Primary care trusts are doing little to tackle the huge variation in the cost and quality of their GP services, the results of a confidential internal NHS survey suggest.

The survey by the PCT funded advisory body NHS Primary Care Commissioning, shared exclusively with HSJ, shows a 50 per cent difference in what PCTs are paying GP practices. This ranges from £107 to £157 per head, weighted by the health needs of registered patients.

HSJ has been told the variation exists because some PCTs are paying extra for services that others have negotiated as part of the core contract with their GPs.

There is so much potential to prevent spending upstream

NHS Primary Care Commissioning director Helen Northall said the results betrayed a tendency for PCTs to focus on their acute care contracts at the expense of primary care spending. This needed to be redressed as spending tightened, she said.

The survey found only one in 10 PCTs has a dedicated team for managing its contracts with GP practices and only 15 per cent could say how much they spent on this kind of monitoring.

Ms Northall said although primary care contracts ostensibly took up only a quarter of PCT spending, in effect they were “far more significant because primary care is the gatekeeper to the rest of NHS spending through prescribing and hospital referrals”.

“There is so much potential to prevent spending upstream,” she said.

If all PCTs had paid their GP practices the lowest average rate of £107 per patient, the analysis shows the NHS would have saved around £1.2bn on its £7bn primary care bill. Tackling high referral rates to acute care and expensive prescribing patterns would have saved even more.

The survey asked 91 PCTs detailed questions about their contract arrangements for 2007-08. The results were shared with HSJ on the basis that individual PCTs are not named.

The results reveal even greater variations in the amount paid to GP practices once the component parts of the contract are broken down. PCTs can pay practices extra under “enhanced services” contracts for additional services and extended opening hours. But there is a fourfold variation in what PCTs are paying for these services on average - from £6 to £26. The average is £14.

Ms Northall said there was evidence PCTs were paying for things they did not need or want. Some were paying extra for services other PCTs had negotiated as included in the core GP practice contract.

She said: “These contracts may have been put in place several years ago and will include a basket of services, such as phlebotomy, which others will quite rightly have negotiated as part of the standard contract.”

Other examples include weight management and infection control. Some practices are charging PCTs more if they book ambulances for patients.

The research also shows significant variations in quality have been slow to change.

Ten years ago HSJ reported on NHS Primary Care Commissioning’s first survey, which found on average 29 per cent of GP practices were single handed - a trait that correlates with poorer outcomes and access for patients.

The latest results show the intervening years have seen just an 11 point reduction in the proportion of single handed practices to 18 per cent.

Sixteen of the 91 PCTs participating in the survey still had more single handed practices than the national average a decade ago.

A Department of Health spokeswoman said the survey data - which is being fed back to individual PCTs as a benchmarking exercise - “provides helpful information that will assist PCTs in identifying variability in practice performance and enables PCTs to focus their attention on those practices that appear to give cause for concern”.

£157 - Amount spent per patient on primary care contracts at the highest spending PCT. The average PCT spend was £130. The lowest was £107

59% - The highest proportion of single handed practices at one PCT in 2007-08. The average was 18 per cent. Three PCTs had none

29% - The proportion of single handed practices in 1997-98

6.7:1 - The ratio of male to female GPs in one PCT. The national average is 1.9 males to each female. The lowest is 0.7 men to each woman

13.7 - The highest number of complaints about primary care per 10,000 patients. The average was 5.6 and the lowest was 0.1

£6 - The amount the lowest spending PCT pays per patient for “enhanced services”. The highest paying PCT pays £26. The average is £14

1 in 10 - Proportion of PCTs that have dedicated contract management teams for primary care. Fewer than two out of 10 PCTs can say how much they spend on such monitoring

PCTs neglect value in general practice