Exclusive: Practices at risk as future LES funding 'uncertain'

Practices face 'great uncertainty' over the future of local enhanced service (LES) income and many could 'implode' if funding is lost due to competitive tendering or cuts, GP leaders have warned.

Where will the axe fall?: Many practice-led services could be lost in the coming year
Where will the axe fall?: Many practice-led services could be lost in the coming year

A GP investigation found dozens of CCGs and PCTs are yet to approve LES contracts and budgets for 2013/14, just weeks before new commissioning roles begin on 1 April.

Fears have also emerged that existing LESs will be recommissioned under standard NHS contracts, opening up the work to a wider range of providers.

A lack of clarity over controversial NHS competition regulations has also delayed local planning and created further uncertainty.

Senior GPs said the delays harm practices' ability to plan financially and warned many could fold if vital local services are lost to alternative providers under competitive tendering in the summer. They called on CCG leaders to 'stabilise' general practice by retaining services currently provided under LES contracts.

How commissioners' plans have stalled
  • 27 out of 97 PCTs and CCGs had not finalised LES plans or budgets by the beginning of March. 
  • NHS Nottinghamshire County said final plans and budgets may not be available until May.
  • Luton CCG said 'these matters are still being finalised' as of 28 February because it had only just been authorised by the NHS Commissioning Board.
  • Final details of enhanced services in West Leicestershire CCG will be published 'at the end of this financial year'.
  • NHS Warrington said that as of 6 March, it 'does not know the Warrington CCG intentions at this time'.
  • NHS Bexley Care Trust refused to outline the budget for a diabetes LES under negotiation as it was 'commercially sensitive'.

A total of 27 out of 97 PCTs and CCGs responding to a Freedom of Information Act request in early March had not yet finalised the LESs they will commission from practices from 1 April, nor associated budgets.

CCGs are expected to roll over almost all LES contracts for at least the first six months of 2013/14 to ease the transition from PCTs. Yet some have opted to change the LESs offered, while many have yet to confirm their plans with LMCs and local practices.

Meanwhile, from April the NHS Commissioning Board (NHSCB) will control enhanced services.

CCGs will pass over control of LESs to the NHSCB by April 2014. However, the board does not intend to commission LESs under the GP contract 'in the long term', instead leaving contracting of 'community services' to CCGs under the NHS contract.

LMCs told GP that talks on the future of local services had stalled as CCGs struggle to secure authorisation from the NHSCB.

CCGs are likely to review all GP-led services after six months. Local councils will be undertaking similar exercises and in some cases this has already begun (see box). LMCs and GP leaders fear that in the summer many GP-led services could then be tendered out to alternative providers under the 'any qualified provider' policy.

This has led to deep concerns from senior GPs about the stability of practice income.

Dr Simon Bradley, chairman of Avon LMC, said delays to finalising services for 2013/14 would add to practices' existing financial worries.

There needs to be a 'massive investment' in primary care to shift care out of hospitals and into the community, he said. 'We trust in CCG colleagues that general practice will not be destabilised. But if trust is breached, practices will disengage from CCGs and they will fail.'

GPC member and Wessex LMC chief executive Dr Nigel Watson said: 'Practices are right to be concerned at a time of great change. LES contracts are not just the icing on the cake. There's a risk of practices imploding if CCGs think the way to solve the problem is to reduce spending.'

Case study GP-led sexual health clinic

Manchester GP Dr Siobhan Macintyre runs an award-winning sexual health clinic for the large student population registered with her practice. The practice offers a dedicated sexual health service Monday to Friday with urgent same-day access for symptomatic patients.

Dr Macintyre describes the service as 'holistic'. Patients can get same-day access and are tested, diagnosed and treated immediately. They can also seek alcohol, smoking and contraception advice.

But now she fears that Manchester City Council is planning to dramatically alter the service when it takes over public health duties in April.

Dr Macintyre said she had been told that in future, local practices will only be funded to screen asymptomatic patients, although symptomatic patients make up 60% of the 1,000-plus cases seen by the clinic each year.

These patients would now have to be referred to a GUM clinic in secondary care.

'Patients should be given the choice to see a local GP who they trust. Those patients should have a right to access a service in primary care,' she said.

Despite heavy investment, the practice may have to consider losing a nurse and a doctor if the changes go ahead.

A Manchester City Council spokesman said: 'Initial discussions have taken place with local GPs about the potential to review LES arrangements and these discussions are ongoing.'

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