GP commissioners blew their budgets by a net 2.5 per cent last financial year, exclusive analysis by HSJ reveals.

If the same scale of overspend was applied to the full NHS commissioning budget of £80bn, it would generate a net deficit of £2bn each year - more than three times the relative size of PCT overspends during the 2005-07 deficit “crisis”, which peaked at £4

If the same scale of overspend was applied to the full NHS commissioning budget of £80bn, it would generate a net deficit of £2bn each year - more than three times the relative size of PCT overspends during the 2005-07 deficit “crisis”, which peaked at £492m.

GP budget deficit could reach £2bn a year

HSJ has obtained the 2009-10 budgets and spending details for 190 practice based commissioning consortia from 33 primary care trusts. The consortia comprise more than 2,000 GP practices - around a quarter of all practices in England.

It will be a very difficult time because GPs like to be loved

Together, the consortia were allocated indicative commissioning budgets totalling £11.5bn. By the end of the year they had spent £11.8bn, producing a net deficit of £289m - equivalent to 2.5 per cent of their budgets.

If the same scale of overspend was applied to the full NHS commissioning budget of £80bn, it would generate a net deficit of £2bn each year (see graph) - more than three times the relative size of PCT overspends during the 2005-07 deficit “crisis”, which peaked at £492m.

The analysis scrutinises actual budgets and spending for the first time at GP consortium level. Previously it had been hoped individual under- and overspenders would balance each other out within consortia. But the analysis shows that in many consortia every member practice overspent.

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In total 83 per cent of the 190 consortia analysed overspent their 2009-10 indicative commissioning budget. In just over half of PCT areas, every consortium was overspent. In Richmond, Suffolk and Oxfordshire PCTs, GP commissioners collectively ran up overspends of 7.8 per cent, 7.2 per cent and 7 per cent, respectively

HSJ’s analysis was based on Freedom of Information Act requests to all PCTs. A number were not able to provide 2009-10 data or report spending and budgets at a consortium level.

Practices identified as not participating in practice based commissioning were excluded from the analysis. Consortium sizes ranged from 42 practices to several standalone practice based commissioners. The data, which is published in full on hsj.co.uk, suggests there is no relationship between consortium size and overspending, although commissioners comprised of just one practice were slightly more likely to underspend.

The white paper says GP commissioning groups will be handed hard budgets from April 2012 and will hold the contracts with acute trusts and other providers from 2013-14.

British Medical Association GPs committee deputy chair Richard Vautrey said the analysis showed how the future was “going to prove very tough times for these fledgling consortia”.

Of the 159 consortia overspending, 47 did so by more than 5 per cent and 12 did so by more than 10 per cent. Five consortia overspent by 20 per cent or more.

Dr Vautrey said the prospect of such significant overspending was “one of the big issues” GPs were concerned about.

He said: “This will put them in the firing line for difficult budget decisions.”

He said that in some ways, that was “no different” from the position PCTs found themselves in now. But he said: “It will be a very difficult time because GPs like to be loved.”

Large overspenders include the North Hillingdon consortium in London, which consists of 18 practices, of which all but three overspent in 2009-10.

Dr Peter Joseph, a GP partner at the Eastcote health centre - one of the three underspending practices - said the difference between under- and overspending practices was not financial acumen or engagement, but rather clinical decision making.

He said: “It all comes down to how people historically refer and prescribe… When someone comes in with a cold, it normally is a cold, but it could be meningitis. It’s about [risk] thresholds.”

A spokesman for NHS Richmond said the commissioning budget represented only part of the PCT’s overall budget, which delivered a surplus in 2009-10.

He said the PCT had a “strong relationship with GPs” and was seeking “innovative schemes to support sound financial and activity management.”

The accountability of overspending GPs