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Huge rise in hospital spending by PCTs

Secondary care costs rose twice as much as primary care costs

Louise Prime

Tuesday, 05 March 2013

Primary care trusts’ spending on secondary care leapt by 40% over eight years while their spend on primary care rose by just 22% over the same period, revealed the Nuffield Trust in a report published this morning. This is despite pledges to move care out of hospitals and into primary care.

The Nuffield Trust report, The anatomy of health spending 2011/12, found that PCTs’ annual spending on hospital care increased enormously between 2003/04 and 2011/12, from £49.1bn to £68.8bn – a jump of 40%. Over those eight years, PCTs’ primary care spending as a proportion of their overall spending on NHS care fell from 26% to 24%. Their spending on primary care as a whole rose by just 22%, from £17.7bn a year to £21.6bn – and much of that occurred immediately after the new GP contract was introduced, with much more modest rises since 2005.

In fact, spending on GP services – general medical services, personal medical services and alternative provider medical services – has been static since 2005.

The report’s authors write: “Despite efforts to move care closer to patients, spending on hospital care has also grown rapidly at an average of 5.2% over the last five years while spending on GP services has seen a real terms decline.”

The Nuffield Trust points out that government policy is “to increase relative spending on community services in order to move care out of acute settings”. Spending on community services has increased rapidly since 2006/07, but the report’s authors point out that although they are important, primary care also has a key role to play in making efficiency savings by more appropriate use of hospital services.

Co-author of the report, Nuffield Trust chief economist Anita Charlesworth, said: “This report shows clearly that, for all the rhetoric, money is still moving into hospitals, not out of them. At the same time, however, we should recognise the success of PCTs in moving some care into the community ...

“Policy-makers must ensure that appropriate support and management is in place to guarantee high-quality local services for patients.”

Chair of BMA Council Dr Mark Porter said: “The real terms decline in spending on primary care is disappointing but not surprising. Investing in community care and GP services would be hugely beneficial to patients and do much to relieve pressure on the hospital sector.”

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