Public health gains in danger as councils cut GP funding
Sexual health, smoking cessation and health checks downsized as a result of government cuts. Caroline Price and Carolyn Wickware report
The Government promised that its £200m cuts to public health services will not affect frontline services – but a Pulse investigation has revealed that local councils are already making cutbacks to essential services.
These include those run by GP practices, such as contraceptive and sexual health services and NHS Health Checks, and facilities that GPs rely on for patient referrals, like smoking cessation.
One council – York City – has made cuts across the board, citing ‘financial constraints’. Other councils are limiting the number of long-acting reversible contraception procedures they will pay practices for.
Meanwhile, a number of councils are completely discontinuing smoking cessation services.
Many of the cuts are as a result of the Government removing funding from local authority budgets.
Chancellor George Osborne announced cuts of £200m last May, meaning the £2.8bn originally earmarked for councils to spend on public health in 2015/16 was cut by 7%. Further public health funding cuts were promised at the autumn spending review, with plans to deliver 4% savings each year for the next five years.
‘Far fewer will quit’
The Treasury told Pulse the £200m figure was based on projected local authority underspends and that the cuts would not affect frontline services.
But GPs expressed concern at the effect on patients. Londonwide LMCs medical director Dr Tony Grewal warned that moves to limit the contraceptive services undertaken by practices ‘will diminish patient choice, limit access to these forms of contraception and diminish GPs’ professional competency to undertake these procedures’.
Dr Alex Bobak, a GPSI in smoking cessation at Wandsworth Medical Centre, south London, says smoking cessation service cuts mean ‘far fewer people will stop smoking’.
And councils are warning that the situation could get worse, with York City Council writing to local GPs to tell them there are ‘more challenging times ahead with further reductions in the public health budget’.
Pulse has learned of six major metropolitan and county councils that are cutting smoking cessation budgets, including Leeds City Council, which announced a cut of £127,000 from its service with ‘more reductions in subsequent years’ likely, due to a £650m shortfall.
Elsewhere, Manchester City Council closed its smoking cessation service completely in October, while in York, only those with chronic diseases will be able to access smoking cessation services from the end of March.
The London Borough of Harrow has shrunk its service by 7% because of ‘attacks on our funding for crucial services’. Lincolnshire County Council and Salford City Council are cutting services by 50% and 10% respectively claiming more people are quitting through the use of e-cigarettes.Elsewhere, Manchester City Council closed its smoking cessation service completely in October, while in York, only those with chronic diseases will be able to access smoking cessation services from the end of March.
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Family planning experts warn this could cost the NHS billions of pounds in the longer term, and ‘reverse a decade of progress’ on training and access to contraception.
The councils changing their current provision include:
- A total of 19 London boroughs, which are putting LARC contracts out to tender as part of a new programme, partly due to ‘the continued squeeze on public sector finances’
- York City Council, which told practices in December it would terminate long-running contracts for chlamydia screening and long-acting reversible contraception (LARC)
- Devon and Torbay councils, which will only fund practices for six LARC fittings, with the rest paid at a nurse hourly rate.
GP practices in one area are being told their contract to provide NHS Health Checks will be terminated at the end of March as a result of cutbacks to the public health budget.
York City Council said it would continue to offer ‘some elements’ of the NHS Health Checks programme, which forms a key plank of the Government’s drive to prevent ill health and curb spiralling NHS costs that result from lifestyle issues such as poor diet, obesity and smoking.
Dr John Crompton, chair of North Yorkshire LMC, said to ‘suddenly stop offering those locally in practices would be a disaster… they have invested a lot of time and effort in this.’
He added: ‘We’ve found locally we’re picking up a lot of early diabetes and managing it – if that’s lost potentially that population will have worse outcomes.’