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A faulty production line

Primary care given just 7% of £250m winter money

Exclusive GP services received only around 7% of the £250m handed to CCGs to take pressure off emergency services this winter despite widespread calls for the money to be used on preventative measures, a Pulse investigation has revealed.

A Freedom of Information request to 74 CCGs which received part of Prime Minister David Cameron’s two-year, £250m per year pot to reduce A&E pressures found that only 2% of last year’s funding was paid directly to GP practices.

Those who did spend the money on primary care said the schemes - including funding GP education and clinical support in NHS 111 call centres, and paying GP practices £35 per patient to offer a walk-in service outside of core working hours - were a success, and said they were looking at funding the schemes themselves.

The Government has been criticised for focusing the efforts on plugging gaps in services with expensive temporary staff rather than allowing commissioners to plan for the longer term and commissioning leaders said that the nature of the winter pressures funding prevented CCGs from planning in the long term.

Mr Cameron announced the £500m pot of funding - which was to be split between the winter of 2013/14 and the coming winter - in August last year. It was predominantly meant for A&E, but the Government said it could also be used for ‘improvements to other services away from A&E so there are less unnecessary visits or longer stays in urgent and emergency wards’.

Pulse asked CCGs that received a part of last year’s funding to provide a breakdown of how they used it, with 74 returning full responses. Between them, they received £179m funding for use last winter but only £13m – or 7% - was spent on GP services. CCGs only paid 2% - just over £4m of the total - directly to GP practices to provide services.

GP commissioning leaders expressed disappointment that not more of the winter money had gone towards GP services.

How NHS winter money was spent

Total money received by the 74 CCGs: £179,300,081

Paid directly to GP practices: £4,021,531 (to approximately around 700 GP practices) = 2% of total

Spent on other GP services: £8,942,884 = 5% of total

Source: A Pulse FOI request to 74 CCGs.

NHS Alliance chair Dr Michael Dixon said: ‘That is the problem with this whole issue, we end up firefighting, and it would be much, much better if we were to use that money on a planned recurrent basis.’

‘This money comes in with quite a short notice and all you can do then to fund general practice is for them to offer more appointments, open on Saturdays and Sundays, and doing the sort of firefighting that you would be doing if, for instance, you put more money into putting more [temporary staff] in casualty.’

Meanwhile, some CCGs found their GP initiatives effective and worth continuing or repeating in future.

NHS West Kent CCG, which received £2,055,000 in winter money, said that the £57,600 it spent to provide GP education sessions and clinical support in NHS 111 has achieved a 40% reduction in the number of ambulances dispatched as a result of 111 calls.

Ten GPs from the NHS West Kent CCG area have been working on the pilot, supporting all calls to the NHS 111 call centre in Ashford, which covers Kent, Sussex and Surrey areas, since mid-February.

The CCG’s assistant urgent care lead, Dr Tony Jones, who organised the pilot project, said: ‘We were keen to use some of our winter pressure money to help alleviate pressures on NHS 111.’

He said that the CCG identified Saturday and Sunday mornings as ‘pressure points’ for calls to NHS 111, and put two GPs in the call centres to ‘floor walk’. When a 111 call is flagged as a possible 999 call, the GPs will determine ‘whether an ambulance is needed or whether there is a more suitable alternative’.

Dr Jones added: ‘The result has been a 40% reduction in the number of ambulances dispatched as a result of calls to 111.’

NHS Central London CCG, NHS West London CCG, NHS Hammersmith and Fulham CCG, NHS Hounslow CCG and NHS Ealing CCG have cooperated to reduce pressures on emergency services in four major hospital trusts. This included a £520,000 scheme that saw 32 GP practices paid £35 per patient to offer a walk-in service outside of core working hours.

A spokesperson for the CCGs said the measures may now become permanent features. She said: ‘These initiatives are currently being reviewed, but early indications are that investment in primary and community care assisted the delivery of the A&E performance targets.’

