GP funding 'billions of pounds' short despite Forward View investment, warns GPC

General practice funding remains billions of pounds short despite an 8% real-terms rise over the past three years, the GPC has warned.

GPC chair Dr Chaand Nagpaul
GPC chair Dr Chaand Nagpaul

GPC chair Dr Chaand Nagpaul warned that plans to restore a 10% or 11% share of the overall NHS budget for general practice were being undermined by the inadequacy of health service funding overall, and the fact that general practice workload was 'a moving target', with an ageing population and work moving increasingly out of hospital.

NHS England's Next Steps document, published last Friday, set out 'service improvement priorities' for the next two years and highlighted the reversal of years of real-terms decline in GP funding under the current health service leadership.

The report says: 'In the years prior to the creation of NHS England, investment in general practice was falling in real terms. Each year since the establishment of NHS England we have made sure it has gone up, with real-terms funding increasing by 8% over the past three years.'

GP funding

NHS England's director of commissioning Ros Roughton also highlighted rising GP funding at a board meeting last week, reporting that GP funding in 2016/17 was on track to exceed by £500m investment in the previous financial year. An update presented to the board by Ms Roughton added that 'core primary care allocations' will rise £301m over the 2016-18 financial years.

But speaking to GPonline as NHS England published the Next Steps report, Dr Nagpaul warned that general practice remained 'billions of pounds' short of the funding required to tackle soaring pressure on GPs and end the crisis facing the profession.

GP Forward View plans to deliver a £2.4bn rise in annual GP funding by 2020/21 would not bring the GP crisis to an end, he warned. The BMA said a week before the GP Forward View was published in April 2016 that general practice needed an injection of £2.5bn a year immediately simply to stand still, Dr Nagpaul pointed out.

Dr Nagpaul told GPonline that general practice funding was 'woefully behind' other sectors of the NHS after years of systematic disinvestment in years when overall health service funding was rising.

Austerity

'While there may be an increasing proportion of NHS funding going to general practice now, it is at a time of austerity,' he warned.

'We recognise the intent by NHS England to increase GP resources - and there has been better investment than in recent years - however, the quantum that can be invested under the current NHS budget in no way corrects the billions of pounds of deficit that general practice has accrued over the past decade.

'What is needed really is to address the fundamental issue that the NHS does not have sufficient resources, and is being asked to make unfair cuts.'

He added that with primary care workload constantly growing, it would need significantly more funding in future than the £2.5bn rise the BMA estimated it needed now to maintain services.

'General practice is a moving target,' Dr Nagpaul said. 'We need to see recognition of the expanding level of care in general practice, recognising the continued expansion of services general practice is providing every year due to the older population and movement of work out of hospital.

Ageing population

'There is also a global crisis in health and social care with cuts and workforce issues - all of this is impacting on general practice. As those parts of the NHS are not able to cope, the shortfall is absorbed by general practice. Practices are suffering the impact of pressure on other parts of the NHS - patients come to general practice as the backstop when they are not receiving the care they need in other parts of the system.'

BMA chair Dr Mark Porter said as the Next Steps document was published that 'demand and years of chronic underfunding means the NHS is now at breaking point'.

'At a time when our hospitals are in deficit, GPs are unable to keep up with the number of patients coming through the surgery door and staff are working under impossible conditions, we need an honest look at the pressures facing the NHS and how to give the investment needed to match the promises made,' he said.

'We spend less on health than other leading European economies and cannot continue to do more, with less. Above all it’s time to end the chronic underfunding of our health service and put together a long-term plan to help solve the ever-growing issues around staffing and funding the health and social care system as a whole.'

NHS England chief executive Simon Stevens, who has said he is the most pro-GP NHS leader in history, acknowledged 'strong' pressure on frontline staff in his comments at the launch of Next Steps.

NHS England said the report was 'probably the biggest national move towards integrated care currently underway in any Western country, [which] will also help to put the service on a more sustainable footing for the future'.

Every GP practice in England will be incentivised to join 'hubs' serving around 50,000 patients under the plans. NHS England primary care director Dr Arvind Madan said last week that investment in general practice under the GP Forward View was a 'massive step change' and a 'vote of confidence in general practice.

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