The future of general practice funding

There is now talk of  reform of general practice funding allocations and major changes in the way

CREDIT: This is an edited version of an article that originally appeared on Ockham

Talk of change has come since the publication of the Fuller Report, which reiterated NHS England’s assertion that ‘Staff in post will continue to be treated as part of the core PCN cost base beyond 2023/24 when any future updates to the GMS contract are considered.’

This is welcome, as many had been concerned that general practice would be expected to pick up the staffing bill for the ARRS staff posts 2024. It is noteworthy, perhaps, that the description is of these staff being part of the ‘PCN cost base’, given the push for PCN funding to come via ICSs in future – which I will come on to.

The report also indicated that there is no planned change to general practice funding until the current five-year contract has run its course. However, the Fuller Report also focuses on primary care funding, including general practice funding, and the shift from nationally to locally driven. 

Everything is pointing to a shift of resources out of the national contract after this 5-year deal expires, with far more to be allocated via ICSs. The distribution of this additional resource will likely be made by ICSs dependent on population health needs, regardless of the specific local needs of primary care providers.

Risks for the future?

This presents several risks for the future of general practice:

• ICSs are governed by a requirement to break even across the system and they cannot ringfence; as a result, funding via an ICS cannot be guaranteed in the same way as funding via a national contract.
• The allocation of locally distributed funds is likely to be based on the health needs of certain populations, meaning distribution across practices will vary significantly. 
• The ability of general practice to influence the direction of funds within a local ICS is far less than its collective ability when negotiating a national contract together. 
• There does seem to be some form of play for some of the existing PCN resources to move into local control. 
• Once resources are within ICS control, they don’t have to come directly to general practice but could come via a partnership mechanism, e.g. a third party ‘support’ provider such as a community trust.

General practice should think carefully about agreeing to any shifts of funds from the national to local systems, but the GPC appears to be placing itself poorly, with its position on the PCN DES.

Whether the service ends up with any choice remains to be seen.