Increasing GP cynicism about the Government’s Forward View is understandable, argues Ben Gowland and, without a clear financial plan, the criticisms can only increase.

There is a growing temptation for many GPs following the recent criticism of the GP Forward View (GPFV) to dismiss it completely. However, the GPFV is a published policy document by NHS England. It makes many promises. Regardless of whether or not you believe the promises to be sufficient, they are real, written down promises. As such they need to be identified, monitored and those who made them held to account for keeping them. Especially the financial ones.

The complexity of the GPFV makes unpicking these promises, in particular the financial ones, very difficult to do. The RCGP has recognised the importance of this task, and has taken steps to establish what financial promises have actually been made to General Practice, and in particular how close these come to the RCGP’s campaign for General Practice to receive 11% of NHS funding (you can find this here).

What financial promises have NHS England actually made? What can we monitor and hold NHS England to account for? Ultimately there are only two that I think we should focus on: the promise to increase recurrent expenditure on General Practice by £2.4bn a year by 2020/21; and the (separate) promise to create a £508m “Sustainability and Transformation Package” that will be invested between now and 2020/21.

It is stated in black and white headline terms that recurrent funding for General Practice will increase from £9.6bn a year in 2015/16 to £12bn a year in 2020/21. It is not, however, broken down. The financial plan is missing. This I suppose provides room for manoeuvre, but at the same time is leading to confusion, mistrust and the growing lack of enthusiasm for the whole document.

The text does not help. One headline says that the £2.4bn “includes capital investment amounting to £900m over the next 5 years”. How can it? The capital funding is non-recurrent. The promised £2.4bn is recurrent. Even the one year share of the 5-year capital pot in 2020/21 would presumably have to be replaced or matched the year after anyway in order for it to be classified as recurrent.

And what do you make of this statement on p12, “The additional investment we are making in introducing new care models will benefit general practice too – and this will ensure investment rises at least in line with the plans set out above, and potentially even more.”? Does it mean any extra money from the transformation fund is part of the additional £2.4bn, or is it in addition to it? The RCGP sought clarification on this very point and were told by NHS England that it is additional. By the RCGP’s calculations this means General Practice will be receiving an additional amount between £561m and £842m extra (depending on whether you think General Practice will receive a “conservative” 20% of the Transformation Fund or an “optimistic” 30%) by 2020/21. For clarity, this is on top of the additional £2.4bn.

Suddenly the RCGP’s enthusiasm for the GPFV becomes a bit clearer. The money that is needed has really been promised.

But will it materialise? Really, will it? We hear talk of a national ‘reset’ of NHS finances. The funding problems in General Practice are often lost in talk of huge acute provider deficits. Every day we hear reports about the impact of continuing PMS reviews and cuts, alongside the ongoing removal of MPIG. If this level of extra funding was really coming, wouldn’t the approach shift to one of reduced growth payments as opposed to actual cuts? CCGs, even those with the most delegated of primary care commissioning budgets do not know when this funding is coming, how this funding is coming, or what this funding will look like. Can you blame practices for not sharing the enthusiasm of the RCGP?

We need the financial plan. NHS England would not accept a plan from a CCG without the financial plan attached, and General Practice must insist on seeing the financial plan that underpins the GPFV. NHS England needs to do this to build confidence that it will deliver what it has set out in the GPFV. General Practice needs it so that it can hold them to account for doing just this.