Budgetary decisions by commissioners across England are affecting GPs’ ability to offer their patients what most people regard as essential services and forcing some practices to close, an investigation by The BMJ has found.
This year, eight in 10 Integrated Care Boards (ICBs) – responsible for planning health services for their local population – either reduced or froze discretionary funding for general practices as a proportion of their overall budget for services such as taking blood, wound care, heart monitoring, and minor surgery, reports Gareth Iacobucci.
For nearly half of boards (43%) this was the second year in a row they squeezed practice budgets for enhanced services.
Enhanced services make up around 10% of GP income overall, although this varies by local area and by practice, as services are optional.
The new government has explicitly said the NHS needs to invest more in primary and community care.
But Dr Katie Bramall-Stainer, chair of BMA GP committee for England, said that the findings showed the scale of financial pressures on GPs’ income and why practices were taking collective action – such as limiting how many patients they see each session and stopping rationing referrals – to drive home to the government the urgent need for greater investment in primary care.
The BMJ asked all 42 ICBs in England how much they have spent on discretionary primary care services over the past three financial years, and what this represented as a proportion of their overall budget.
For 2024-25, 34 ICBs provided comparable data. Of these, 27 (79%) either reduced or froze their discretionary spend on primary care services as a proportion of their overall budget compared with 2023-24. Only 7 (21%) increased it.
And 15 ICBs (43%) reduced or froze discretionary spending in both 2023-24 and 2024-25.
Andy Pow, director at accountancy firm Forvis Mazars, which provides accountancy advice to practices, said that pressure on income was forcing some practices to make staff redundant or not replace them.
Dr Bramall-Stainer agreed that the squeeze in discretionary funding ‘plays its part in why practices are closing, and we are haemorrhaging experienced GPs from the NHS workforce.’
This is why the BMA’s GP committee is calling for a sustainable new GP contract across England to deliver greater health equity, greater value for money to the Treasury, and better financial balance for more practices to stop closures, she said.
The data also show huge variation in the amount of discretionary funding and how it is defined, making direct comparisons difficult.
Ruth Rankine, director of primary care at the NHS Confederation, said GPs and ICBs were being frustrated by pressure to maintain capacity in acute care and balance budgets, which was leaving ‘very little bandwidth to start trying to fulfil the government’s ambition to move more care closer to home.’
She added, ‘Where enhanced services are continuing to be commissioned, there is no uplift to the contract value to account for increasing costs, and in many cases services that are reducing demand on other parts of the system are being decommissioned.’
