Exclusive: Public health threat as GPs face LES cuts

Millions of pounds have been stripped from practice-run smoking cessation and contraception services and GPs fear further cuts by cash-strapped councils in April.

A GP investigation has found that primary care organisations (PCOs) across the UK withdrew swathes of public health-related local enhanced services (LESs) in 2012/13.

One GP expert feared councils could make further cuts when they take on public health in April. A sexual health charity said withdrawing funding for contraception services was ‘short-sighted’.

Although local public health services were cut, funding for the national NHS health checks scheme in England soared. The GPC called on CCGs to prioritise services for local needs and warned that funding only national schemes would ‘make a mockery’ of local budgets.

Data obtained by GP from 98 PCOs under the Freedom of Information (FOI) Act showed GPs faced large swings in LES funding in 2012/13.

Further analysis of the data for 87 PCOs looked at trends within specific types of enhanced services and extrapolated these figures to reflect the national picture. This shows NHS health checks saw the largest growth in funding of any LES between 2011/12 and 2012/13, rising by £8.7m to £22.4m. Anticoagulation services rose by £3.9m to £30.5m.

But some services saw deep cuts. Funding for smoking cessation fell by £3m, or 28%, and spending on long-acting reversible contraception (LARC) services fell £2.3m to £17m, a loss of £1 in every £8.

Extended hours LES funding suffered the biggest fall of £19.2m, continuing the siphoning of cash away from the LES as the national DES was extended for another year.

The investigation also found LESs for acupuncture, aromatherapy, babies in prison, chiropractic and circumcision have been commissioned in recent years.

Birmingham GP Dr Charles Broomhead, a member of the Smoking Cessation in Primary Care group and community contracts lead for Birmingham CrossCity CCG, said cuts to smoking cessation were ‘highly regrettable’.

Expert view: The GP

Birmingham GP Dr Charles Broomhead, member of the Smoking Cessation in Primary Care group

‘I understand why smoking cessation services are being withdrawn: it’s a soft target. It’s easier to cut smoking cessation services than to cut back on other subjects, like dementia services.

‘But from my perspective, it’s fundamental we stop people smoking. We know that smoking is pivotal in so many disease areas, so it’s a vital process to continue.

‘The effect on patients will be not as much support in quitting as they would have had, and the longer-term consequences of tobacco use. We’ve seen a reduction in asthma admissions in children because of the smoking ban, so we may see retrograde steps in that.’

From April, councils in England will commission public health services. Dr Broomhead said councils ‘desperately short’ of funds may seek further cuts in smoking care.

NHS health checks are the fastest growing LES, but are part of a national scheme introduced by the DH.

GPC negotiator Dr Chaand Nagpaul said it was ‘vitally important’ for CCGs and local authorities to prioritise the needs of their population ahead of national targets.

‘It would be doing patients a disservice if money was diverted from areas of need to meeting political targets,’ he said. ‘It’s a test of the government’s attempt to devolve decision-making to CCGs. If they are hamstrung to only fund central targets, it makes a mockery of the idea that CCGs are in charge of budgets.’

Audrey Simpson, acting chief executive of the Family Planning Association, said the charity was ‘increasingly concerned’ about LARC availability in general practice.

‘LARCs are among the most effective contraceptive methods and evidence from NICE clearly shows that they generate genuine cost savings for the NHS,’ she said. ‘Withdrawing enhanced funding to provide them is a short-sighted, expensive approach.’

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