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The News Line: Feature General Practice is already ‘stretched close to breaking point’ – BMA GP committee deputy chair Dr Richard Vautrey
Tower Hamlets march to stop the closure and sell-off of GP surgeries
‘WE cannot continue to meet rising demand with falling investment, general practice is already stretched close to breaking point so we need to address this as a matter of urgency,’ warned Dr Richard Vautrey, deputy chair of the BMA GP committee, yesterday.

He was responding to a report by parliamentary watchdog, the Public Accounts Committee, which calls for inequality in local area funding and a fall in funding for general practice to be addressed.

From April last year the government began phasing out the minimum practice income guarantee (MPIG).

MPIG provides an important financial lifeline to many smaller GP practices by guaranteeing a minimum level of funding that is not dependent on the number of patients a GP practice has on its practice list.

The ending of MPIG threatens the closure of 22 GP practices in Tower Hamlets, east London and 106 nationally.

Dr Vautrey said: ‘Variation in local funding is a longstanding problem which has not been addressed for many years.

‘While the pace of funding improvements for CCGs has been very slow, general practice has been subjected to very rapid and unreasonable funding changes which are having'' a major impact on some GP practices, especially in rural areas and some areas of significant deprivation, as they lose much needed investment.

‘Access to services should not be a postcode lottery, being dependent on the unfair variation in funding for local health services.

‘It’s imperative that all areas have the necessary funding to deliver the same quality of services as each other.

‘Crucially, the report rightly highlights the fact investment in general practice has been falling, while at the same time patient demand has skyrocketed.

‘General practice is carrying out 340m consultations a year – up 40m since 2008 – but underinvestment is having a major impact on GPs’ ability to cope with rising demand and the growing needs of an ageing population.’

The Public Accounts Committee on Friday published its ‘25th Report of this Session’ which examined the National Audit Office’s report Funding healthcare: making allocations to local areas, on the basis of evidence from Paul Baumann, Chief Financial Officer, NHS England, Richard Douglas CB, Director General of Finance and NHS, Department of Health and Simon Stevens, Chief Executive, NHS England.

Its analysis found that nearly a million patients a year are driven to A&Es because they cannot get a GP appointment.

This has raised again the ongoing concern that access to GPs is too limited and forces patients to look elsewhere.

The proportion of NHS spending given to GPs, walk-in centres, optometrists and dentists fell from 29 per cent in 2003/4 to 23 per cent in 2012/13, Funding Healthcare reports.

Labour MP Margaret Hodge, Chair of the Committee of Public Accounts, said:

‘It is deeply concerning that the proportion of total funding devoted to primary care has fallen, even though primary care is vital for tackling health inequalities.

‘Over the last decade, the proportion of total spending committed to primary care fell from 29% to 23% as a consequence of the NHS prioritising hospital initiatives such as reducing waiting times.

‘One of the government’s key policy objectives in allocating health funding is equal access for equal need.

‘Yet we found huge variations in funding for CCGs (Clinical Commissioning Groups) – from £137 per person below their fair share of available funding in Corby to £361 per person above their fair share in West London.

‘Around two-fifths of CCGs and three-quarters of local authorities are receiving more than 5% above or below their target funding allocation.

‘This has important implications for the financial sustainability of the health service as underfunded CCGs are more likely to be in financial deficit.

‘Of the 20 CCGs with the tightest financial positions at 31 March 2014, 19 had received less than their fair share of funding.

‘At the current rate, it would take around 80 years for all local health commissioners to reach their target allocation.

‘It would take around six years before no clinical commissioning group remained below its target allocation by more than 5%. For local authorities and the expenditure on public health, this would take 10 years.

‘We recognise that in moving only gradually from current funding levels the Department’s and NHS England’s priority has been to maintain the stability of local health economies, but this very slow pace of change puts at risk the financial sustainability of those most under-funded.

‘Furthermore, target funding allocations may be unreliable in some areas because they are based on estimates of population size taken from GP registration numbers.

‘GP registration numbers tend to be inflated as people may remain on lists after they have moved out of an area. At the same time, GP lists do not include unregistered patients which may disadvantage areas with high levels of inward migration.

‘NHS England should confirm its commitment to move clinical commissioning groups to within 5 per centage points of their fair share of available funding and set out a precise timetable for doing so.

‘It should also take immediate action to ensure that all area teams are complying with its guidance on validating GP lists, at the same as taking forward its longer-term plans to gain greater assurance over the data.’

In its conclusions and recommendations, the committee’s report says: ‘In 2014-15, the Department and NHS England allocated a total of £79 billion to local commissioners of healthcare, equivalent to £1,400 per person.

‘Following the reforms to the health system in 2013, there are three separate funding allocations.
‘In 2014-15, NHS England allocated £64.3 billion to 211 clinical commissioning groups for hospital, community and mental health services and £12.0 billion to its 25 area teams for primary care; and the Department allocated £2.8 billion to 152 local authorities for public health services.

‘The amount of funding that individual commissioners are allocated is calculated using “funding formulae” that apportion the total funds available …

‘In deciding actual funding allocations, the Department and NHS England consider that they should only move local commissioners gradually from their current funding levels towards their fair shares, to ensure that local health economies are not destabilised.

‘The slow progress towards target funding allocations means the government has not fulfilled its policy objective of equal access for equal need.

‘In 2014-15, nearly two-fifths of clinical commissioning groups and over three-quarters of local authorities remain more than 5 per centage points above or below their target funding allocations.

‘Funding for clinical commissioning groups varies from £137 per person below target to £361 per person above target.

‘This has important implications for the financial sustainability of the health service as underfunded clinical commissioning groups are more likely to be in financial deficit: 19 of the 20 groups with the tightest financial positions at 31 March 2014 had received less than their target funding allocation.’

The report adds: ‘Decisions about funding for the different elements of healthcare and social care have been made without fully considering the combined effect on local areas …

‘Many people need both healthcare and social care, and lower spending in one sector may cause additional costs in the other …

‘The primary care funding formula was developed with limited input from the advisory body and remains an interim approach.

‘NHS England has improved the funding formula for clinical commissioning groups, which is now based on more detailed data.

‘However, these improvements have not been made for primary care …’


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