Funding shift leaves practices at risk

A rise in the proportion of GP funding delivered through locally-agreed deals leaves the profession exposed as the NHS enters a period of financial austerity, GP leaders admit.

Dr McCarron Nash: core funds

Figures from the NHS Information Centre show that the proportion of GP funding that comes from nationally-agreed directed enhanced services (DESs) has dropped.

DESs delivered 52 per cent of enhanced services funding in 2007/8. But this fell to 44 per cent in 2008/9.

A forecast for 2009/10 predicts that DESs will again make up 44 per cent of spending. Funding for all enhanced services is expected to rise by nearly 9 per cent to £885 million in 2009/10, having risen by 3.3 per cent between 2007/8 and 2008/9 to £786 million.

The breakdown also shows that just £19.4 million was spent on the five clinical DESs agreed as part of the 2008/9 GMS contract deal, despite a guarantee that they would be worth '£50 million annually'. A further £30 million is forecast to be spent on clinical DESs in 2009/10.

Spending through APMS practices is forecast to rise to £20.7 million in 2009/10 from just £11 million in 2007/8.

GPC negotiator Dr Beth McCarron-Nash told GP that DES spending had fallen partly because many PCTs had agreed with GPs not to implement the extended hours DES.

'A lot of the DES money has been spent through LESs,'

she said, pointing out that the GPC believed the DES was 'not fit for purpose'.

'I think most money should be in the global sum,' Dr McCarron-Nash said. 'I would prefer a core funding rise so practices can get on with their basic job.

'Enhanced service money is always going to be more vulnerable, and I would not like to see the pendulum swing to the point where practices are essentially negotiating PMS contracts.'

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