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Just 11 ICBs allocate winter support to general practice

Just 11 ICBs allocate winter support to general practice
By Eliza Parr
2 December 2023

GPs in a small number of areas have received local top-up funding to cope with additional winter pressures, but the majority of UK practices have seen no support, Pulse can reveal.

No national funding is available to GP practices this winter, as the Government’s £200m pot announced in September was not directed towards general practice.

At a local level, of the 25 ICBs who responded to Pulse’s request, only 11 confirmed they have allocated additional money to GP practices over and above usual funding.

Most of these funding pots are aimed at increasing capacity in general practice and focus on respiratory conditions. 

The remaining 14 ICBs confirmed that no additional money has been provided to GPs, while 17 ICBs refused to respond. 

The picture is less varied in Scotland and Wales – of the health boards that responded to Pulse’s request, none had allocated winter funding to GP practices.

In Northern Ireland, the Department of Health confirmed that £3.4m has been provided to GP practices to ‘increase their capacity in light of the anticipated increase in demand over winter’.

Where winter funding is being provided to general practice

England – ICBs

  • Black Country
  • Buckinghamshire, Oxfordshire and Berkshire West
  • Cambridgeshire and Peterborough
  • Cornwall and Isles of Scilly
  • Coventry and Warwickshire
  • Hertfordshire and West Essex
  • Lincolnshire
  • Mid and South Essex
  • North Central London
  • Staffordshire and Stoke-on-Trent
  • Surrey Heartlands

Northern Ireland

  • Department of Health 

Examples in England include Hertfordshire and West Essex, where the ICB has matched its offer of the past two years by allocating an additional £1.43 per weighted patient in order to ‘build capacity for winter pressures’. 

Staffordshire and Stoke-on-Trent ICB has provided a total of almost £3m to ‘fund additional primary care provision during winter’ – this will deliver an extra 2,370 practice level appointments per week, as well as winter hub appointments for same day urgent access.

South Staffordshire LMC chair Dr Manu Agrawal, who was closely involved in negotiating this funding, told Pulse that this will ‘absolutely’ benefit practices and that uptake is likely 100%. 

The funding will be allocated for practices to deliver an extra half hour of appointments per 1000 patients on their list, and this scheme will run through December and January.

However, Dr Agrawal highlighted that this is the first time the ICB has given practices adequate notice of additional winter funding – it is usually offered at the last minute – and it only came after ‘a lot of pressure’ from the LMC.

He added: ‘We’ve been talking about winter planning since April and it’s only now that they’ve listened to us. In all honesty, winter starts in October – we’ve got six months of winter. 

‘But at least we’ve got a plan. They’ve given practices some notice this time – four to six weeks’ notice – to plan the clinics and plan the sessions.’

Areas where no winter funding has been allocate to general practice

England – ICBs

  • Bath and North East Somerset
  • Bristol, North Somerset and South Gloucestershire
  • Cheshire and Merseyside
  • Derby and Derbyshire
  • Devon
  • Dorset
  • Humber and North Yorkshire
  • Lancashire and South Cumbria
  • North East and North Cumbria
  • North West London
  • Shropshire, Telford and Wrekin
  • South East London
  • Sussex
  • West Yorkshire

Scotland – health boards

  • NHS Borders
  • NHS Forth Valley
  • NHS Highland (not yet taken a decision) 
  • NHS Orkney 
  • NHS Greater Glasgow and Clyde
  • NHS Lothian
  • NHS Tayside
  • NHS Ayrshire and Arran
  • NHS Western Isles

Wales – health boards

  • Aneurin Bevan University Health Board
  • Hywel Dda University Health Board
  • Powys Teaching Health Board
  • Cardiff and Vale University Local Health Board

In Sussex, the ICB said that ‘seasonality’ is part of the ICB’s financial planning, and that winter funding had been included within the overall allocation to general practice.

