LESs - now sometimes called 'locally commissioned services' - remain an important source of practice income, delivering £267m in 2015/16 according to the latest figures available from NHS Digital.
However, investigations by GPonline have revealed that this figure is far below the level it should be at, because the NHS is failing to pay GP practices for non-core services they deliver that are worth tens of millions of pounds.
Findings from our latest poll show that GPs expect cash-strapped CCGs to further reduce services they pay for, although many say commissioners will continue to expect practices to deliver the work.
A total of 64% of 184 GP partners who responded to a question on LESs said they expected this source of income to drop in 2017/18 compared with the previous financial year.
One in five (21%) respondents expected LES income to remain unchanged in the current financial year, while just 4% said it would increase - with the rest unsure.
GPs said services relied on by patients were being lost, while practice income also suffered. One respondent wrote: 'Because of cost-cutting, a LES for mental health in our CCG has been stopped. This offers a really good service to our patients. Its stoppage also caused a huge drop in our practice income.'
One respondent said local commissioners had little choice. 'CCGs are broke due to the government's "efficiency savings" drive.'
Another said the removal of LES work presented a dilemma for practices. 'Gradually they are being removed or restricted. On one hand I think great, don't need to do the work, on the other hand patients get a more and more restricted service.'
Wessex LMCs chief executive Dr Nigel Watson, however, said he did not expect to see LES income reduce. 'I think it will increase,' he told GPonline. 'We are looking at more work being delivered in the community and being moved out of hospitals - I am not looking to see funding from locally commissioned services go down.'
Dr Watson said CCGs were not broke, and could afford to fund LESs they believed were cost effective. However, he said that huge variation remained between CCGs in terms of overall spending on locally commissioned services. 'So I'm not surprised that some CCGs are looking at that.'
He added that the shift to providing services at scale had also led to CCGs revisiting existing services commissioned locally, with some opting to move services to federation-wide deals.
However, he warned that if CCGs stopped funding services, they should expect the service to stop. 'If they have paid in the past, they clearly accept the service is outside core work - so stopping paying means decommissioning it.'