Practices with closed lists keep enhanced services

PCTs are continuing to commission enhanced services from practices with closed lists even though they are not obliged to.

The GMS contract says that having a closed list 'is likely to prejudice' a practice's enhanced service application because it suggests that the practice's resources should be concentrated on core services.

However, an investigation by GP has found that while in the past PCTs might have denied enhanced services to practices that had closed their lists, they have now backed down.

All the areas GP contacted, including Kent, Liverpool, Birmingham and Devon, are allowing practices with closed lists to provide enhanced services.

Practices have been concerned that they would experience a huge loss in income if forced to close their lists next year when the government bans open-but-full lists. A GP investigation revealed that the number of closed lists could treble as a result (GP, 3 March).

Liverpool LMC secretary Dr Rob Barnett said that 18 months ago, PCTs in Liverpool tried to remove enhanced services from practices with closed lists, but they stopped once they realised it was not good for the PCTs or patients.

Dr Stuart Drage, GPC negotiator and joint chief executive of London-wide LMCs, said he had not heard any recent reports of PCTs in London barring practices with closed lists from enhanced services, although this had happened in the past.

Dr Robert Morley, executive secretary of Birmingham LMC, said the PCT had not removed any enhanced services from practices with closed lists, but they had given a 'veiled threat to stop GPs closing their lists'.

But Dr Morley fears the PCTs might invoke the threat as more private providers move into primary care. In Heart of Birmingham PCT, for example, 40 of the 76 practices have open-but-full lists and eight are already closed.

Dr Morley said the PCT would want to bring in private providers to supply core services and was likely to use enhanced services to attract them.

'Enhanced services are the main reason people don't close their lists, but it will become an issue in the context of alternative providers,' he said.

Dr Philip Leech, principal medical officer for primary care at the DoH and a former GP, admitted that closing a practice list 'will not necessarily result in losing enhanced services'.

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