relieve the strain.
GPC negotiator Dr Chaand Nagpaul said PCTs' focus on short-term savings was storing up rising costs for the future.
He warned that bids to make up shortfalls in acute sector savings by cutting primary care would be a 'total disaster'. 'The whole rationale of (cutting) secondary care costs depends on a primary care infrastructure to absorb care in the community. It would be illogical, counterproductive and damaging to cut primary care.'
Many 'early wins' are also exhausted, leaving further savings targets in doubt. A bid to save £500,000 by reducing outpatient review visits in NHS South of Tyne and Wear Cluster was abandoned as 'unachievable' after the cluster found no further savings could be made.
A spokesman for the Greater Manchester Cluster said: 'During this period, patients in Bolton & Pennine NHS Acute Trust were given a choice of treatment in the independent sector or at existing NHS providers, mainly in the areas of orthopaedics and general surgery. This action was taken to treat and or offer choice to patients who had been waiting more than 18 weeks from referral by their GP, in line with patients' NHS Constitutional rights.
He added: 'The position has improved significantly in both areas for patient waits.'