The value of the healthcare resources used by practice based commissioners significantly varies from the indicative budgets they have been set.

Analysis by HSJ compares the “fair share” budget of 1,802 practices with their actual consumption patterns based on referrals to hospital providers.

This shows that 44 per cent are on track to over-consume against their budget by an average of 8 per cent and 49 per cent were under-consuming by the same amount.

If that pattern were reflected across the entire NHS commissioning budget of £84.4bn in 2010-11, gross over-consumption would reach up to £6.8bn.

On average, patients in the poorest areas used fewer NHS resources than budgeted, while their richer counterparts used more, a trend also reflected in HSJ’s analysis of patient reported outcome measure data.

When practices are divided into groups of five, according to patients’ deprivation, England’s poorest fifth consume, on average, 1.8 per cent less of total NHS resources than they would be expected to, while patients in the richest fifth consume almost 1.7 per cent more than their health needs suggest they should.

The data is based on the latest practice based commissioning toolkit, which sets the proportion of the primary care trust total commissioning budget - or “fair share” - each GP practice should receive for commissioning health services for its registered population.

The toolkit shows how much NHS resources patients at each practice actually use - based on data such as hospital episode statistics.

Practice based commissioning budgets are only “indicative” so practices do not suffer penalties if they “overspend”. Nor do they profit from underspends. Some PCTs are considering making the budgets “hard” or “real” - in line with Conservative party policy.

A recent board document from NHS Cambridgeshire shows it aims to save £2.4m this financial year by incentivising GPs to reduce hospital referrals by giving them “real budgets” and “direct responsibility” for commissioning care.

HSJ has been told the discussions include allowing practices to keep a 10 per cent share of underspends as a profit, but having to suffer the results of overspending - a risk practices will try to mitigate by grouping into “clusters”. Cambridgeshire practices contacted by HSJ said there were concerns those with a history of “overspending” would be shunned by clusters.

Practices are also expected to demand their budgets precisely match their “fair share”, at present around 18 per cent are more than 10 per cent under or over their “fair share”.


National GP referral guidelines are needed to reduce inequalities