Infrastructure fund 'faltering' warns GP leader, as CCGs handed control

The £1bn primary care infrastructure fund is 'faltering', GP leaders have warned, as control of the fund shifted to CCGs to help pay for increased capacity in out-of-hospital care.

Dame Barbara Hakin: 'The fund is designed to improve services for patients’
Dame Barbara Hakin: 'The fund is designed to improve services for patients’

GPC chairman Dr Chaand Nagpaul has demanded an explanation from NHS England as to how the fund, first announced by the chancellor in the 2014 autumn statement, will be ‘rescued’.

In a letter to CCGs on Wednesday NHS England national director of commissioning operations Dame Barbara Hakin asked local commissioners to make bids by the end of February 2016 for the second of four tranches of funding.

The fund has been renamed the ‘transformation fund’, Dame Barbara said, ‘to send a clear signal that the fund is designed to improve services for patients’. Commissioners have been told bids can be for projects which increase capacity of out-of-hospital care.

While ‘the bulk of the fund will be deployed to improve estates and accelerate digital and technological developments in general practice’, said Dame Barbara, the money will be used to improve access and the range of services available in primary care, including through technology, workforce and support for working at scale across practices.


Winning bids in phase two will have until 2019 to complete, unlike those in phase one which had just a year. GPC called for the extended timeframe to apply to phase one projects so they do not suffer because of delays.

More than 1,000 GP practices across England shared £192m of the first £250m tranche to improve premises.

The remainder of the first tranche of funding was earmarked for other purposes: £10m for the GP workforce 10-point plan, £5m to pilot clinical pharmacists in general practice, £7.5m for community pharmacy access to summary care records, £25.5m for IT interoperability in the prime minister’s Challenge Fund pilots, and £10m targeted support for struggling practices in special measures.

While the first £250m wave was mostly used to support improvements to existing practice premises, NHS England had indicated that subsequent waves of funding would also be used to support service transformation.


In her letter to CCG leaders Dame Barbara said phase two bids would be assessed according to: 'increased capacity for primary care services out of hospital; commitment to a wider range of services as set out in your commissioning intentions to reduce unplanned admissions to hospital; improving seven day access to effective care;and increased training capacity.’

She added: ‘We are encouraging proposals which create additional capacity for patient care, harness technology which helps to improve patient care or enable innovation in patient care. Proposals which will support improved training for clinical staff will also be welcomed.’

When he announced the funding in December 2014 George Osborne said it would ‘'pay for modern premises and technology’.

Health secretary Jeremy Hunt told MPs the money, taken in fines from banks, would pay for ‘new surgeries and community care facilities in the places where people most want them: near their own homes and families’. Mr Hunt said the facilities would ‘be encouraged to join up closely with local job centres, social services and other community services.’

But once control of the funding was handed to NHS England, chief executive Simon Stevens linked it to his Five Year Forward View plans to create new care models and extended access.

Dr Nagpaul said the promise of £250m a year to fund premises was supposed to address the problem that 40% of GPs feel their premises are so inadequate they struggle to provide basic healthcare.


‘Unfortunately, the reality on the ground is that the scheme has been fraught with delays and administrative hurdles, with large numbers of promised improvements to GP practices across the country yet to start,' he said.

‘We support the extension of the timeline for this process to be completed, but this must apply to the first tranche of funding this year so those who have seen delays are not disadvantaged. Just as worryingly, it now appears that some of the funding may now be siphoned off into other projects and priorities. This is simply unacceptable: ministers promised this funding would improve GP services infrastructure and they should stick to that commitment.’

Dr Nagpaul added: ‘We now need to ensure that these earmarked resources are deployed to ensure that GP premises are fit and able to deliver effective care, and that is done in the quickest possible timeframe. We will be immediately raising our concerns with NHSE and demanding an explanation of how we are going to rescue this faltering programme.’

Photo: Pete Hill

Read the full letter here

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