PCT cost-cutting has created a gulf in enhanced services income between practices, with the highest earners bringing in 18 times more than the lowest, GP can reveal.
Income per patient varies from just £1.98 per patient for some practices to more than £36 per patient in others, figures from specialist medical accountants Ramsay Brown & Partners show.
The variation means some average-sized practices earn more than £200,000 a year from enhanced services, while others barely reach five figures.
The top earners can generate twice as much income from enhanced services as they do from QOF, the data reveal.
Laurence Slavin, a partner at the specialist accountancy firm, told GP that some practices with higher enhanced service income are in areas with high need, but many low earning practices are also in these areas.
The number of enhanced services that practices provide and achievement can also account for some variation.
But Mr Slavin said: 'The attitude within the PCT is the most significant factor. PCTs see local enhanced services (LESs) as a soft target.'
Some practices would lose up to £35,000 from enhanced service cuts this year, warned Mr Slavin. Last month Haringey PCT suspended all LES payments to practices.
The problem extends to Wales, where the Welsh GPC estimates that some local health boards spent just 20 to 30 per cent of their share of a £5 million funding package for enhanced services in 2008/9.
The DoH pledged a 1.5 per cent increase in investment in enhanced services in England for 2008/9, but the GPC claims little has reached practices.
Dr Grant Ingrams, secretary of GPC West Midlands, said PCTs 'have taken the government spin that GPs are overpaid and underworked' and are looking to cut enhanced services spending.
'I know PCTs in our area are talking about large cuts to the enhanced services budget. Not because of the situation in the future, but because of the financial mess they are in now.'
David Stout, NHS Confederation PCT network director, said because there was no contractual obligation to provide LESs, it was an area of the primary care budget where PCTs could look to make savings.
Dr Jane Lothian, secretary of Northumberland LMC, said GPs urgently need to redefine core work as PCTs seek to squeeze more and more services into PMS contracts.
GPC member Dr John Canning agreed that PCTs seem to want a return to a pre-GMS situation where GPs were paid to 'do what they do' rather than being resourced for additional work.
'We are still in relatively good times for funding. After the spending review is when the country has to pay money back. There are tough times ahead.'
|Enhance services pay|
|Enhanced services income per patient|
Data from 180 practices in London and the south east of England
Top five practices
Bottom five practices
Source: Ramsay Brown & Partners