Global sum ‘barely covers’ staffing costs for GP practices, BMA data reveals

Global sum income meant to cover all expenses for core general practice ‘barely covers’ staffing costs for the average GP practice, a new data analysis by the BMA has revealed.

The union obtained detailed accounts data from 61 practices in England through a survey, with 90% giving details for 2023/24 and 2024/25, and 79% also sharing details for 2022/23.

Their analysis found that when breaking down expenses, excluding partner pay, practices spend most on staffing – with average employee costs making up 72% of non-reimbursable expenses in the last financial year.

It also found that while the global sum is meant to cover all expenses for delivery of essential services, it ‘barely covers’ staffing costs for the average practice, with the data showing that for 2024/25 global sum income for the average practice per registered patient was £111.82, and staff costs came to £99.26.

Experts told Pulse that the data is exemplary of the fact that while staff costs have been rising, the global sum ‘has not kept up’.

The BMA’s GP committee said that ‘key insights’ from the data have been shared with NHS England and the Department of Health and Social Care, ‘ensuring their awareness’ of the financial pressures facing GP practices in England.

The data showed that overall expenses per patient increased more sharply than overall income per patient in 2024/25 and as a result, net income per patient increased only marginally, meaning a real-terms decrease when accounting for inflation.

The analysis said: ‘We received 165 complete submissions, covering three financial years (2022/23 to 2024/25) and coming from 61 unique practices in total. We broke down earnings, expenses, and net income by registered and weighted patient.

‘When adjusting for CPI inflation, net income per patient dropped in 2024/25. This means income per patient is eroding whilst workload per patient continues to increase.’

The survey remains open on a rolling basis and GP practices have been invited to submit their data to help the BMA build a ‘growing and increasingly robust resource’ to help with GP contract consultations and negotiations.

Katie Collin, partner at specialist medical accountancy firm Ramsay Brown, told Pulse that the global sum is ‘completely insufficient’ and ‘has been for years’.

She said: ‘It’s been steadily worsening, largely because big jumps in staff costs haven’t been fully taken into account.

‘Multiple minimum wage increases have driven wage bills through the roof, and recruitment challenges have only made matters worse – competition for staff is growing, with many making the move to work for PCNs, the private sector, or even abroad.

‘It’s heaping additional pressure onto partners who feel they’ve no choice but to offer bigger salaries – beyond what the global sum allows for – to secure the talent they need.

‘But while staff costs have been rising, the global sum hasn’t kept up. It’s based primarily on inflation, and time and time again, we have seen small increases that fail to address all of the cost-driving factors practices are up against.

‘The ever-problematic Carr-Hill formula doesn’t help either, and always ends up exacerbating the issue for some more than others.’

She added that most practices have been relying on income from QOF and enhanced services to ‘make ends meet for a long time’, realising years ago that the global sum alone ‘just won’t cut it’.

And for them the talk of new neighbourhood contracts potentially taking some of these services out of general practice is ‘a major cause for concern’.

She added: ‘These additional services have become a real lifeline for hundreds of practices, simply because the global sum is so completely, woefully inadequate.’

The Doctors’ Association GP spokesperson Dr Steve Taylor said that the data showed the impact of real term cuts to the global sum.

He told Pulse: ‘With cuts in global sum of 20% in real terms over the past 10 years, increasing staff costs, national insurance and other inflation, it’s no surprise that it now only just covers costs.

‘Many practices are unable to meet the needs of patient care due to the inability to employ GPs. The Government needs to do much more to “bring back the family doctor”, their manifesto pledge.’

A Department of Health and Social Care spokesperson said: ‘These figures do not take into account the £1.1 billion boost this Government has given general practice after years of neglect – the biggest funding increase in more than a decade.

‘As well as providing the funding practices desperately need, we’re fixing the front door of the NHS by cutting red tape that ties up GPs’ time and by recruiting over 2,000 GPs.

‘We now have the highest number of fully qualified GPs since at least 2015, and thanks to the hard work of GPs and action taken by this Government, patient satisfaction is up for the first time in a decade.’

The global sum was increased from £121.79 to £123.34 per patient in July last year to implement the 4% staff pay rise recommended by the pay review body.

The Government is currently reviewing the Carr-Hill formula for GP funding, which could include a departure from the existing approach.

And the Treasury has also recently launched a review focusing on how to shift funding from hospitals into primary and community care, including testing new financial flows.