The GPC warned that clinical commissioning groups (CCGs) would be forced to impose deep cuts to make up ground lost by PCTs on NHS efficiency savings targets that aim to save £20bn by 2015.
A second GP investigation published on GPonline.com last week found that PCTs were already making heavy cuts. One in three PCTs has attempted to make savings by expanding restrictions on 'non-urgent' procedures (see box below).
|NHS efficiency targets|
Source: GP investigation.
PCTs must deliver 4% efficiency savings per year for four years between 2011/12 and 2014/15, under plans set out by NHS chief executive Sir David Nicholson. But data obtained under the Freedom of Information Act from 76 PCTs show that 45 (59%) are not hitting this target.
NHS Bradford and Airedale forecast it would save 1.3% of its total budget. The PCT added, however, that 'major providers' locally would need to make £20m additional savings.
But others are driving through efficiency savings of up to 8.2%, prompting concerns about a 'slash and burn' approach to the so-called Nicholson challenge.
GP leaders have raised concerns about the findings, warning that if PCTs do not meet efficiency targets, CCGs will have to make deep savings.
GPC chairman Dr Laurence Buckman said the findings show that there will be significant pressure on PCTs and CCGs to 'cut even more' next year.
'Clinical commissioning groups will have to show great ingenuity in doing their best to introduce cuts in a humane way, and I suspect they will find that difficult,' he said.
Conservative MP and former health secretary Stephen Dorrell (Conservative, Charnwood) said the results were 'concerning' because the NHS must meet the challenge to keep up with patient demand.
Failing to meet the savings challenge in its first year would make it 'more difficult' in the subsequent years as 'ground will have to be made up', he said.
'Failure to meet it in the first year is concerning enough, but it's clearly more concerning when you see it in the context of the requirement to meet it four years running.'
GPC deputy chairman Dr Richard Vautrey also warned that the situation could be much worse as PCTs may not actually achieve their efficiency savings forecasts.
'Failure to meet this challenge stores up the potential for more draconian cuts in services later in the economic cycle,' he said.
Dawn Scrafield, director of finance at NHS South West Essex, which planned a saving of 8.2%, said it was a 'tough challenge' but could be achieved without compromising clinical care.
Rachael Maskell, Unite's national officer for health, said: 'I have made strong representations at the NHS Staff Council about the expectation on trusts to make the largest cuts to the health service since its formation in 1948.
'It might be the case that the government has not fully understood the damage that such cuts would cause - it is one thing to look at cold statistics produced by Treasury mandarins, but quite another, turning away elderly patients in pain.
'Unite is asking that these 'efficiency savings' are reviewed or the government will be responsible for damaging the life chances of thousands of patients.
'Ministers continue to argue that more resources are going into the NHS. However, the increased budget and the savings from the cuts are all going to fund the expensive and bureaucratic health system that David Cameron and Nick Clegg are introducing in the Health Bill.
'This is money that will eventually end up in the pockets of the six-figure salary private health company bosses, and won't be spent on more hip replacements and day surgery.
'We know that services are being cut in a very real way. For example, speech and language therapists are experiencing 9% cuts across the board, and mental health services in Nottingham are also being severely hit.'