Is general practice in trouble?

Like other parts of the healthcare system over the past four years, general practice has been under pressure financially. But is it, as the Royal College of General Practitioners’ current campaign suggests, in need of saving1 or, as a recent Nuffield Trust review reports, “in crisis”?2 And, if general practice is in trouble, why do three quarters of the public remain satisfied with it?3

In terms of funding, general practice accounted for around £8.8bn (8%) of total NHS spending in 2013-14. This share has reduced by about 0.7% since 2008-09. It has also reduced in real terms. Between 2005-06 and 2013-14 total investment in general practice fell by 6% in real terms—equivalent to nearly £560m (€710m; $880m, fig 1⇓). Over the period of the current parliament (since 2010-11), it fell by 2.5%. This is in contrast to a real rise in total NHS spending of …