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‘Primary care providers’ should support ICSs in balancing books, says NHS England

‘Primary care providers’ should support ICSs in balancing books, says NHS England

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.



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

The Locum 13 February, 2023 5:13 pm

Thank the gender non-specifc man in the sky that I’m no longer a partner

Some" Bloke 13 February, 2023 5:29 pm

not really news

Fedup GP 13 February, 2023 5:39 pm

Please do cut the enhanced service – most of them are loss making anyway.

(Can I just check – the ICB’s aren’t stupid enough to think I’ll keep on doing the work for free are they? Are they?)

David Jarvis 13 February, 2023 6:23 pm

Primary care budget tiny compared to hospitals. But I bet I know where cuts will happen. Hope the hospitals are ready for the tsunami coming as primary care implodes. 27 million seen in A&E 340million seen in primary care. I know that you can’t directly compare case mix but if A&E think it is bad now with a finger in the dyke then be very afraid. Of course at the unit cost of an A&E attendance the workload would rapidly exceed the total cost of primary care. But hey who would be surprised if the idiots haven’t thought it through.

Northern Trainer 13 February, 2023 7:22 pm

As always we go for clickbait and looking shortsighted or risk looking lazy. The crime here remains underfunding across all the care system forcing non-clinicians to redesign/improve/squeeze more. We need to be one loud voice screaming at the source of all this mess.

Darren Tymens 13 February, 2023 7:24 pm

Which means ICSs can raid your LCS budget to pay for Trust overspends, such as when they overspend by £20K on tea and biscuits for a small number of staff in one month:

And when those same LCSs are given en masse to PCNs, theywill raid those budgets even more easily:

And when the new contract is imposed shortly all new investment will be funnelled through ICSs and PCNs, making it ripe for ‘topslicing’ for ‘pilot projects’ and also to be used to fill holes in the Trusts’ biscuit budgets:

Northern Trainer 13 February, 2023 7:31 pm

In our patch a 2ww referral meeting all the effin criteria has a phone assessment with a physicians associate at 6weeks prior to a colonoscopy a few weeks later. With no comms from their secondary care team they repeatedly book to see us, we chase up and hear nothing.
If their scope is normal, despite ongoing pain, bleeding, weight loss and bloating – they are discharged by letter back to GP “to consider further investigation” having never met a surgeon.
Surely our consultant colleagues haven’t sanctioned or helped design this?!
It only results in one thing – patients facing a delay in treatment and attending A&E in desperation.

Anonymous 13 February, 2023 10:05 pm

Physician associates diagnosing on the phone?

I am going to look into private healthcare insurance for my family.

Just My Opinion 13 February, 2023 11:20 pm

Its fine. As already commented, enhanced services are generally loss making and are only done for patient convenience.
If they cut funding, we’ll stop doing it and refer all the patients to the hospital.
Good luck.

David jenkins 14 February, 2023 11:01 am

er… !

i do not ask the bean counters to check bp’s, assess diabetics etc etc etc

and i am not going to do the work that these highly paid, 9-5, no risk, bean counters do for half their salary !

the DoH gave the bean counters the jobs – it is quite unreasonable to expect to pay us less for doing their (unnecessary) jobs for them !

if they want to cut fees for our extra work, that’s fine.

if you went to tesco to buy milk, and had no money, they would say “no money – no milk. go away and come back when you can pay for your goods”

it may be very sad, but that is what the great ken clarke, ex health secretary (remember him ?) said when he changed the rules (i think it was 1990) – “i want to see general practices run like small businesses”

amen !

paul cundy 14 February, 2023 6:31 pm

Dear All,
OK so we, the most cost efficient and resource denied part of the NHS should help sort out their mess?
The arrogance and lack of insight is astonishing.
Paul C