For many years there has been a gross inequity in general practice funding in many areas of the UK. This means that some practices can boast twice as much financial support as those that lie at the bottom of the funding table. Even surgeries next door to each other can have vastly different contracts.
Our GP practice, along with many others in the most deprived part of Bristol, comes at the bottom of the table. Historically, this funding inequity dates back to when GP contracts were initially negotiated, and were based on factors such as premises and level of service provision to patients. Many surgeries negotiated very lucrative deals while others were barely balancing their books.
Over the years, although poorly funded practices may have evolved, their contracts remain unchanged, leaving them trying to achieve higher targets on a lower budget. And this has other costs: surgery staff are working harder and becoming exhausted and disillusioned. This comes at a time when the NHS is going through a critical period of change, there are pressures from the Department of Health to ensure "each pound spent is used to bring maximum benefit and quality of care to patients", and there is a move to push more work into primary care, and make efficiency savings in hospital trusts.
Nationally, there has been a desire to equalise the funding across GP practices. Some primary care trusts (PCTs) have taken initiatives to correct the imbalance but others have been severely hampered by having to engage in lengthy consultations and appeals with high-earning practices. The process is likely to be dragged out over years, the argument being that PCTs do not wish to destabilise practices that have enjoyed generous earnings for a long time. There is no extra money in any case, say the PCTs, and equalisation can only come from savings from richer practices that would subsidise the poorer ones.
Funding should reflect the needs of the local population and not just be based on outdated contracts. Working as a GP in a highly deprived area, I see patients with many complex needs. There are problems of teenage pregnancy, high drug use, domestic violence and an increasingly elderly population. This puts huge strains on the hospital trust and local GPs, who often struggle just to keep their heads above water.
At our practice we would like to be able to employ more doctors so we can increase access and length of consultations for our patients. Our district nursing team is stretched to the limit, but if we could fund more community nursing this would be an invaluable asset for older people and the housebound. Our PCT had promised us an increase in funds, so we were planning to employ more staff. Unfortunately, this led to uproar among the richer practices, which form the majority in the city, so we are now facing delays and no clear commitment to extra funds.
The future of general practice remains uncertain. When PCTs are dissolved under the coalition's changes to the NHS, local commissioning groups (which already exist locally) will manage funds and be overseen by national commissioning boards. Locally there could be conflicts of interest, as consortia of practices are made up of both rich and poor practices. Most practices in our commissioning group have generous contracts and so it is not in everyone's interest to reassess funding. Yet PCTs need to act if we are to help the most vulnerable people in our society. At our practice, we are not prepared to wait any longer. Together with other poorly funded surgeries in Bristol we have formed a body to lobby the PCT to distribute funding more equitably.
• Zara Aziz is a GP partner in a practice in north-east Bristol. She is part of the local GP consortia group
