GP practice finances in disarray as workload soars, think tank reveals

More than one in four GPs say their practice's end of year financial situation for 2016/17 will be bad or very bad, according to a think tank report that reveals a 10% rise in patient contacts over the past two years.

The report appears to confirm the impact the GP crisis is having on the wider NHS, with data showing that GP referrals have risen sharply over the past five years. More than 3.6m GP referrals took place in the quarter to June 2016, compared with 2.9m in the same quarter five years earlier - a 26% increase - the report shows.

The latest quarterly monitoring report by the King's Fund think tank - which includes polling of GPs for the first time - found that 23% of GPs predict their practice's end of year financial situation for 2016/17 will be bad, with a further 6% predicting it will be very bad.

Just 20% of GPs said their practice's financial situation would be good, while 51% said the position would be neither good nor bad.

GP funding

Across the wider NHS, the King's Fund survey found that half of NHS trusts predict they will end 2016/17 in deficit. One in 10 CCG leads predicted they would end the financial year in deficit, with 63% forecasting a surplus - but almost three quarters of CCGs admitted their end of year plans depended on significant financial support - including drawing down surplus funding from previous years or having funding from their '1% risk reserve' returned to them.

The GP survey findings confirm the growing financial pressure facing general practice at a time when workload for the profession has gone through the roof.

Data from GP IT systems across a sample of 202 practices analysed in the report show that patient contacts with GPs in the first two quarters of 2016/17 rose 10% compared with the same period in 2014/15.

Face-to-face GP contacts with patients rose 6.1% over this period, with a 36.6% spike in telephone consultations accounting for the rest of the rise.

The King's Fund survey of GPs found that more than half reported having difficulties filling GP partner or salaried GP positions, and around 45% were struggling to recruit nurses.

GP workforce

A third of GPs said their practice was considering cutting partners' pay to cope with financial pressures, and around 45% said they would consider dropping unfunded services.

Expanding use of skill mix and telephone triage were the top responses GPs were considering to manage rising demand - with around a third of GPs citing these options.

The rise in GP referrals is creating a vicious cycle that is further driving up practice workload, the report suggests. 'GP referrals to secondary care are growing at a rate that outstrips population growth,' the report says. 'While this causes increased activity for secondary care, it also generates additional work for general practice both in making the initial referral and following up tasks once the patient has been seen in secondary care.'

GPC deputy chair Dr Richard Vautrey told GPonline that the rise in referrals was no surprise given soaring demand for GP services.

'We have a growing elderly population, and the key is - are there the right support mechanisms in the community to keep people out of hospital. General practice and community nursing services are under such pressure, and the funding to help them cope is yet to materialise.'

He pointed out that practices were under huge pressure because the numbers of patients being seen was increasing, those patients were more frail and had greater multimorbidity than before, and rising patient expectations were being generated by messages coming from the government about seven-day care and public health messages encouraging more visits to GPs.

Findings from the King's Fund report echo results of recent GPonline surveys. GPonline revealed this month that half of GP partners were considering cutting their take-home pay, and that practices serving 5m patients could be forced to close in the next year.

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