‘It is expected that some of these measures could be rolled out on a permanent basis if proven successful and it is anticipated that similar demand management measures will be put into place for winter 2014/15.’

Other CCGs who spent money on primary care services included NHS Warwickshire North CCG, which gave 28 practices a one-off payment of 4p per registered patient as part of an £80,000 scheme to provide same-day telephone assessment or consultation for all requests for advice or to book practice appointments within 30-60 minutes of the initial request.

In NHS Southern Derbyshire CCG, 55 out of 56 local practices took part in a winter money-funded £268,000 scheme to supply extra home visits.

Dr Steve Kell, co-chair of NHS Clinical Commissioners (NHSCC), said in future CCGs should commission more services from GP practices – but added that this would require a clarification of rules related to CCGs commissioning primary care services.

He said: ‘I think 2% [of funding spent directly on GP practices] doesn’t exactly surprise me. I think that needs to increase in the future but that will need clearer working rules with NHS England in terms of co-commissioning and working together.’

‘I think in the future GPs will do more, but it is difficult with the lack of clarity around the rules. It is essential that they are clarified before next winter. I would also say, because you have looked at winter money spent by CCGs, that NHS England as the primary care commissioner has to increase its funding on GP services, especially for the winter period. But I would also hope that CCGs are actively including primary care and general practice in their plans.’

NHS England is currently looking at options for CCGs to take a greater role in commissioning general practice jointly with NHS England’s area teams.

Readers' comments (9)

  • Vinci Ho

    The common sense is funding to have GPs sitting on NHS111 and also to improve OOH will certainly cut down the number of people going to A/E. You can argue funding practices properly to open in weekends is the same as investing more in OOH services.
    It is time for 'efficiency spending ' rather than 'efficiency saving '.

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  • The best predictor of future performance is previous perfomance, hence the decision not to fund Primary Care.

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  • Many patients do need to be admitted, the main issue is not primary care, but getting patients out of the acute sector and back into the community or home. That is where the money should be spent.

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  • Dr Mustapha Tahir

    Until those in power accept that much more of NHS budget should be in primary care, we shall keep going in a vicious circle of winter crisis.

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  • Bob Hodges

    The 'Pressures on NHS 111' are entirely of it's own making. Allowing it to suck another penny away the rest of the NHS is criminal.

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  • I "love" anonymous 12;32 comment.
    It is so reminiscent of world war 2 line management on the Burma railway construction.
    "this (starving prisioner) cannot lift as much as this (well nourished soldier) so clearly does not deserve feeding for the lesser work"
    I was told the above with real names by a former POW Royal Marine in 1975.
    Does it only take 1 or 2 generations for the corruptive effects of power to reduce people to promulgating unjust comparisons and apparently sincerely believing they are " fair comment"?
    It should not surprise me- the only other command system that published acceptable policies, then took its senior management into closed rooms to brief on the actual" implementation and interpretation of the publication" I am currently aware of was the Third Reich.
    Not a paradigm I would wish to follow or be associated with in any way Mr Hunt, but each to his own.

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  • Bob Hodges

    Past performance? Like seeing 93% of all the patient contacts for 7.49% of the budget?

    You're right - past performance suggests that General Practice is the only thing stopping the NHS being 'privatised' straight into the pockets of the 'city elite' today.

    We must be removed!

    Royal Mail was 'accidentally' sold off on the cheap but the tax payer got to keep all the pension liabilities so has to endure more austerity.

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  • Well said, Andrew Mimnagh !

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  • Gaurav Tewary

    Anonymous at 12:32- that's called blaming the victim. i sincerely hope you are not a NHS manager.
    If the argument you promulgate were true we should sack the managers first and all failing trust, 111 and ambulances that are not keeping up with the winter pressure (happens every year so they should have been prepared) should be sacked and replaced guessed it. A GP lead OOH service that will be miles ahead of anything Westminster can cook up.

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