Supplementary evidence from NHS England to the DDRB this week warned that 'to suggest there is no scope for improvement [on efficiency] would not be accurate'.
'Practices do have opportunities to reduce their costs, including through federating - or even simply clubbing together to purchase supplies and achieve economies of scale,' NHS England claimed in response to questions from DDRB officials.
NHS England's evidence also made clear that it did not accept that funding should necessarily increase to match rising practice expenses, despite expenses now having risen to 63.5% of gross earnings.
BMA evidence to the DDRB last month warned that practices' viability was now seriously under threat, because 'GP workload has increased substantially but limited ability to reduce expenses means that personal income continues to fall, thus completing the vicious circle'.
But NHS England's evidence to the DDRB says: 'It does not necessary follow that, just because a particular expenses category has increased in the past – or appears to be doing currently, as in the case of professional indemnity insurance - we should necessarily automatically fund any increase relating to that going forward.'
GPonline reported this year that one in three GPs say their indemnity costs have risen 20% in the past five years.
Meanwhile, NHS England makes clear that despite arguing in the Five Year Forward View that 'NHS pay will need to be competitive in a buoyant economy' any pay award to GPs will 'need to live within the government’s public sector pay policy, of only funding uplifts of up to 1%, for the next four years'.