BMA leaders have told GPs that they should not feel guilty dropping services they do not receive funding for – and it may actually be in patients' best interests to do so.
But three in five (59%) respondents to a GPonline poll reported that their practice currently provides some non-core services gratis, suggesting that nationwide the profession delivers care worth tens of millions of pounds for free. Just 15% of practices said they did not provide any non-core services without extra payment, while those remaining indicated they did not know.
A similar survey GPonline ran last year showed up to 70% of practices were providing some of these services for free, suggesting some practices have started cutting back on services.
Unfunded GP services
ECG recording is the most commonly provided non-core service provided for free by GPs, the latest poll suggests, with the majority (69%) of respondents providing the service for no additional payment, despite it not being covered by the core GP contract.
This was followed by 66% saying they provide spirometry for free, 56% providing post-operation suture removal, 55% ring pessary insertion, 53% 24-hour ambulatory BP monitoring and 50% phlebotomy.
The services are just some of 33 included in the GPC's Quality First document last year, which lists non-core services that are voluntary for practices to do and should attract additional funding.
Responses reveal that many GPs were not aware they were providing these services above and beyond their contracts. ‘I did not realise that a lot of these services could attract additional funding,’ admitted one.
GPC deputy chairman Dr Richard Vautrey told GPonline: 'Often, practices have been delivering services to patients that are well beyond their responsibilities through goodwill and their feeling of professional responsibility, for no additional resource.
'But, increasingly, practices do need to ensure that the core services they are providing to patients are their first and foremost, number one priority and they do need to think very hard whether they can maintain additional services when they haven’t got the resources.
‘GPs and practices should not feel guilty about dropping activities if they're not resourced properly. In many ways, they almost have a duty to do so if it’s undermining the quality of service they're providing to their patients. There won’t be a resolution to these problems if they continue to pick up the pieces that others in the NHS are dropping upon them.
‘If practices really want to resolve the funding issues within the community, then they do need to be brave enough to say no and ultimately, if enough practice do do that, then the CCG or other commissioners will have to find the resource to make that service viable if that is what they want to choose to do in the future.’