Chancellor Rishi Sunak announced an extra £5.9bn in capital funding for the NHS in a budget announcement on 27 October, but GP leaders and accountants hit out at the government over its failure to mention general practice.
Accountants warned that 'little' of the additional funding announced for the health service will trickle through to general practice, despite the Conservatives promising an extra 50m GP appointments a year by 2024 and 6,000 more full-time equivalent GPs.
The budget has also been criticised for a failure to address pension tax problems that have forced doctors to reduce their working hours, for confirming changes to accounting rules that look set to trigger cashflow problems for practices and for failing to address the impact of NHS pay awards and national insurance increases on primary care.
BMA GP Committee chair Dr Richard Vautrey said:'It was hugely disappointing that yesterday’s budget made no mention of general practice and the government has again failed to set out any credible plans for how 50m appointments can be delivered or offer support to boost the workforce.
'Crucially, we need more GPs and that means investing in increasing medical school places now, alongside measures to boost retention such as reforming pension taxation, as the situation is currently unsustainable.'
Deborah Wood, chairman of the Association of Independent Specialist Medical Accountants (Aisma) and healthcare services partner at MHA Moore and Smalley, said the budget would not deliver significant extra funding for primary care or tackle a long-standing workforce crisis.
'Much has been made of the additional £5.9bn for the NHS, but little of this money will come into primary care,' she said. 'Nor was any financial support offered to address the workforce crisis currently hitting general practice and the wider NHS.'
She added: 'Increases in national insurance contributions and the minimum wage will inevitably lead to above-inflation unfunded pay increases for practice staff.'
GPonline reported earlier this year that an average GP practice in England could face a £15,000 hit because practice funding has not been uplifted to reflect additional employers' costs linked to a 1.25% national insurance rise that kicks in from April 2022.
GPs could also face a damaging rise in income tax next year because changes to accounting rules will make 2022/23 a 'transition year' in which doctors could 'experience higher than normal profits' and as a result, increased tax liabilities.
Notes accompanying the budget confirmed the changes to accounting rules, and Ms Wood warned: 'For practices that do not currently have a 31 March accounting year end, this could lead to sizeable cashflow issues when the new rules come into force, as tax bills normally payable on retirement will be advanced. Many practices will need to decide whether to amend their accounting year end to match the 31 March year end.'
BMA pensions committee chair Dr Vishal Sharma said the government should have offered more in the budget to ease workforce pressures created by pension tax rules. He said: 'It’s so frustrating to see the chancellor missing an important opportunity to help keep thousands of doctors working in the NHS. He absolutely should have reformed the long-standing issues with pension taxation to avoid affected doctors reducing their working hours or retiring altogether.
'It’s all very well announcing almost £6bn pounds worth of capital investment for the NHS, but without plans to increase staffing or, crucially, to ensure that we retain the doctors we have, the impact on the huge backlog of patients needing care will be minimal.'