Three in five (59%) of almost 300 GP partners polled said their practice was providing at least some non-core services without extra funding.
The majority of GPs are providing services including ECG recording, spirometry, ring pessary insertion, suture removal and ambulatory BP monitoring without the additional funding these services should attract, the results suggest.
The GPC warned that the NHS was exploiting the goodwill of GPs and urged the profession to be more 'business-like' and clamp down on unfinanced work to incentivise commissioners to fund services properly.
Unfunded GP work
Just 25% of GPs said their practice did not provide any non-core services for free, and another 16% said they did not know.
Meanwhile, some GPs who do receive funding for particular non-core services, said this was often only a ‘small amount that did not cover’ the expenses of doing the work.
The proportion of GPs delivering unfunded enhanced services remains unchanged from last year, despite the BMA making repeated calls for GPs to refuse work they are not paid for.
However, the number saying they provide no services for free has risen from 15% last year.
The BMA first published its Quality first guidance advising GPs on how to better manage workload two years ago. The guidance urged GPs to seek funding from commissioners or refuse un-resourced work.
The GPonline survey results also reveal many GPs do not realise they should be receiving extra funding to provide these services.
Duty to patients
Many more said they were in a difficult position, feeling compelled to provide the services at their own expense out of a sense of duty to patients.
‘It’s an us or no one story,’ one GP said, while another said it was more convenient for patients ‘to get it done locally rather than having to go to hospital’. ‘It affects patient care if services are stopped,’ warned another.
A third (31%) of respondents said they had dropped some services over the past 12 months as a means of easing ever-expanding workloads.
The results suggest over half (55%) of practices are considering dropping services over the next year, while just a fifth (19%) ruled out the possibility of doing so at all.
Respondents widely suggested that services such as sexual health – including LARC fittings – and minor surgery could be up on the chopping board.
GPC deputy chairman Dr Richard Vautrey said: ‘GPs by their nature want to do as much as they can for their patients, and they find it very hard to stop doing services once the necessary funding is withdrawn.
‘It’s one of the reasons why we have concerns that the NHS exploits the good nature of GPs and doesn’t commission the services properly as they ought to do.
‘GPs really do need to look at the cost of providing these services – not just the cost to themselves personally and the workload burden – but also the financial costs. They need to look at the bottom line and ensure they are not effectively paying out of their own pocket to provide NHS services.
‘They are running businesses and they need to be business-like in the way that they approach these things. GPs do have the power to stop these things. They are self-employed businessmen and women and while it is difficult – and it can always be very difficult to say no – sometimes that can actually be the best way to get a proper service commissioned.
‘Patients would get a better deal in the long-term, because they get a sustainable service and it’s not undermining the GP service or adding a further burden to them, which ultimately will lead to a worse service overall.’