The share of the total health budget spent on GP services fell for the third successive year in 2014-15, according to figures from annual accounts. This is despite national NHS leaders’ declared intention to expand primary care.

  • Share of health spending going on GP services falls for third year in a row
  • Decline comes despite national officials’ intentions to expand primary care
  • CCG and GP leaders say the trend should “ring alarm bells” across the NHS

The last financial year also saw a shift in spending on GP services from NHS England to clinical commissioning groups, HSJ analysis shows.

Department of Health accounts recorded GP services spending as £7.65bn in 2014-15, up from £7.56bn in 2013-14 – a 1.2 per cent increase. Total DH spending increased by more, and as a result GP spending as a proportion of the total fell from 6.3 per cent to 6.2 per cent. This figure fell in the previous two years also, from 6.7 per cent in 2011-12 to 6.5 per cent in 2012-13.

Figures in NHS England’s accounts show spending on GP services also fell as a proportion of total NHS commissioners’ spend between 2013-14 and 2014-15.

The national body reported that GP spend grew overall by £186m, a 2.3 per cent increase.

NHS England’s own GP spending fell slightly from £7.27bn to £7.26bn. This was compensated for by CCGs, whose spending grew by 31 per cent between 2013-14 and 2014-15 to £447m.

NHS England remained the sole commissioner of core GP services in 2014-15 – its primary care co-commissioning policy, under which some CCGs have taken on this budget, only came into effect in April this year.

Commissioners told HSJ the reasons for the large CCG spending increase were:

  • CCGs deciding to invest in general practice;
  • guidance from NHS England suggesting they do so; and
  • 2013-14 figures being artificially low for technical reasons.

In relation to its own spending fall, NHS England said in its annual report it had “been necessary to defer some planned investments in primary care” to offset its overspending on specialised services in 2014-15.

Some sector sources said there may be a greater increase in GP spending in 2015-16 because £350m national funding has been allocated through the prime minister’s challenge fund and the first year of the primary care infrastructure fund.

Several GP and commissioning leaders said they were concerned about the apparent failure to increase GP services’ share of spending.

The Royal College of GPs’ centre for commissioning lead David Payne said: “The figures are very concerning. Despite the best intentions, the overall funding in general practice is falling and that should be ringing alarm bells right across the NHS.”

He also called for a “a review of the current payment by result system”, which he said drew resources into acute care, and a move to “capitation budgets”.

North East Lincolnshire CCG chief clinical officer Peter Melton said the figures would “concern a lot of CCG leaders”. He said there was a “frustration that there was an ambition to develop primary care at scale but a lot of CCG leaders are feeling that hasn’t really happened”.

National Association of Primary Care chair Nav Chana said the “disproportionate spend on other parts of the sector as opposed to GP services” needed to be “urgently corrected”.

Cumbria CCG chair Hugh Reeve said he was “very frustrated and very sad” at the figures. He said the failure to grow general practice’s share of funding was because the activity based tariff payment for acute care drew resources towards those services. For his CCG it was “becoming more difficult” to invest in GP services “because our budget… is very constrained”.

“We have to pay for hospital activity and if that’s not going down it’s not releasing resources for us to invest in other services,” he added.

NHS England said a publication by the Health and Social Care Information Centre later this year would report on GP investment in 2014-15 more accurately.

Analysis: GP share of NHS spending falls for third year