Around 20 per cent of the entire NHS budget is currently spent on primary care.

Of this, a little under half pays for prescribing. A further 3-4 per cent of a typical primary care trust budget goes on dentistry. Another 1-2 per cent funds opticians and optometrists. The rest, perhaps 7 per cent of total NHS expenditure, is spent on primary care medicine: that is, on GP practices.

Considering the scale of the NHS financial squeeze, it’s an area receiving surprisingly little scrutiny. The gloom of a 4 per cent annual cash saving does not appear to preoccupy practice managers; the dark arts of skill mix review and tendering for contracts remain largely alien. Neither commissioner challenge nor performance monitoring appear excessively onerous. Sure, the occasional zealous London PCT may import consultants to verify GP practice lists; but most don’t.

Indeed, recent changes to the quality and outcomes framework are reckoned to boost average practice income by more than £12,000 per year. It’s a reward for prospective savings in prescribing.

This has nothing to do with GP prowess in commissioning, whether as individuals or within clinical commissioning groups. This is about the day job: seeing patients. The near silence of the (GP-led) NHS Future Forum – and the government response to its report – on primary care efficiency implies business as usual within the GP sector. The issue is conflict of interest once practices commission £65bn of NHS spending.

They disregard an important report published as recently as March by the Nuffield Trust. NHS reforms in England: managing the transition considers it “unrealistic to imagine that the overall efficiency challenge for the NHS can be met by acute sector productivity improvement and management cost savings alone”. Primary care, the think tank concludes, “should become a key focus” of the QIPP (quality, innovation, productivity and prevention) programme.

The argument is: saving £20bn is hard enough. Trying to save that mainly on acute hospital care, where the NHS spends less than 40 per cent of its resource, pretty well guarantees failure. It’s time for primary care to carry its share of the burden.