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ICBs told to prioritise ‘financial balance’ ahead of GP recovery plan

ICBs told to prioritise ‘financial balance’ ahead of GP recovery plan
By Eliza Parr
9 November 2023

NHS England has instructed ICBs to prioritise ‘financial balance’, with the GP recovery plan among a host of targets being deprioritised for now.

In a ‘reset’ letter sent out yesterday, NHS England said that ‘following discussions with Government’ it has agreed that priorities for the remainder of the financial year should be:

  • to achieve financial balance;
  • protect patient safety; and
  • prioritise emergency performance and capacity, while protecting urgent care, high priority elective and cancer care.

‘The foundation of this reset should be protecting patient safety, including in maternity and neonatal care, and prioritising UEC so that patients receive the best possible care this winter.

‘Progress on existing commitments on elective and primary care recovery programmes, as well as other goals, should build on that foundation,’ the letter said.

Strikes by junior doctors, consultants and other professionals throughout the year have resulted in ‘unavoidable financial costs’ of around £1bn, the letter claimed.

The Government has agreed to offset this via an £800m funding injection although it admitted this included a ‘reprioritsation of national budgets’, and the King’s Fund said only £100m was new money.

The Government has also agreed to reduce the elective activity target for the rest of this financial year to a national average of 103%, down from 109%. 

ICSs have been asked to pull together a ‘rapid two-week’ action plan which lays out how they will ‘live within their re-baselined system allocation’, based on the assumption there will be no further consultant or junior doctor strikes.

‘The primary focus for elective activity should be on long waits and patients with urgent care and cancer needs, including reducing the cancer backlog,’ the letter said. However it added that ‘primary care plans should protect improvements in access.’

NHSE’s senior leaders wrote: ‘As a result of these pressures, for the remainder of the financial year our agreed priorities are to achieve financial balance, protect patient safety and prioritise emergency performance and capacity, while protecting urgent care, high priority elective and cancer care.’

It added: ‘We know how hard you have been working to maintain progress on implementing the recovery plans for elective care, urgent and emergency care, and primary care – as well as wider Covid recovery and priority transformation programmes – in the face of extraordinary pressures from prolonged industrial action.

‘We hope that this letter provides the clarity you have been seeking to now enact, along with system partners, those actions necessary to balance these financial challenges with your wider responsibilities.’

The King’s Fund criticised NHS England’s announcement today, saying the money allocated ‘is not enough’ to secure financial balance and to meet elective recovery ambitions.

Director of policy Sally Warren said: ‘We cannot pretend this is enough money to do everything that the NHS would like to do to give patients the care that they expect and deserve.

‘A reprioritisation process is now going to have to take place on how England delivers healthcare, and this winter healthcare leaders may have to abandon their plans to install additional beds, hire more staff and bring in support from voluntary organisations – measures the NHS traditionally uses to get through seasonal pressures.

‘Yet again, NHS leaders are put in the unenviable position of having to delay investment in buildings and technology to keep services running day to day – these kind of short-term decisions create longer term challenges.’

She added: ‘The cycle of annual emergency funding for the NHS based on a series of short-term plans is no way to run a health service efficiently.

‘We need to get back to a place where the health and care system does not face a meltdown every winter, but that requires long-term decisions that can bring demand, capacity and efficiency back into better balance.’

In January this year, Prime Minister Rishi Sunak pledged that NHS waiting lists will fall, making it one of his five key priorities for 2023.

Latest NHS figures show that as of August, 7.75 million people were waiting to start their first treatment, and last month a think tank predicted that the NHS waiting list will reach a high of eight million next summer if current trends continue – regardless of strike action.

In September, general practice was excluded from a £200m funding pot announced by the Prime Minister to ease winter pressures.

A version of this story was first published on our sister title Pulse.

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