Oct 315 min read

Autumn budget 2024 What does this mean for Primary Care Networks?

Updated: Nov 12

At THC, we provide resources for PCN leaders, and the focus on this blog is on the Autumn 2024 budget which was released on 30th october 2024.

All eyes were on Rachel Reeves as she delivered Labour’s first budget after their 14 year hiatus; in amongst Nusrat Ghani’s many pleas to the house to “simmer down”, the first female Chancellor in British history announced a package of policy decisions in their bid to “fix the foundations of the economy and deliver change by protecting working people, fixing the NHS and rebuilding Britain.”

In this blog, Natasha Payce, Healthcare Assistant Manager | PCN Lead Kent-Gatwick region | MHA - UK member of Baker Tilly International, shares her take on the budget.

I then provide my take and some actionable next steps.

Read this carefully and share it with your colleagues.

Let's jump in!

Q . Natasha, what does this Autumn Budget 2024 mean for Primary Care Networks?

Whilst awaiting further details to be released, it is my initial opinion that the most significant impact on PCNs will be the revision of Employers National Insurance contributions is a double blow which will need consideration and forward planning to avoid becoming problematic to cashflow:

1️⃣ Increase of rate from 13.8% to 15%

Worded carefully as an increase of 1.2 percentage points, whilst factually correct, could be construed as being a little misleading in downplaying the effect of the uplift. Interpreted in a different manner, it is, in fact, an increase of 8.7% on your existing employer's National Insurance bill, before the impact of point 2 below.

2️⃣ Reduction of secondary threshold from £9,100 to £5,000

When added to the % increase above, this would cost £615 for every employee on the first £9,100 of earnings per annum.

To ease the burden of the increases above on small businesses, the Employment Allowance will be increased from £5,000 to £10,500. Unfortunately, this benefit will not filter through to PCNs, PCN Ltd companies, or GP practices; due to their work being wholly or mainly of a public nature are not eligible to claim Employment Allowance.

The table below shows an indicative increase in cost to PCNs based on a typical salary:

	Example salary	Employers National Insurance	Employers National Insurance	Employers National Insurance
		2024/25	2025/26	Increase
Clinical Pharmacist	62,340.00	7,347.12	8,601.00	1,253.88
Social Prescriber	40,159.00	4,286.14	5,273.85	987.71
Care Co-ordinator	33,396.00	3,352.85	4,259.40	906.55

Q. Natasha, How about the spending review? Could this hold more hope for PCNs?

X The Increase in NHS funding by £22.6bn attracted cheers from many in the House of Commons. However, considering that it is over a two-year period and using 2023/24 as the baseline, the increases in 2023/24 may have already eaten into the primary care allocation.

X 40,000 elective appointments each week – the objective being to reduce the waiting time from referral to consultant-lead treatment to 18 weeks. There was no mention of increasing capacity at primary care level.

X 200 upgrades to GP surgeries – perhaps a positive baby step in the right direction, we do not yet know what an ‘upgrade’ means but this equates to approximately 1 GP practice per 5 PCNs. It will be interesting to see what these upgrades include.

Q. What next…?

We expect the GMC to start lobbying NHS England to get funding into Primary Care contracts to help fund the increase in costs, ideally we would like to see the ARRS maximum reimbursable amounts uplifted accordingly in the 2025/26 Network DES. We also expect them to be lobbying on behalf of practices in relation to increase in National Minimum Wage.

Certainly not one of the headline topics from the budget, however, one that perhaps will have the most significant effect on primary care over the coming years was the mention of a 10-Year Health Plan to be announced in Spring 2025. The focus of shifting hospital care to the community for a proactive and personalised neighbourhood health service raises many questions over the future landscape for PCNs and INTs.

If you would like any advice on navigating the changes to Employer NI or any other financial matter relating to PCNs, contact at natasha.payce@mha.co.uk.

Tara's Take

As a PCN Manager, regular readers know I emphasise looking beyond the current financial year when it comes to workforce planning.

1️⃣ Calculate additional NI costs per staff member. In for 24/45 and 25/26, how will the following impact your network?

Worst case: No uplift
Various uplift scenarios (2%, 4%, 6%, 8.2%)

2️⃣ Review your current spend and if you have topped up any ARRS funding from other sources, review the sustainability of this and impact if this funding was removed.

3️⃣ Be ready for supplier costs to rise. As the cost of living increases and businesses have rising costs, these costs will undoubtedly be passed on to you, the client.

4️⃣ Document everything. The biggest cause of conflict in networks relates to finances.

Document your findings, risks and concerns and communicate this to ensure transparency. If you are ensure of anything, speak to your CD, Manager, finance lead, board or accountant. You decide who is the most appropriate person.

There is no need to panic. Use this time to plan, prepare and focus on sustainable financial planning rather than maximising current spend just in case using every penny leaves you with nowhere to go.

Remember, PCNs are member practices that work together, so decisions should benefit all.

I hope this helps.

About Tara

Tara Humphrey The Business of Healthcare Podcast

I'm Tara; I am the founder of THC Primary Care, an award-winning healthcare consultancy specialising in Primary Care Network Management and the host of the Business of Healthcare Podcast.

I have over 20 years of project management and business development experience across the private and public sectors, and I have supported over 200 PCNs by providing interim management, training and consultancy.

I have managed teams across multiple sites and countries, have an MBA in Leadership and Management in Healthcare, have been published in the London Journal of Primary Care, and am the author of over 250 blogs.

I have 3 children. My eldest has Asthma, my middle child has a kidney condition called Nephrotic Syndrome, and my youngest daughter has Type 1 Diabetes, so outside of work, healthcare plays a huge role in my life.

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