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GPs ‘unsurprised’ as IFS report lays bare health under-spending against pledges

GPs ‘unsurprised’ as IFS report lays bare health under-spending against pledges

Health spending has grown ‘by less than planned’ since the last general election, with cash top-ups ‘insufficient’ to offset inflation, a leading think tank has found.

Plans set out in the 2019 election campaign indicated the DHSC budget would increase by 3.3% a year above inflation, however spending has risen by only 2.7% a year on average, according to analysis by the Institute for Fiscal Studies (IFS).

GP leaders said the report’s findings are concerning given the ‘chronic underfunding’ in general practice, which has gone from a recruitment to an employment crisis, driven by the Government’s squeeze on practice finances.

Key findings of the report

Over the past four decades, health spending has shown a clear tendency to rise faster than planned. But in recent years higher than expected inflation has reversed this trend. 

The Department of Health and Social Care (DHSC) budget has grown by less than planned over this parliament, with cash top-ups insufficient to offset the effects of higher inflation.

Conservative party plans at the 2019 general election implied that the day-to-day DHSC budget (for England) would rise by 3.3% per year in real terms; latest plans imply average growth of 2.7% per year between 2019–20 and 2024–25. This is a marked departure from the experience of recent decades.

Source: IFS

The IFS report said that despite the pandemic, ‘record’ waiting lists and ‘growing’ rates of ill health, real-terms day-to-day health spending in England has risen ‘no quicker than was planned five years ago’, despite additional funding.

‘The point is that this additional funding has been insufficient to offset unexpectedly high rates of inflation,’ it added.

Lancashire and Cumbria LMC chief executive Dr Adam Janjua told Pulse that he was ‘absolutely not surprised by the report and its findings’.

He said: ‘This is something that we have been voicing concerns about on behalf of general practice for some time now.

‘The figures look moderately respectable only because the recent Covid pandemic spending is propping up the numbers.

‘We also know that spending on things like secondary care has taken a bigger proportion of the NHS budget so this means that GP funding has reduced by a bigger proportion.

‘This chronic underfunding is now showing its results in terms of more unemployed GPs than ever before despite seeing unprecedented demand for GP appointments from patients.’

He also added that ARRS funding could be ‘skewing the figures for GP funding’ making it look like there has been more investment in primary care.

‘Sadly core GP funding is really lagging behind,’ he added.

DAUK spokesperson Dr Steve Taylor, a GP in Manchester, told Pulse that ‘much of the spending’ has been directed ‘poorly’.

He said: ‘The Government has often spoken about record NHS funding. It does this without any mention of inflation, increasing population or the opportunities created by innovation in health.

‘The facts are much of the spending has been directed poorly and at times misspent. There is a national emergency in recovering from the pandemic but also years of previous austerity which have lead to poor facilities and infrastructure.

‘So yet again we hear that even what has been promised has not been met. Sadly this is no surprise to someone who has seen the decline in provision over the past 14 years.’

RCGP council member and Tower Hamlets GP Dr Selvaseelan Selvarajah also pointed to the failure to invest in core general practice.

 He said: ‘One of the solutions many of us repeatedly highlight is investment in core general practice where we can focus on prevention and proactive care.’

RCGP chair Professor Kamila Hawthorne said the findings ‘come as no surprise’ to frontline NHS staff who are trying their best to care for their patients in the face of ‘increasingly intense’ pressures.  

She said: ‘This funding situation will mean that NHS services will struggle to meet the current needs of patients, but it will also mean that we’re less prepared for escalating growth in need for care if, as expected, trends continue.  

‘The NHS is highly valued by patients but according to recent surveys satisfaction has fallen. This is all the more reason to invest properly in the NHS, so that it has the resources and workforce necessary to deliver patients the care they need.

‘An appropriately funded general practice service will be vital to this, given that GPs and our teams make the vast majority of NHS patient contacts, in turn alleviating pressures elsewhere in the health service.’  

NHS Confederation chief executive Matthew Taylor said he was worried about of ‘difficult decisions’ that may have to be made over staffing levels and service closures due to squeezed funding.

He said: ‘The fact that health spending has not risen as quickly as planned five years ago leaves the NHS with a mountain to climb in order to improve performance and tackle lengthy care backlogs with the threat of further industrial action looming over it as well.

‘We are very worried about what kind of difficult decisions may have to be made over staffing levels and service closures due to squeezed funding. We also know that unrealistically tight revenue settlements are often followed-up by emergency top-up funding, which is not the way to plan for the future or boost productivity.’

A DHSC spokesperson said: ‘We are providing the NHS with record funding of nearly £165bn a year by the end of this Parliament, an increase of 13% in real terms compared to 2019/20, which is making a real difference in cutting waiting lists.

‘The Chancellor also announced at the Budget that the NHS in England will receive a £2.5bn day-to-day funding boost this year and a further £3.4bn investment in the latest technology from 2025, helping to unlock £35bn in savings.’

In March, the Chancellor announced a ‘day-to-day funding boost’ for the NHS in England but failed to allocate any additional funding to general practice.



Please note, only GPs are permitted to add comments to articles

Darren Tymens 14 May, 2024 4:57 pm

But that’s the NHS as a whole, and includes the ever-increasing sums thrown at a failing secondary care.
What would be very interesting to see would be how the investment in Core general practice has changed over the last 6 years.
To be clear
– Not in PCNs.
– Not in ARRS staff.
– Not including Covid payments.

Just Core GMS, in real terms – and taking into account increases in population size and/or workload as well, please.
That might make people sit up and take notice.

Dave Haddock 14 May, 2024 7:40 pm

NHS primary care a bottomless pit of want.
Meanwhile huge sums squandered on pointless PCN staff, pointless meetings, pointless bureaucracy, the ARRS fiasco.. More money means more squandering.
Please can we replace the NHS with something that actually works..

Dr No 15 May, 2024 10:05 am

@Dave H… I take a broader view… please can we replace the Government with one that actually works.