Practices in Wales have been stripped of £18,000 a year on average after ministers scrapped all DESs specific to the principality introduced in 2006/7.
Cuts worth more than £9 million in total were imposed after GPC Wales rejected an offer from Welsh Assembly ministers that would have brought a £10,000 cut per practice.
In England, one-year deals for access, Choose and Book and practice-based commissioning, worth around £30,000 in total, have not been renewed for 2007/8.
GP leaders confirmed that there is now no obligation on practices to carry out the work, or any mechanism to pay them for it.
A handful of PCTs have rolled out local enhanced services to replace the DESs, but the DoH said no decision has yet been made on their future nationally.
The losses will compound the effects of the core pay freeze, which BMA policy experts predicted would trigger a 6 per cent real terms cut in pay in 2007/8 (GP, 30 March). This figure did not take account of DES losses.
A 20-page GPC guidance document on how practices should respond to the pay freeze, being published as GP went to press, is likely to suggest practices ditch any work that is unfunded, including lapsed DESs.
GPC deputy chairman Dr Laurence Buckman said it would be ‘strange’ for practices to continue to provide services for free.
‘We think the DoH will want to continue access, but there is no guarantee of that. We have had no reply about that or Choose and Book, and nothing on paper about what happens from 1 April.’
GPC Wales chairman Dr Andrew Dearden said the cuts in Wales to DESs including mental health and learning disabilities would hit patients: ‘Patient services will be damaged and patients will suffer.’
GPs in Northern Ireland could also lose DESs worth £25,000 per practice. GP leaders in the region admitted they were ‘not 100 per cent certain’ that DESs for access and long-term conditions would be maintained.
In Scotland, the Scottish Executive health department has agreed to continue the access DES, but other one-year DESs for cardiovascular disease, cancer referral, learning disabilities and carers, worth £12,000 in total per average practice, have not been renewed.
But the prospects for 2007/8 enhanced services appear better in Northern Ireland and Scotland than in the rest of the UK.
GPC Northern Ireland chairman Dr Brian Dunn hoped to meet ministers this month to confirm that the £4 million a year currently spent on DESs would be maintained.
GPC Scotland said it would issue a statement on DES funding for 2007/8 after a new national government takes office on 9 May, but it expects current funding to continue.
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