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GPs work for free to protect patients' care

As PCTs delay enhanced services deals, GPs are having to treat without pay – Susan McNulty and Ian Cameron report

The vast majority of GPs are doing unpaid work under the new contract to ensure patients do not suffer as a result of PCTs' failure to commission many national enhanced services, Pulse has learned.

A Pulse investigation involving GPs in 75 PCTs found that in 49 (65 per cent) of them GPs were providing at least some national enhanced services for free.

The research reveals that trusts have focused on commissioning services involving relatively large numbers of practice patients, leaving GPs to decide whether to treat smaller groups of patients without payment or refer them elsewhere.

Few PCTs have commissioned nursing home care, MS care and depression, and suture removal has rarely been commissioned as a local enhanced service.

But the GPC told GPs that services had been categorised to control workload, and by doing unfunded work they were giving trusts a green light to dump more unresourced work on them.

Grassroots GPs, however, told Pulse they found it impossible to turn patients away.

Dr Daniel Brett, a GP in Bristol, said there was no money on the horizon for enhanced services for drug misuse and depression, which took up about three hours a week.

He added: 'There isn't anywhere to refer them to. I am left with a moral obligation and don't feel I can turn these people away.'

Dr Steven Charkin, a GP in north London, said a depression service had been a 'non-starter' with his PCT and he would continue to offer care.

'We like to think we just get on with it and anything that can be done in general practice should be.

'It would be fantastically difficult, with someone in front of you, to say "We're not paid to do that".'

But the GPC said this undermined the contract's aim of ensuring GPs only did funded work, and warned that their goodwill would run out by

autumn.

GPC member and Essex LMC chair Dr Brian Balmer said: 'GPs doing this for free are undermining colleagues because the PCT won't commission from anyone.'

GP will treat while waiting for PCT deal

Dr Thomas Bloch believes even the most militant GPs will find it difficult to turn patients away instead of providing enhanced services on an unpaid basis.

Dr Bloch's practice in Broadway, Worcestershire, is providing a wide range of services without pay pending a meeting with the PCT. These include IUCD fitting, anti-coagulant monitoring, and care of drug misusers.

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