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A faulty production line

Enhanced services 'abused'

A fudge over the definition of enhanced services has left primary care organisations free to bend the rules with impunity, GP leaders claim.

The GPC has received reports of PCOs abusing the system to include GP appraisals, occupational health, clinical governance, community nursing, GPs working in A&E, and prescribing incentives under the enhanced services banner.

GP negotiators have vowed to report such 'creative labelling' to the NHS Confederation for the 'necessary action to be taken'.

Dr David Jenner, contract lead for the NHS Alliance, warned it may prove impossible to sanction the PCOs because 'the definition of a local enhanced service is incredibly woolly'.

The GPC says its understanding is that a local enhanced service must provide 'medical care for patients'. But a circular sent to PCOs by the Department of Health stressed its list of suggested enhanced services 'is not exhaustive'.

Bristol South and West PCT has admitted spending £48,000 of its enhanced service budget on GP appraisals. A spokeswoman said: 'This is a health community with particular financial problems. We believe developing GP services is one way of enhancing patient care.'

GP negotiator Dr Laurence Buckman said the strongest action the GPC could take against such rule-bending was to report PCTs to health minister John Hutton. But the department was unable to list any sanctions that could be used to haul trusts into line.

The department is still refusing to reveal whether enhanced services spending pledges add up to the £315 million promised by Mr Hutton in England this year.

Ruth Cuthbert, NHS Confederation GP contract project manager, said it would be 'unfortunate' if trusts failed to meet the pledge but added: 'There really is little that can be done this year given the delay in the ballot.'

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