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Hospital funding soars by 30% as cash is sucked from GPs

By Nigel Praities

Hospitals are raiding primary care budgets at the same time as an increasing proportion of their workload is being shifted onto GPs, a Pulse investigation reveals.

PCT funding for secondary care services has risen more than twice as fast as for primary care over the last three years, with the amount of cash paid to hospitals leaping by 30%.

Yet over the same period, trusts have set up an average of five new community services each under the Care Closer to Home strategy – for services such as ENT, musculoskeletal medicine and stroke. Trusts claim to have simultaneously reduced capacity in hospitals, but that is not reflected in the figures.

The findings refute the conclusions of last week's report from the Audit Commission, which suggested Care Closer to Home was not being implemented because there had been no shift of funding to GPs.

Our analysis of funding at 101 trusts provides firm evidence that work has been shifted into the community under Care Closer to Home, but without the resources required to manage the new workload.

Projected funding of secondary care for 2009/10 is 30% higher than in 2006/7, compared with a rise of just 14% for all elements of primary care, including enhanced services and practice-based commissioning.

And in some PCTs, the disc-repancy is even more extreme.

NHS Middlesbrough has actually cut its primary care budget by 5% since 2006/07 while increasing secondary care spend by 29%. It did this despite opening up the PCT average of five new community services over the same period. NHS Middlesbrough claimed the stark difference was a result of boundary changes and that its new Darzi centre was an example of its primary care investment.

Dr John Canning, secretary of Cleveland LMC and a GP in Middlesbrough, said the figures showed hospitals were becoming much more aggressive in pursuing funding: ‘Hospitals are taking more of a commercial approach. There are serious questions about secondary care funding and how the tariff works. It cannot be right that it is much easier to admit a patient than get an outpatient appointment.'

Nearly two-thirds of PCTs said they had achieved the aim of shifting care ‘closer to home', although only 30% could identify hospital services where capacity had been reduced or services decommissioned. The findings support the GPC's view that more resources are needed.

GPC chair Dr Laurence Buckman said: ‘This needs to change if we are going to have more services in the community, but it won't because the Government is determined never to put another penny into primary care.'

ENT services are among those set up closer to home with no shift in funding ENT services are among those set up closer to home with no shift in funding

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