Exclusive: Systematic underfunding of GPs is driving up the NHS deficit, new research shows

Systematic underinvestment in general practice and district nursing, coupled with deep cuts to social care, are the main factors driving financial meltdown in the NHS, according to landmark research by primary care academics.

In findings set to be presented at this year’s RCGP Annual Conference in October, researchers from NHS Greater Glasgow and Clyde show that slipping targets for NHS finance and performance across the UK are directly linked to cuts in GP services.

Despite record investment in the health service overall and record numbers of employees, the researchers argue, GP funding cuts and erosion of services that closely support it have undermined the NHS gatekeeper function, leaving the NHS fragmented and unable to control costs and demand.

The findings further strengthen the case for restoring to general practice the 11% share of NHS funding it received a decade ago. General practice currently receives around 8% of the health service budget, a figure that could rise to 10% by 2020 under plans set out in NHS England’s GP Forward View.

GP funding cuts

Disinvestment in GP services has been dramatic in recent years. Findings published earlier this year showed that real-terms investment in general practice had fallen by £250m since the Conservative-Liberal Democrat coalition government took office in 2010.

Official data also show that GP partners’ income dropped by almost a quarter in just seven years after a rise when the 2004 GMS contract took effect.

Dr Helene Irvine, a lead author of the research who will present her findings in detail at this year’s RCGP conference in Harrogate, told GPonline: ‘By investing substantially in everyone but the GP and their key ally the district nurse, we have created a very expensive, fragmented service that is not efficient and results in overdiagnosis.

‘We have financial failure and overspending, difficulties recruiting staff to certain specialties, expensive locum costs to keep it all going.

‘Looking at the totality of the NHS north and south of the border, we are spending more than ever, with more people on the payroll than ever, but failing on performance targets like four-hour A&E waits.’

NHS performance targets

Referral targets were also being missed and patients with cancer were waiting longer than they should, added Dr Irvine, a consultant in public health medicine at NHS Greater Glasgow and Clyde.

‘I’m arguing this is because of the increasing fragmentation of the NHS,’ she said. ‘We have reduced the joined-upness of it despite the rhetoric about integration. And the key bit essential to making it all work and controlling overdiagnosis is the GP.'

RCGP chairwoman Dr Maureen Baker said: 'General practice is the cornerstone of the health service - it keeps the NHS afloat and our patients safe, so it is vital that our profession receives the necessary level of funding so we can continue to provide quality care across the UK.

'This valuable research reinforces what the college has been saying for years, underpinning the crucial need for investment in general practice, in the best interests of the health service and patient care.

'GPs and our teams make in excess of 370m patient consultations a year – at least 60m more than five years ago – yet the number of family doctors has increased only slightly and over the last decade, funding in our service has significantly decreased.

'In England, NHS England’s announcement of the GP Forward View provides real hope for general practice and we will be pushing on with our efforts to ensure that the pledges to increase investment in our service and build our workforce are implemented swiftly and effectively.'

Dr Baker said the college's recently appointed network of regional ambassadors would hold NHS England to account on delivery of pledges in the GP Forward View.

Find out more about the RCGP Annual Conference 6-8 October and book your place in Harrogate

*additional reporting by Graham Clews

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