GPs in England are grappling with a £400 million "black hole" in funding from a swathe of cuts over the last three years, going against the grain of government policy to push care out of hospitals and into the community.
A "successive underinvestment" in general practice coupled with population growth has led to the amount being spent per person in England falling by 7% (in real terms between 2010 and 2013), as surgeries are having to cope with a drop in resources while hospital funding is continuing to rise.
The figures, unveiled by the Royal College of General Practitioners at its annual conference in Harrogate last week, have prompted a call to boost funding for general practice from 9% to 10% of the total NHS budget and for 10,000 new GPs (a far cry from the 2,000 extra promised by the government).
RCGP chair Clare Gerada told delegates that GPs make the NHS "safe, value for money and accessible", and warned that a lack of funding, coupled with growing pressures for extended service provision, pose a serious risk of destabilising the whole healthcare system.
In an emotional last address to the conference as RCGP leader (Maureen Baker takes the helm in November), which received standing ovation, Gerada blasted the Health and Social Care Act - "delivered by a government that promised no more top-down reorganisation" - for causing "chaos and confusion".
"In 10 years' time the NHS Act will be viewed as one of the most historic misjudgements of all time", she said, but urged GPs to "stick to their values" and "hang in there, it will get better."
Looking forward, Gerada said the time for GP practices working in isolation has passed, that a system fit for the 21st century should centre on integrated care, with provider organisations led by (geographically aligned) GPs and primary, social and acute care budgets merged into one.
NHS England is due to publish a national Strategic Framework for Commissioning of General Practice Services sometime this autumn.