Ben Gowland has read the new GP Forward View a number of times – despite its length! The question on his and everyone else’s lips is “Is there real coffee underneath the froth?”

The new GP Forward view is full of headline promises, but at the same time it is a marathon read (60 pages), repetitive and unwieldy.

Everything hinges on the money. The headline is an additional £2.4bn investment in General Practice. But what is that money, and is it really ‘additional’? How much will practices actually receive? You have to work hard to unpick this from the document, but here is how I think it breaks down:

This year’s GP contract (previously agreed) contains an uplift of 3.2%, totalling £220m. If this is replicated over the next 5 years General Practice will end up with a total funding rise of c£1.1bn. Remember, following the government’s 5-year funding settlement for the NHS at the end of 2015, NHS England had already promised investment in General Practice of 4-5% each year until 2020/21.

Capital investment of £900m. Capital investment promises to General Practice are hard to track. In 2014 £1bn was promised over 4 years from 2015/16 to 2019/20 as the General Practice Infrastructure Fund. This then became the Primary Care Transformation Fund, and then the Estates and Technology Transformation Fund. It looks like £100m of this was spent in 2015/16 (my assumption), and that the existing fund (£1bn less the £100m) has been re-announced as £900m with the deadline extended until 2021. We await the new name…

Recurrent investment of £500m for extra primary care capacity. This money is essentially for 7 day working, and is not for everyone. Hidden away in the document it explains this funding, “will be tested with the current GP access fund sites during 16/17”, meaning (I assume) it includes the funding NHS England has already promised to continue the services at the existing Prime Minister’s Challenge Fund sites. It will be “linked to” investment in 111 and out of hours, raising questions as to whether the money will even make it to core General Practice. This money is only accessible for “groups of local practices and other providers”.

These three pots together make a total uplift of £2.5bn, by my calculations. The promise is for £2.4bn, and the difference must therefore mean that the core expectation of GP practices should be that the annual rise in core contract value will be slightly less than that received this year, over the next 5 years. The only recurrent money that is ‘new’ is the additional funding available to those who pursue the government’s 7 day working agenda. More froth, it seems, than coffee.

This funding “will be supplemented by” a £508m sustainability package. This is essentially non-recurrent funding that will be invested over the next 5 years. It breaks down into 3 distinct pots:

1. £56m of what is essentially crisis support: £40m to continue the £10m investment that was made into vulnerable practices in 2015/16 for another 4 years (bizarrely it is going to start with £16m investment in 2016/17); and £16m for specialist services for GPs suffering burn out and stress.
2. £206m for ‘workforce measures’: the part funded pharmacist programme will be extended (£112m); a new Pharmacy Integration Fund (described as “£20m in 2016/17 and rising by £20m each year”) which is essentially for community pharmacy; a £15m practice nurse development programme; a £6m practice manager development programme; £3.5m in “multidisciplinary training hubs” to develop a wider workforce; plus an unspecified investment in GP recruitment and retention measures. 3000 new mental health therapists were also announced, but the document is silent on the source of funding for these.
3. £246m to ‘support the redesign of services’: £45m to stimulate the uptake of online consultations; a £30m national development programme ‘Releasing Time for Patients’ for all GP practices; plus CCGs to come up with £171m to stimulate providers of extra capacity, to implement the 10 ‘high impact changes’ for General Practice, and to improve in-hours access.

So there you have it: the uplift in core funding over the next four years will be equal to or less than that received this year, the £500m of additional recurrent funding is not really available to the average practice, and at least half of the non-recurrent funding will be focussed on improving access. The lack of clarity in the document I suspect was designed to make the promise of funding look greater than it actually is, and on first reading it did exactly that. Once the reality of what is actually on offer sinks in, there may well be more heartache ahead for both General Practice and the Government.