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GPs fight to stave off spending cuts

Enhanced services and appraisal funding under threat as desperate trusts look for savings

By Helen Crump and Anna Hodgekiss

GPs are fighting to stave off swingeing cuts in funding by PCTs trying desperately to find savings.

Enhanced services are coming under threat across large swathes of the country, with trusts in particular targeting 'basket' deals, a Pulse investigation has found.

At least five PCTs have proposed axing existing agreements in order to fund the new directed enhanced services ­ even though these are backed by new money.

In other areas, trusts have ended funding for appraisers and told GPs they will have to pay them if they want an appraisal (see right).

The cuts have been triggered by Government demands that PCTs break even this year and its decision to top-slice their budgets to act as a contingency.

In one of the worst-hit areas, Thames Valley, the strategic health authority has told trusts that enhanced services have 'no more priority than any other spend, irrespective of payments made in 2005/6'.

Dr Paul Roblin, chief executive of Thames Valley LMCs, said the result was that PCTs across the region were ending basket deals: 'There is a degree of brinkmanship ­ they are stopping the baskets and expecting us to do the work for nothing.'

Cheshire and Merseyside strategic health authority has also told PCTs to end basket deals.

GPs in the West Midlands reported similar problems.

Basket deals were agreed by GPs in many areas as a compromise because of PCTs' unwillingness to agree specific local enhanced services.

Dr Rob Barnett, Liverpool LMC secretary, said: 'PCTs say they have no money and that GPs are awash with cash, so they're going to try to get something for nothing.'

Dr Peter Madden, secretary of South Cheshire LMC, said the health authority wanted to price services individually. 'They are trying, but we are fighting it,' he said.

Dr Nigel Watson, chief executive of Wessex LMCs, said Kennet and North Wiltshire and West Wiltshire PCTs intended to use existing enhanced services cash to pay for new DESs.

Three PCTs in north Yorkshire had similar plans, but backed down after GPs threatened to boycott all of the new DESs. Colchester PCT has also proposed the move.

GPs in Worcestershire, Somerset and Avon have also reported efforts by PCTs to make practices do more work for less money.

Dr Laurence Buckman, GPC deputy chair, said: 'If you've not had funding for something, I suggest you stop doing it.

'It would be insane to do the work for nothing.'

Where the axe is falling

· West Midlands, Oxfordshire, Bedfordshire, Cheshire: No more basket deals

·Liverpool: Enhanced services 'retainer' axed

·Gloucestershire: Appraisal funding scrapped

·North Yorkshire, Worcestershire, Essex: Existing enhanced services ended to pay for new DESs

·Wiltshire: No more LESs

·Somerset: Extra post-operative work for less pay

·Avon: PBC DES renamed

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