General practice in England saw a real-terms drop of 2.5% in total funding after the Covid pandemic, despite significant increases to PCN investment.
NHS England’s annual dataset on total investment in general practice, published last week and showing data up to 2022/23, covers all funding even if not paid directly to practices, such as IT, the PCN DES and money for general practice ‘transformation’.
It showed that between 2021/22 and 2022/23, total investment excluding Covid-19 costs increased by 4.1% in cash terms from £14.2bn to £14.8bn (see Table 1 below).
But in real terms, investment went down by £376m, which equates to a drop of 2.5%.
This new evidence of reduced funding comes as latest data for October 2024 showed that practices in England have delivered a record level of appointments, reaching 41.3 million which is over 3 million more than in October 2023.
Table 1: Investment in general practice excluding Covid-19 costs (£ millions)
| 2018/19 | 2019/20 | 2020/21 | 2021/22 | 2022/23 | |
| Cash terms | £11,271.327 | £12,342.579 | £13,387.491 | £14,235.851 | £14,821.363 |
| % change | 3.05% | 9.58% | 8.53% | 6.18% | 4.11% |
| Real terms | £12,880.958 | £13,779.860 | £14,174.562 | £15,197.309 | £14,821.363 |
| % change | 0.92% | 6.98% | 2.86% | 7.22% | -2.47% |
Source: NHS England
NHS England noted that there was ‘significant additional funding’ invested in PCNs via the Additional Roles Reimbursement Scheme (ARRS) among other services.
The figures showed that while total investment in enhanced services, in QOF and in premises went down, PCN DES funding increased by £655m over the same period (see Table 2 below).
Doctors’ Association UK GP spokesperson Dr Steve Taylor pointed out that NHS England has ‘neglected’ the fact that the increase in cash terms includes payments to PCNs.
He said: ‘These payments aren’t available for GP practices to use and are only available for ARRS services.
‘When stripping this away, practices have had real terms cuts in income. This results in fewer GPs employed, practices closing and many more considering closures or cut backs.’
NHS England did not include Covid-19 costs in its real-terms calculations of investment over time, but the dataset revealed a significant drop in Covid vaccinations costs, from £727m to £119m.
Total investment in general practice including Covid costs therefore saw a reduction in cash terms of around £91m.
Before publication, these figures are ‘discussed and subsequently agreed’ with the BMA’s GP Committee England (GPCE), according to NHS England.
The GPCE told our sister publication Pulse that this data ‘adds to the already overwhelming evidence of chronic underinvestment into NHS general practice’, and that funding has been ‘on a dangerously steep decline for far too long’.
GPCE deputy chair Dr David Wrigley said: ‘This underfunding has now reached a breaking point, with practices closing at an alarming rate—unsurprisingly given the circumstances. On top of this we now have the hammer blow of additional costs for National Insurance which practices simply cannot afford.’
He called on the Government to take ‘immediate action by adequately investing into general practice to stabilize struggling practices’.
The data published this week is collected by NHS England via ICBs, and is believed to be an ‘accurate summary of how investment in general practice has changed over time’.
Table 2: Investment by service (£ thousands)
| 2020/21 | 2021/22 | 2022/23 | |
| Global sum | £3,854,038 | £4,141,896 | £4,435,119 |
| QOF | £756,265 | £818,126 | £787,717 |
| Total enhanced services (ES, LIS, GP extended hours etc.) | £1,127,872 | £1,142,019 | £1,095,894 |
| Premises | £940,480 | £984,888 | £981,248 |
| IT | £558,212 | £519,996 | £499,256 |
| Total transformation investment (improving access, workforce etc.) | £706,713 | £795,260 | £486,526 |
| PCN DES | £568,474 | £1,017,203 | £1,672,587 |
Source: NHS England
The RCGP that ‘shrinking funding for primary care doesn’t make sense for GPs, patients or the wider NHS’ as GP practices ‘make the vast majority of NHS patient contacts’.
College chair Professor Kamila Hawthorne said: ‘We’ve heard some encouraging proposals from the new Government to move more care into community settings which is what GPs and patients want, but funding will have to follow this. General practice can’t keep doing more with less.’
‘With the 10-year health plan on the horizon in the new year we need certainty, and serious investment in primary care if we are going to be able to get general practice back on track and delivering on the government’s ambitions,’ she added.
Responding to the latest GP appointment and workforce data published this week, the Health Foundation said the figures ‘speak to the huge effort that has gone into meeting the high level of demand for primary care’.
Policy fellow Jake Beech said: ‘The number of full-time equivalent GPs in England is still fewer than in 2015. Although the expansion of other staff working in general practice – like pharmacists and paramedics – has helped to expand the number of appointments available, these staff cannot replace GPs who are responsible for managing the most complex cases.’
He said the Government must ‘ensure general practice is given the resources it needs to recruit and retain more GPs’ if it is ‘serious’ about ambitions to move care of hospital and into the community.
In response to the new GP investment data, the Department of Health and Social Care said general practice has been ‘underfunded for years’ and that it is ‘determined to fix the front door’ of the health service.
A spokesperson said: ‘General practice is key to our aim to move more care out of hospitals and into the community as part of our 10 Year Health Plan, and we have already put an additional £311 million into GP practices.’
This year’s Autumn Budget announced a £22.6bn funding boost for the NHS over two year, with an additional £100m of capital funding ‘earmarked’ for GP estates upgrades.
It is not yet clear how much of this £22.6bn will be allocated to general practice, but health secretary Wes Streeting recently urged GPs to ‘hold tight and wait for funding allocations shortly’.
A version of this article was first published by our sister title Pulse
