One area where we are likely to see huge changes in general practice is in enhanced services. Many GPs are concerned that this is where primary care organisations (PCOs) will attempt to make cuts and medical accountants are already warning that enhanced service income is being targeted.
This week GP reveals that spending on enhanced services varies wildly - one of the largest firms of medical accountants in England represents practices that are paid just £1.98 per patient for enhanced services, while others are paid £36 per patient. Most of this variation stems from differing levels of payment for local enhanced services (LESs).
LESs play an important role in general practice. They provide funding for extra clinics and staff and enable practices to devise innovative services and solutions to local health problems.
In an NHS increasingly based on local decision-making, one would expect LESs to be thriving. But, when times are tough and money is tight, enhanced services, and in particular LESs, can be seen as easy pickings by managers holding the purse strings.
Enhanced services have often been a battleground between GPs and PCOs. In recent years a number of PMS deals have been used to break the differentiation between essential, additional and enhanced work enshrined in the new GMS contract. What once would have been 'enhanced' has been sucked into core work.
And this has all happened when the NHS is still in relatively good financial shape. When the boom years end is this situation likely to become even worse?
Practices cannot provide services for which they receive no funding. Slashing enhanced services is a stealth cut on practice income that will ultimately damage patient care. PCOs would do well to remember this and not simply focus on how the figures stack up.