Exclusive: GPs provide services worth tens of millions of pounds for free

GP practices deliver services worth tens of millions of pounds for free, GP leaders have warned, after a GP survey found more than two thirds carry out unfunded work.

Up to 70% of GPs are providing some non-core services without extra funding, the poll of 600 GPs and practice managers found.

As well as providing work that should attract enhanced services funding for free, up to 85% of respondents said their practices faced inappropriate demands from other parts of the NHS for unfunded work.

The revelations come after the BMA published guidance for practices struggling under the weight of unfunded workload. Quality first: managing workload to deliver safe patient care offers practical advice on how GPs can secure funding from commissioners, or refuse unresourced work. GPC chairman Dr Chaand Nagpaul said the results of GP’s survey highlighted the ‘unacceptable variation in enhanced services’, which are funded in some areas and not in others. Health and Social Care Information Centre data reveal that in some CCG areas practices receive £30 per weighted patient on average from local enhanced services (LESs), while in other areas practices receive nothing.

Dr Nagpaul called on practices to challenge this variation. GP asked doctors and practice managers whether they provided without extra funding any of a list of 33 enhanced services identified by the GPC as voluntary and non-essential.

A total of 72% said their practice was providing ECG recording, 69% spirometry and 63% post-op suture removal unfunded.

One GP said their practice had provided many of the additional services as LESs, but the practice continued to provide them after they were decommissioned and funding stopped.

One GP pointed out the difficulty in deciding what should receive additional funding, suggesting that ECG and spirometry ‘are probably now core services’. 

He added that while his practice resisted providing post-op suture removal, ‘it is not always practical for patients to return to remote hospitals’.

Another added: ‘The excessive array of income streams is absurd, how can we focus on our core job when we need to collect small pots of money to survive. It is nonsense – pay us sensibly and fairly.’

Practices also revealed the extent of requests from other parts of the NHS for unresourced services, with 85% providing hospital test result follow-ups, 82% seeing patients referred back by hospitals for prescriptions, and 82% having to make re-referrals to related specialities. 

One GP said they were under ‘extreme pressure’ from care homes to provide home visits by default. 

Another GP added: ‘So much is dumped at our door, but as we have the cradle-to-grave responsibility it is churlish to refuse. It is known we will do it without payment.’

GPs were also asked how they link with other practices to ease workload pressures. From 300 responses, almost half said they ran joint training or education, while a third provide peer support for
areas such as CQC preparation.

Dr Nagpaul said: ‘This survey vindicates the purpose of producing our workload handbook, highlighting the scale of inappropriate and unfunded work that is overloading GP practices daily, and taking them away from being available for essential services to their patients.’

Londonwide LMCs medical director Dr Tony Grewal said up to 20% of practices’ workload could be unfunded non-core services provided because there was no provision elsewhere for patients.

‘That is what GPs do,’ he said. ‘It’s a good thing for patients and the NHS has relied upon it for many years.’

He said general practice was likely to be losing ‘tens of millions’ of pounds in funding.

* Editorial: CCGs should fund unresourced services

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