Historic underinvestment in GP funding puts government’s neighbourhood health agenda at risk
General practice funding failed to keep pace with hospital spending in the decade to 2024/25, despite repeated commitments to shift care closer to home, according to a new Health Foundation report.
The health charity calls for a clear multi-year commitment to increase the proportion of NHS spend on general practice, alongside a review of all GP funding streams.
The Health Foundation has warned that the government’s ambitions to move care into the community and realise its vision for a neighbourhood health service are at risk without a sustained focus to shift the proportion of NHS spending towards general practice.
Between 2015/16 and 2024/25, despite repeated government commitments to shift funding from secondary to primary care, the proportion of money spent by NHS England and Integrated Care Boards (ICBs) on primary medical care fell from 8.8% to 8.3%. Over the same period, the share spent on acute services, such as hospitals, increased from 38.4% to 42.6%.
Under the current Labour government, the 2025/26 and 2026/27 GP contracts have provided a boost in funding. The 10-Year Health Plan committed to shifting the share of NHS investment going into primary and community care. But current policies, proposing the introduction of Integrated Health Organisations – most likely to be led by large NHS trusts – risk shifting the focus back towards hospitals. The report warns that a clear policy commitment is needed to increase the share of investment going into general practice so it can deliver the central role expected of it in the government’s neighbourhood health agenda.
Practices provide the vast majority of first contact and ongoing care to the public throughout the year, yet the amount allocated to general practice per patient per year is substantially below the average cost of a single ambulance or emergency care episode. In 2026/27, for £219 per patient on average, practices will typically provide 5 to 6 appointments per patient per year, carry out all non-patient facing work and meet the costs of running a practice, such as staffing and overheads.
The report also calls for a review of all general practice funding streams, not just the Carr-Hill formula (which accounts for three fifths of payments made to practices and is currently undergoing a review). It finds that the way funding is distributed between practices may contribute to inequities, with the overall mix of payments playing an important role. Although the current Carr-Hill formula directs more funding to practices in more deprived areas and rural communities, this may not be sufficient. And once all funding streams are combined, these favour practices serving less deprived populations, underlining the need for government to look at all payments collectively.
The report, the first to provide a comprehensive picture of GP funding in England, also finds marked variation in GP earnings over time and between GPs. GP contractors' – also known as partners – income per session was nearly double that of salaried GPs, and a gender pay gap, disadvantaging female GPs, exists among both contractor and salaried GPs even after accounting for reported working hours.
The Health Foundation urges policymakers to commit to a clear multi-year investment to increase the proportion of NHS spend on general practice, which could be achieved through a minimum investment standard. This should be accompanied by a review of all funding streams and of where unwarranted variation in GP pay exists. This will be necessary to ensure any additional investment supports access, improves continuity of care, addresses inequalities and strengthens workforce sustainability.
Dr Luisa Pettigrew, Senior Policy Fellow at the Health Foundation, said:
‘General practice is the foundation of the NHS. Yet its funding has not kept pace with the role that recurrent governments have expected it to play. While the 2025/26 and 2026/27 GP contracts provided a boost in funding, this followed a decade in which the share of NHS spend going to general practice had fallen.
‘The government consultation on proposed Neighbourhood Provider models states that there will be 'no new national funding'. But if the government are serious about delivering better neighbourhood health services and strengthening care outside of hospitals, more money will be needed in general practice. A clear, multi-year commitment to increasing investment is needed, alongside a review of all funding flows into general practice and of how they are used to ensure that funding is allocated fairly and efficiently.
‘Without this, general practice and neighbourhood health ambitions are being set up to fail, and aspirations to shift care closer to home and reduce costly, avoidable pressure on hospitals will be left unrealised.’
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Nadine Sheikh-Sobeh
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