'Worrying' dip in primary care cash
A fall in the proportion of NHS funding spent on primary care in England is "deeply concerning", the chairwoman of a powerful committee of MPs said.
Spending watchdog the National Audit Office found that between 2003-4 and 2012-13 the proportion of total spending committed to primary care fell from 29% to 23%.
NHS England said the trend was the consequence of focusing resources on hospitals to reduce waiting times, but vowed to reverse the decline in future.
The figures emerged in a Commons Public Accounts Committee report which criticised the way funding is allocated to local health commissioners.
The MPs expressed concerns about the decline in the share of money devoted to primary care, which they said was "an important way of tackling health inequalities".
They said: "NHS England told us that primary care is expected to have more impact than clinical commissioning group spending on reducing inequalities.
"However, between 2003-04 and 2012-13, the proportion of total spending committed to primary care fell from 29% to 23% as a consequence of the NHS prioritising hospital initiatives such as reducing waiting times.
"NHS England said it planned to reverse this trend and increase the proportion of healthcare funding being spent on primary care.
"It would also like to bring together the budgets for clinical commissioning groups and primary care to increase local flexibility with the intention of better targeting local priorities."
The MPs called for the Department of Health and NHS England to "set out the rationale for decisions about how funding is split between different funding streams, including assessing the implications of any changes in the distribution of funding".
Committee chairwoman Margaret Hodge said: "It is deeply concerning that the proportion of total funding devoted to primary care has fallen, even though primary care is vital for tackling health inequalities."
The cross-party committee said that "very slow progress" was being made towards ensuring that all areas received their fair share of health funding following a change in the way money was allocated.
Officials have "prioritised maintaining the financial stability of local health economies" in the way the new arrangements have been phased in to avoid any areas seeing drastic cuts, but this has meant that anomalies remained.
The MPs said: "Around two-fifths of clinical commissioning groups (CCGs) and three-quarters of local authorities are receiving allocations more than 5% above or below what would be their defined share.
"This has consequences for financial sustainability - of the 20 clinical commissioning groups with the tightest financial positions at March 31 2014, 19 had received less than their defined share of funding."
The committee said NHS England has more work to do on tackling inaccuracies in GP list data, which are a key factor in calculating an area's fair share of funding.
Labour MP Mrs Hodge said: "One of the Government's key policy objectives in allocating health funding is equal access for equal need. Yet we found huge variations in funding for CCGs - from £137 per person below their fair share of available funding in Corby to £361 per person above their fair share in West London."
NHS England told the MPs it wanted to get all CCGs to within five percentage points of their target allocations within two years.
But Mrs Hodge said: " At the current rate, it would take around 80 years for all local health commissioners to reach their target allocation. It would take around six years before no clinical commissioning group remained below its target allocation by more than 5%.
"For local authorities and the expenditure on public health, this would take 10 years.
"We recognise that in moving only gradually from current funding levels the Department's and NHS England's priority has been to maintain the stability of local health economies, but this very slow pace of change puts at risk the financial sustainability of those most under-funded.
"Furthermore, target funding allocations may be unreliable in some areas because they are based on estimates of population size taken from GP registration numbers.
"GP registration numbers tend to be inflated as people may remain on lists after they have moved out of an area. At the same time, GP lists do not include unregistered patients which may disadvantage areas with high levels of inward migration.
"NHS England should confirm its commitment to move clinical commissioning groups to within five percentage points of their fair share of available funding and set out a precise timetable for doing so.
"It should also take immediate action to ensure that all area teams are complying with its guidance on validating GP lists, at the same as taking forward its longer-term plans to gain greater assurance over the data."
An NHS England spokeswoman said: "The PAC's recommendations - which we agree with - have already partly been overtaken by events because the extra £2 billion the NHS is getting from April means we're going to be able to halve - from 34 to 17 - the the number of local clinical commissioning groups more than 5% under their fair share of NHS funding, and we're on track to have completed the job the following year, as recommended by the PAC.
"Similarly, from April we have now been able to increase primary care and mental health real terms funding at a far higher rate, with more to come in future years."
A Department of Health spokesman said: "We are increasing the health budget by billions each year and the NHS has changed the way it gives money to local areas so that it better reflects population size and targets areas of deprivation."