Across the UK, GP surgeries are quietly approaching a financial cliff edge — one
that risks destabilising the very foundation of NHS primary care. While media
attention continues to focus on patient access, waiting times, and staffing shortages,
there’s a less visible but equally dangerous threat unfolding: the deepening financial
fragility of general practice.
Unless action is taken soon, 2025 could be the year many surgeries are forced to
make impossible choices — reducing services, cutting staff, or even closure.
At the heart of this crisis lies a stark mismatch between rising operational costs and
flatlined core funding. Inflation has affected every part of surgery operations.
Practices are dealing with energy bills that remain substantially above pre-crisis
levels. Medical supplies, indemnity insurance, administrative software, and even
cleaning contracts have become significantly more expensive. Yet despite these real-
world financial pressures, core contract funding has remained frozen, forcing
surgeries to do more with less — year after year.
One area of supposed relief, the Additional Roles Reimbursement Scheme (ARRS),
has ironically added pressure for many practices. Although ARRS was introduced to
help practices by embedding new roles — such as care coordinators, social
prescribers, and pharmacists — the reality is more complicated. In many Primary
Care Networks (PCNs), the funding for these roles is stretched to its limit. Surgeries
are now facing long-term liabilities for staff they can’t afford to supervise, support, or
retain sustainably. Managing ARRS staff often comes with hidden overheads and
when things don’t go to plan, it’s the practice — not the system — that picks up the
shortfall.
The Quality and Outcomes Framework (QOF), historically a key income stream for
many practices has also become increasingly unreliable. With rising patient
complexity, growing demand, and fewer staff hours to dedicate to proactive care,
hitting QOF targets is harder than ever. In some areas, practices are seeing a
5–10% reduction in QOF income — a financial blow that can tip marginal practices
into deficit.
And then there’s the structural time bomb: frozen global sum funding. In simple
terms, surgeries are being paid the same or less — in real terms — to deliver more
care to more patients with increasingly complex needs. There has been no inflation-
linked uplift to match the rising cost of service delivery and practices have no
commercial levers to raise prices, renegotiate fees, or reduce mandatory obligations.
This creates a deeply unstable operating model. Practices are expected to run as
lean, efficient businesses, yet they have none of the tools, freedoms, or protections
that a private enterprise would possess. The result is a fragile ecosystem, where
even minor financial shocks can have disproportionate consequences.
What’s most concerning is the silence. While a handful of leaders and organisations
have raised the alarm, the full scale of the problem remains underreported and
under-acknowledged. Practice managers and GP partners often suffer in silence,
papering over financial cracks while trying to protect patient care. But this approach
is no longer sustainable.
There are practical steps that can be taken. Surgeries need to audit their non-clinical
spending more rigorously, especially in areas like energy procurement, where mis-
sold contracts and hidden broker commissions are quietly draining thousands of
pounds per year. Practices can also benefit from federated models — pooling staff
and resources to create efficiencies and improve negotiating power with suppliers.
More fundamentally, there must be a national conversation about core contract
reform. The current funding model is outdated and unfit for the level of responsibility
now shouldered by primary care. ARRS funding needs to be future-proofed, QOF
thresholds need revisiting, and global sum payments must be linked to real-world
inflation.
If we continue down this path — with rising costs, stagnant income and increasing
complexity — the question is not if surgeries will fail, but when. What’s happening
isn’t a natural outcome of mismanagement or inefficiency. GP surgeries aren’t failing.
They are being failed. (2025)