Editorial: LES certainty needed - not variability

In your latest fortnightly GP, we reveal the results of our exclusive Freedom of Information Act investigation into local enhanced service (LES) funding.

It finds that across the UK, there are winners and losers in 2012/13. Some primary care organisations (PCOs) predict that by the end of the financial year, they will be offering contracts worth £2.8m more than in 2011/12, while others are withdrawing contracts worth up to £1.7m.

As GP revealed exclusively last month, most GPs report that their take-home pay is falling. Negotiations between the BMA and the DH over GMS contract changes for 2013/14 have broken down, with the government proposing changes including the most radical QOF overhaul yet, which could see every practice losing £15,000.

It is difficult to remember a period of greater uncertainty, unless it was before the arrival of the new GMS contract in 2004.

With the benefit of hindsight, that contract brought short-term gains (increased income and the shedding of out-of-hours responsibility) but in the long term, has enabled the government to threaten to impose the current proposed deal.

The policy of any qualified provider (see the exclusive interview with health minister Lord Howe, page 21) will add to the LES uncertainty, with practices facing greater competition from alternative providers to offer future services.

Clinical commissioning groups (CCGs) will be under pressure to hit the ground running when they take over from PCTs in April 2013. But which CCG, or any UK PCO for that matter, would want to have to explain to a practice's patients that it was no longer viable because of funding uncertainty? Particularly when it was within the PCO's gift to do something about it.

At a time of such GMS contract uncertainty, the awarding of LESs to local practices already taking a hit on QOF would help them to ride out the current funding storm.

GP calls on CCGs to recognise that to do their best for patients, it is in no one's interests for a highly valued GP practice to go to the wall because agreement cannot be reached on the new GMS contract.

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