Efficiency plans published by PCTs in recent months reveal the extent to which work will transfer to primary care under the NHS cost-cutting drive.
But the huge increase in workload will be imposed as NHS organisations ratchet up pressure on practices to slash referrals, work longer hours and offer more consultations per session, among other efficiency measures.
Many PCTs are planning to step up value-for-money reviews of PMS and GMS contracts to cut costs, and to review enhanced services. One PCT will benchmark funding for local enhanced services against other trusts and adopt 'existing NHS lower quartile' rates of pay.
NHS Mid Essex also aims to drive up GP productivity 'getting more for the NHS pounds - increasing the number of appointments offered per session, increasing sessions per week, increasing opening times'.
NHS Norfolk's quality, innovation, productivity and prevention (QIPP) plan outlines plans for a 25% rise in primary care 'activity'. 'Spells, contacts and attendances' will rise from 4.3 million a year now to 5.4 million in 2014/15.
NHS Peterborough plans a 14.6% rise in activity.
The Peterborough plan aims to achieve a £15m reduction in spending on acute care, with just a £6.4m boost for primary and community care. These trends are mirrored in QIPP plans for other PCTs.
But the drive to increase efficiency in primary care will put significant pressure on practices as they take on the extra work.
GPC deputy chairman Dr Richard Vautrey warned that patient safety could be at risk if work was transferred to primary care without enough extra funding. 'We have a long history in the NHS of promises of movement of money with activity, but have rarely seen that delivered,' he said.
He added that practices had already 'cut costs to the bone' as the government imposed pay freezes and expenses rose.
NHS Confederation deputy chief executive David Stout said the challenge for the NHS was 'enormous'. 'The only way to meet it is plan early, engage staff, prepare the public and stay ahead of the curve,' he said. 'If you leave it too late, you will end up cutting quality and services.'
