4.3 General Medical Services resources
4.3a Could the Department give an account of the funding
streams for the General Medical Services budget and provide a
trend analysis?
1. The two funding streams that make up the GMS budget
are the discretionary—(cash-limited) and non-discretionary
(non cash-limited) budgets. Table 4.3.1 gives a trend analysis.
Table 4.3.1
TREND ANALYSIS OF FUNDING STREAMS OF THE GMS BUDGET
2. GMS GPs as a whole receive an average level of pay
per GP plus reimbursement of all expenses. Some of these expenses
are reimbursed directly in whole or part. Of these direct reimbursements,
some eg a proportion of staff, premises and IT costs are met from
discretionary spending; pay and remaining expenses are delivered
through non-discretionary spend. Actual expenditure each year
may deliver more or less than the profession's entitlement to
pay or expenses. This outcome can only be finalised when a firm
estimate of GMS expenses is available some two to three years
after year end. Over or underpayments are then corrected in subsequent
years.
3. From 1998-99 PCG and HA (and from 1999-2000) PCT,
discretionary expenditure on reimbursing GMS GPs' practice staff,
premises and IM & T expenses has been protected by the introduction
of the "GMS expenditure floors". These require each
PCT/G or HA to deliver year-on-year increases in GMS discretionary
spend which are at least in line with GDP.
4. All elements of a PMS Pilot's allocation are funded
by transfers of money from the national GMS non-discretionary
budget or from a health authority's or PCT's unified budget.
5. Please note that GMS discretionary and non-discretionary
data lines are taken from the latest 2000-01 Departmental Report—Table
6.12 FHS gross expenditure. It should be noted that due to an
oversight the GMS data also reported at table 7.3 on key statistics
was not amended to mirror these figures. These corrections will
be actioned in the next publication of the Departmental report
for consistency purposes.
4.3b Could the Department provide an account of capital
allocations for primary care investment and the sources of funding
(both HCHS capital and revenue and Family Health Services budgets)
over the last eight years for England and by health authority?
Can they reconcile the General Medical Services budgets against
the HCHS and Family Health Services budgets?
6. There are no capital allocations specifically for
GMS or PMS. The majority of funding for capital in GMS or PMS
is made available through revenue funding streams: HA revenue
allocations which includes GMS discretionary and PMS funding and
GMS non-discretionary spend. Capital related expenditure in the
discretionary element includes cost rents, improvement grants
and computer purchases and PMS funding, while the non-discretionary
element includes GMS notional rents.
7. GMS capital is allocated as revenue because HAs do
not own the assets acquired. A transfer from HCHS capital to revenue
is made each year to fund an element of the total discretionary
GMS provision.
8. The table below shows the transfers of funds made
for year's 1993-94 to 2000-01. Details of transfers for earlier
years are not available.
TRANSFER OF HCHS CAPITAL FOR HA REVENUE ALLOCATIONS FOR
1994-95 TO 2001-02
|
| 1994-95 | £22m
|
| 1995-96 | £23m
|
| 1996-97 | £24m
|
| 1997-98 | £25m
|
| 1998-99 | £26m
|
| 1999-2000 | £26m
|
| 2000-01 | £27m
|
| 2001-02 | £27m
|
|
4.3c Could the Department provide a trend analysis
of the costs of the rental reimbursement schemes (in graphic form)
by category (eg notional, actual etc) and an explanation for any
changes?
9. The information is shown in table 4.3.2 below and
in figures 4.3.1 and 4.3.2.
Table 4.3.2
SPEND ON GMS PREMISES (ENGLAND) 1993-94 TO 1999-2000
Explanation of Changes
(i) All data is based on FIS(FHS)4 part B and part C Health
Authority financial returns respectively
(ii) Non Discretionary:
* From 1997-98 Actual rents was split to additionally show
introduction of Health Centre rents incurred.
* Health centre rates were created in 1997-98 to identify
costs incurred.
(iii) Discretionary
Again with the introduction of monitoring Health centre spend
from 1997-98—Improvement Grants have been split to separately
identify Health Centre spend.
(iv) The decrease in cost rent spend in 1999-2000 is due in
part to GPs having transferred out of GMS into PMS pilot status.
It is also suspected that HAs are misreporting spend correctly
between their cost and notional rents which would account for
the continued increase in notional rents.
(v) Data up to 1995-96 is based on the returns of the former
90 FHSAs. Data from 1996 onwards is based on Health Authority
returns.
Source: Financial returns from the former 90 Family
Health Service Authorities (up to 1995-96) and then the 100 England
Health Authorities.
4.3d Could the Department provide an account of the
total value of the asset base in primary care by category of owner,
eg HA, LA, GP, private provider?