But West Sussex LMC member Dr Clare Sieber told Pulse they were informed over the summer that GP practices will not receive any specific winter pressures funding.

‘Clearly with no additional funding, there can be no additional response by general practice to the inevitable seasonal surge, despite one of the key priorities of the ICB being to improve access to primary care,’ Dr Sieber said.

The BMA’s GP Committee England chair Dr Katie Bramall-Stainer said ICBs ‘should be directing new and additional system funding’ towards practices this winter, but also that the Government ‘must invest additional money’ and ‘do much more’ to address the workforce crisis.

She said: ‘Practices try their hardest to keep their most frail patients out of hospital each winter, and this should be a top system priority, ensuring acute flow and supporting those patients who have been discharged too.

‘They are already offering phenomenal access, seeing the equivalent of between 1 in 2 and 1 in 3 of the local population each month, but we appreciate particular seasonal pressures.

‘This is why GPs need winter pressures funding just like other parts of the system to help them manage the increased demand arising from such seasonal spikes.’

RCGP vice chair Dr Victoria Tzortziou-Brown told Pulse that there will ‘always be a degree of regional variation in how funding is applied’ locally, but that the Government’s lack of national support ‘may well exacerbate these discrepancies’.

She highlighted that GPs are the ‘first port of call’ for winter illnesses, but that ‘we simply don’t have enough GPs’ and the funding ‘has not kept up with growing demand’, meaning practices will be in a ‘precarious position’ over the next few months.

Dr Tzortziou-Brown added: ‘Even the Acute Respiratory Infection Hubs (ARIs) , which have been included in the Winter Relief Plan as one of the high priority interventions, may not operate in all areas of the country this winter due to lack of funding.

‘This is despite evidence that ARIs prevented hundreds of thousands of both extra A&E admissions and GP appointments, saving the NHS over £4 for every £1 spent last year.

‘If we are to prevent a health crisis this winter, we must make sure general practice is not overlooked and is supported consistently across regions.  

‘Our manifesto outlines solutions – including a fairer share of NHS funding and an OPEL-type escalation system for general practice- that can help improve patient access to safe and timely care this winter and safeguard the future of general practice and the wider NHS.’

Responding to Pulse’s data on local funding, the Department of Health and Social Care pointed to its primary care recovery plan which announced investment of £240m for digital technology, the long term workforce plan which pledged to increase GP training places by 50%, and also the rollout of Pharmacy First schemes.

‘It is vital that the public can access primary care services when needed and we are making it easier for patients to see and contact their GP, with 29 more appointments in every GP practice, per working day, compared to 2019,’ a spokesperson said.

In Scotland, the RCGP recently complained that GPs had been ‘culturally and systematically neglected’ in the Government’s planning for a winter surge.

Funding was announced for recruitment to the ambulance service and a ‘hospital at home service’ – but the plan made no specific announcements for general practice, despite recognising that demand for GP appointments was high last winter.

Refused or ignored Pulse’s request

England – ICBs

  • Bedfordshire, Luton and Milton Keynes
  • Birmingham and Solihull
  • Frimley
  • Gloucestershire
  • Greater Manchester
  • Hampshire and Isle of Wight
  • Herefordshire and Worcestershire
  • Kent and Medway
  • Leicester, Leicestershire and Rutland
  • Norfolk and Waveney
  • North East London
  • Northamptonshire
  • Nottingham and Nottinghamshire
  • Somerset
  • South West London
  • South Yorkshire
  • Suffolk and North East Essex

Scotland – health boards

  • NHS Dumfries and Galloway
  • NHS Grampian
  • NHS Lanarkshire
  • NHS Shetland
  • NHS Fife

Wales – health boards

Pending FOI response (media team refused to respond):

  • Cwm Taf Morgannwg University Health Board
  • Betsi Cadwaladr University Health Board
  • Swansea Bay University Health Board

This story first appeared on our sister title, Pulse.

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