GP funding could be endangered by new NHS England guidance that puts the onus on ‘primary care providers’ to help commissioners achieve a balanced financial position, accountants have warned.
NHS England’s planning priorities and operational planning guidance for the coming year instructs integrated care systems (ICSs) to work with primary and secondary care providers to deliver a balanced net system financial position.
The explicit inclusion of primary care in this requirement seems to be a new addition for this year’s guidance, last updated on 27 January, as it does not appear in the same guidance for 2022/2023.
Accountants have warned that such guidance may lead to ICSs looking at local enhanced service budgets as a potential way of making savings.
The guidance says: ‘ICBs and NHS primary and secondary care providers are expected to work together to plan and deliver a balanced net system financial position in collaboration with other ICS partners. Further details will be set out in the revenue finance and contracting guidance for 2023/24.’
However, the need for balanced budgets across the system ‘will present challenges for primary care’, according to Andrew Pow, board member of the Association of Independent Specialist Medical Accountants (AISMA).
While GP contracts are separate to ICSs and ringfenced, practices do receive funding through local schemes, such as extra money for local enhanced services.
Mr Pow said: ‘Many of these schemes have continued in the current year. However, the risk in the future is that they will move to a PCN-commissioned services or, indeed, be removed altogether in some cases if financial budgets are tight.
‘At a time when GMS baseline funding is being increased at below inflation rates, this could have a significant impact to practice funding. If ICBs choose to move funding into primary care then resources could increase. However, this would be most likely at PCN level rather than at individual practice level.’
The NHSE planning guidance indicates further details can be found in the revenue finance and contracting guidance for 23/24, however there is no clear information on how the net financial position works in practice.
The contracting guidance states that ‘other primary care allocations’, separate to the GP contract, are subject to the requirement for ICSs to ‘break-even’, which means to ‘seek to achieve system financial balance’.
NHSE declined to provide any comment.