Hammersmith and Fulham CCG has approved plans to replace a local enhanced service (LES) contract for extended hours services with the standard directed enhanced service (DES) model from July - a move Hammersmith and Fulham LMC chair Dr Seth Dassanayake says will cost practices ‘tens of thousands of pounds’.
A spokesperson for Hammersmith and Fulham CCG has confirmed that the LES tariff is ‘significantly higher than the national DES tariff’, which will be implemented on 1 July 2019 as practices begin working together in primary care networks.
Dr Dassanayake said the cuts could be linked to soaring costs facing the CCG as numbers of patients joining the digital-first GP at Hand service continue to rise. The CCG has cited the service - which now has around 50,000 registered patients - as a ‘key driver’ of cost pressures, although it denies cuts to extended hours are related to GP at Hand.
GP at Hand
The Hammersmith GP warned that cuts to the services practices are able to provide could lead to a further surge in patients quitting local surgeries and moving to GP at Hand. He said practices in Hammersmith and Fulham CCG had been 'protected a little bit by our excellent extended access' - but could now suffer as they are forced to scale it back.
Dr Dassanayake said practices would be forced to reduce the number of extended hours appointments they offer and that even core-hours services would be affected by cuts of this scale - with some practices potentially at risk of closure. His own practice was likely to cut extended hours provision to '70% of what it formerly was'.
'We’re running on such thin margins that these kind of changes are really hard to weather,' he said. 'We’ve got this kind of dangerous mismatch of cutting to core services while the demand for doctors is massive and how we bridge those gaps is really difficult. So if you havent got a diverse range of income for your practice - which many GPs don't, especially the smaller ones - this is very destabilising.'
Asked whether the cuts could lead to practice closures, Dr Dassanayake replied: ‘Absolutely, yes. Each practice will have to restabilise itself after this impact and I’m not sure how that will happen. It will be very individual and each practice will deal with it differently.’
‘It’s a major shudder to the economics of each practice so it will have repercussions,’ Dr Dassanayake told GPonline. ‘Across the patch I think the funding cut is going to equate to about eight sessional GPs.’
Until now, the majority of practices in Hammersmith and Fulham had been able to provide extended hours access under the LES ‘because it was paid at a reasonable rate’, Dr Dassanayake said - but he described the DES funding as ‘terrible’.
A spokesperson for Hammersmith and Fulham CCG said it was ‘not possible to make any correlation between an increase in GP at Hand registrations and a reduction in practice income as a result of the funding change'.
The spokesperson added: ‘The decision to reduce the level of payment for the LES is not related to GP at Hand. The CCG has a very challenging financial position and has reviewed all of its areas of spend in order to ensure value for money and reduce costs where possible.’
Once the network DES takes effect from July 'the onus is on practices to agree the provision of extended hours access within their network in consultation with their patient participation groups to meet the local needs', the spokesperson said.
'We do not anticipate a significant reduction of appointments, particularly given the increased flexibility to provide alternative consultation methods and utilise a wider skill mix of staff. However, the CCG is committed to supporting practices and networks as they transition towards the anticipated national network DES.'
A Babylon spokesperson said: ‘Almost all GP practices are businesses, whether in their own right or as part of a larger group, and so we all have to face the reality of making our services available at the cost agreed by the NHS. Babylon GP at Hand doesn't receive any additional funding compared to other practices, and indeed we are not reimbursed for many of the costs that other practices receive additional NHS income for.
‘We want to make it easier for patients to see a GP, so this issue between Hammersmith & Fulham CCG and NHS England needs to be resolved, but it is not for us to tell other organisations, or GP practices how to run their services.’