Despite the share of health spending in general practice falling for the third year running, there are reasons for hope, but GP leaders need to be given a better chance of success.

“Very frustrated and very sad” was the reaction of leading GP commissioner Hugh Reeve to our evidence that the share of health spending going to general practice has fallen for the third successive year.

The main motivation for many clinical leaders who were persuaded to run CCGs several years ago was to invest in primary care, so their irritation is easily understood.

North East Lincolnshire CCG’s Peter Melton says: “There was an ambition to develop primary care at scale but a lot of CCG leaders are feeling that hasn’t really happened.”

There’s hope

There are a couple of reasons for hope.

The first is that in this financial year £350m has been committed to national ringfenced funds for primary care. That may be a platform for the GP share of the pie to increase.

The second glimmer of light is HSJ’s finding that, while NHS England slightly reduced its general practice spending, CCGs increased theirs substantially.

This may indicate that, as CCGs take on full GP budgets under the “co-commissioning” policy, they will use their new muscle to speed up primary care investment.

‘As CCGs take on full GP budgets, they could use their new muscle to speed up investment’

The potential pitfall is that, although moving GP budgets from NHS England to CCGs should insulate them from raids to pay for specialised services, they are more liable to be called on to subsidise general acute demand.

Worryingly, the GP leaders we spoke to report it is getting more difficult, not easier, to invest in primary care as hospital demand grows, increasing the bill under the payment by results tariff, and with commissioners under pressure to help cut provider deficits.

They call for a move to capitated payment rules incorporating both primary and secondary care. This has been recommended by NHS leaders at all levels ad nauseam, not least through HSJ, in recent years.

HSJ analysis has shown more than 50 NHS trusts were paid bailouts to the tune of £1.2bn last year. This illustrates how utterly defunct the current rules and incentives are – a further blow to those arguing to keep them in place.

Decisive action here would give GP leaders in commissioning a chance at success and might even stem their frustration.

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