10. The total value of premises occupied by GPs is around
£2.23 billion. This comprises £1.75 billion owner-occupied
premises, £280 million rented from the private sector and
£200 million for NHS-owned health centres.
4.3e Could the Department provide an account of estimates
of backlog in repairs and maintenance for primary care nationally
and by health authority?
11. Financial data on the value of backlog repair and
maintenance for the GP estate is not held centrally. However,
from a total of around 11,000 premises, analysis of a sample of
3,912 rented (excluding health centres) and notional rented premises
showed the following:
4.3f Could the Department provide data on the sources
of finance for primary care premises and debts outstanding?
12. The vast majority of GP premises are funded through
private capital borrowed from the range of specialist and high
street financial institutions and banks. Details of outstanding
loans are considered commercially sensitive and are not available.
In addition, NHS LIFT is a new initiative for which contracts
have yet to be signed. Please see attached Annex A on NHS Lift
rationale
4.3g Could the Department provide baseline data on
the changing ownership of primary care premises and provide details
of the top ten new provider companies?
13. The ratios for GP premises are 63 per cent owner-occupied,
21 per cent private sector owned and 16 per cent occupying NHS-owned
health centres. To date, premises built by third party developers
have mainly replaced existing premises already rented in the private
sector. It is expected therefore that the above ratios currently
remain constant.
14. The leasing of purpose built premises to GPs is still
a relatively new concept involving an increasing number of developers
with varying numbers of completed projects. A "top ten"
list of companies is not yet feasible in this maturing sector
of the GP estate. However, the Department has issued standards
of size, design, construction and lease terms that all third party
developers should give regard when building premises suitable
for modern primary care.
4.3h Could the department provide data on practice
premise size (single handed, 1-4, 4-8, 8-12, 12 plus and average
list size) by ownership category?
15. We do not hold this information. The survey/sampling
exercise mentioned earlier (4.3e) is not robust enough yet to
indicate the proportion/numbers of different sized practices occupying
either leasehold or freehold property.
4.4 Inflation
4.4a Could the Department give an explanation as to
the level of funding set aside for inflation in 2001-02? In particular,
can it give the average inflation funding allocated to each health
authority, the average pay awards to each (subjective) staff group
and the inflation assumptions for non pay including capital charges?
4.4b Could the Department provide a breakdown of the
components of the health specific inflation indices for revenue
spending on HCHS and Family Health Services respectively, together
with capital spending on HCHS, for 1998-99 and 1999-2000, together
with estimates for 2000-01? The tables for the HCHS should show
separate inflation indices for Review Body staff and non-Review
Body staff pay, and whatever other breakdowns of staff are available.
4.4c Would the Department state what the increase
in expenditure on the NHS has been since 1992 in cash terms, real
terms (GDP deflator) and real terms (NHS deflator)?
4.4d Would the Department provide a table showing
the construction of the NHS inflation index from main sub-indices
of pay and other factor costs since 1992, and comment on the assumptions
underlying this construct? Would the Department provide the weights
used for each sub-index, for each year?
4.4a Could the Department give an explanation as to
the level of funding set aside for inflation in 2001-02? In particular,
can it give the average inflation funding allocated to each health
authority, the average pay awards to each (subjective) staff group
and the inflation assumptions for non pay including capital charges?
HEALTH AUTHORITY
INFLATION
1. NHS funding will rise by almost £4.2bn in 2001-02—equivalent
to 6.9 per cent real terms growth. This funding was agreed following
the outcome of both the 2000 Spending Review (SR2000) and the
Chancellors Budget statement in March. The Department made assumptions
about the pay, price and demand increases likely over the next
three years, as well as efficiency and other value for money improvements.
These assumptions informed the debate on funding levels for future
years.
2. In 2001-2002 health authorities received on average
an 8.9 per cent increase in resources. Additional funds have also
been allocated through other mechanisms, such as centrally held
Modernisation monies and via Capital allocations.
3. This overall allocation will help the NHS to meet
healthcare pressures reflected in local Health Improvement Plans.
However, it is for health economies, including health authorities
in partnership with NHS Trusts, Primary Care Groups and local
authorities, to determine how best to use their funds to meet
national and local priorities for improving health and modernising
services. The significant additional resources available will
aid them in this process.
4. It is not, therefore, possible to provide average
'inflation' funding allocated to each health authority. The Health
Service Cost Index (HSCI) covers England only and so a retrospective
view is also not possible. It should be noted that the Market
Forces Factor (MFF) used in allocations will provide a level of
adjustment for various factors which affect prices in each health
authority.
Pay
5. The table below shows the settlements awarded to those
staff whose pay arrangements are determined by the Review Bodies.
