GPs fear public health LES cuts

Practices could lose thousands of pounds in local enhanced service (LES) income as councils face multi-million pound swings in public health budgets from 2015.

Councils across England fear their public health funding could be cut by up to 85%, while others face increases of up to 48%.

The DH has given all councils in England a 'target' public health budget. Their allocations for this year and next are largely based on historic PCT public health spending.

Budgets for 2013/14 range from £20 per head in Windsor and Maidenhead, in Berkshire, to £186 in the City of London.

But in 2015 the public health funding formula is likely to change, leaving councils fearing sudden cuts. The target level of funding for City of London, for example, is £29 - far below its current level.

Chairman of Hackney Council's health and wellbeing board Jonathan McShane said his council is likely to lose up to £10m from its public health budget because it has been earmarked for a 35% cut. 'The key question is over what period,' he said. 'There is no indication.'

The DH confirmed that the Advisory Committee on Resource Allocation (ACRA) is looking at the public health funding formula. A DH spokesman said it would be 'premature to speculate' on the outcome.

But Mr McShane warned that some enhanced services could face the axe because councils are only mandated to provide five services. These include sexual health, health checks and the national child measurement programme.

Smoking cessation, obesity or public mental health services are not covered and could be at risk.

'The vast majority of public health money goes on sexual health and drug and alcohol services, and there will be pressure on those,' he said. 'You aren't allowed to place restrictions on mandatory services. It is all the other stuff that will have to go.'

Accountants estimate the average practice has a £30,000 annual income from LESs. LMCs say that in some areas, a quarter of these services are currently commissioned by local authorities.

A GP investigation of 98 primary care organisations revealed that funding for smoking cessation LESs had been slashed by £3m (28%) in 2012/13, compared with the previous year (GP, 18 February 2013).

GPC deputy chairman Dr Richard Vautrey warned that further cuts in public health services provided by practices would affect patient care.

'We would want money currently spent in general practice, which supports important work such as offering help with smoking cessation or providing sexual health services, to continue to be spent in general practice,' he said. 'Any cutbacks would have an impact on our patients.'

Manchester council is in line for a 24.8% boost in public health funding. Manchester LMC honorary secretary Dr John Hughes called for more LESs to be commissioned with this money.

'We offer excellent value for money,' he said. 'Compared with other providers, councils are getting a good deal from primary care.'

Dr John Hughes

A DH spokeswoman confirmed that councils would receive increases in public health funding in 2013/14 and 2014/15.

She added: 'ACRA is beginning the next phase of its work looking at the public health funding formula to make sure local authorities are receiving enough funding. This phase is only just beginning and it would be premature to speculate on the resulting formula.'

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