As a result of the underspends, enhanced services, including those for sexual health, warfarin monitoring, dermatology and COPD, have been cut or not commissioned, LMCs report. PCTs are already facing criticism for their lack of investment in sexual health services (GP, 20 January).
Many PCTs are believed to be using enhanced services cash to cut deficits in other areas, despite calls from the DoH, SHAs and GPs for the money to go to enhanced services.
Unspent enhanced services cash from 2004/5 was rolled over into this year, but there is no similar agreement for 2005/6.
Out of 43 PCTs that responded to a GP request for information, 14 predicted underspends.
The highest projected underspend was £491,000 in Kensington and Chelsea PCT, 17.6 per cent of the floor. Dacorum PCT, in Hertfordshire, forecast an underspend of about £400,000, 23.2 per cent of its floor.
Anecdotal evidence shows the problem may be worse in other areas. Bedfordshire and Hertfordshire LMC reported that a Bedfordshire PCT was on course to underspend by up to £700,000.
GPC deputy chairman Dr Laurence Buckman called the findings 'very disappointing'.
He said enhanced services floors were often too low to cover any additional work, and underspends were likely to cut existing work. He urged practices to ditch services that were unpaid.
Dr Buckman added that he was not surprised at the figures 'because PCTs are in such appalling debt'.
He said negotiations on the fate of unspent enhanced services funds were ongoing, but he accepted that PCTs could not be forced to spend the money.
John Swain, primary care director at Bedfordshire and Hertfordshire SHA, said PCTs could not be forced to spend up to the floor because they were freestanding, statutory organisations. He added that acute financial problems meant some trusts would not reach their floors.
'We would like stronger, community based services for diagnostics, diabetes, COPD, musculo- skeletal services, and dermatology,' he said. 'Some PCTs have developed enhanced services for these, but others have not.'
A DoH spokesman said: 'All PCTs should plan and have firm commitments in place to achieve the enhanced services floor. There is no legal obligation on PCTs, but there is an agreement that the floors are met.'
SERVICES AT RISK
Unfunded enhanced services
- Sexual health
- Warfarin monitoring