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Brutal truth of primary care cuts finally emerges

GPs are finally realising the extent to which NHS 'efficiency savings' are going to directly affect primary care. It's time to fight back...

When the banks first crashed, and the UK economy teetered on the brink of collapse, the NHS remained an island of eerie, artificial calm. PCTs still had their annual uplifts, and although everyone knew that budgets would get tougher after the general election, it seemed primary care would be insulated for at least a while from the financial chaos swirling around it.

It doesn't feel like that any more. When the Department of Health unveiled plans to make up to £20bn of efficiency savings by 2014, they sounded rather like a code for NHS cuts, but GPs were perhaps slow to realise the degree to which they had been placed in the financial firing line. Over the past couple of weeks, the brutal reality has crystallised as Pulse has revealed details of those plans. And at last week's BMA rally, doctors' leaders spelled them out in uncomfortable detail, with predictions the NHS is facing its most savage cuts since the early days of Margaret Thatcher.

Given the state of Britain's public finances, it is probably not worth railing against the cuts per se – even though they do make a mockery of the Government's pledge to protect the NHS. Deep cuts are now inevitable whichever party leader steps through the doors of Downing Street in May or June. But there are cuts and there are cuts. The battle over the NHS will mirror the political debate more widely, and centre around how compassionate, sensible and evidence-based are the cuts proposed. You have made it clear, as we demand in the Pulse Manifesto for General Practice, that cuts should focus on Darzi contracts, managers and external consultants – not frontline services.

There is ample evidence the NHS has been desperately wasteful over the past few years, and ought to be able to cut its cloth without slashing its services. Just this week, Pulse reveals a Darzi centre was so overpaid for walk-in consultations its payments have had to be reduced, less than a year after launch. Connecting for Health is piling millions into the fast-tracked rollout of the Summary Care Record, and even heavy cuts to NHS spending on management and consultants will do little to dent the rises over recent years.

Yet NHS managers are often failing to look in the obvious places as they prepare their efficiency savings. Appointment length, mental health services, health visitors – all these are coming under severe financial pressure. Again this week, Pulse reveals more than a fifth of PCTs are reviewing whether they should continue to fund LESs, and in doing so are planning cuts to primary care at just the same time as GPs are being asked to take on more hospital work. There is nothing compassionate, logical or evidence-based about cuts such as these. GPs must be vocal in ensuring they are not allowed to happen.

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