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GPs write to CCG to say they are stopping all 'unfunded' work

Exclusive GPs in Lincolnshire will stop offering non-essential services they not commissioned to provide unless they are given the cash to do so under a new LMC-led campaign, Pulse can reveal.

Around 100 practices in the area have drafted letters to CCGs notifying them of their intention to stop offering unfunded services, which could see them stop providing treatments such as ear care, ECGs and 24 hour blood pressure monitoring.

It comes as Dr Chaand Nagpaul identified the withdrawal of non-contractual work as a potential legal form of action that practices can take to reduce their workload in an email to practices, as Pulse exclusively revealed. 

Lincolnshire LMC's move represents the first reported example of an LMC going ahead with this organised form of action.

The LMC told Pulse it was currently in discussions with the CCGs in the county about the proposals, and hoped to resolve the issue by March 2017.

The LMC's members originally voted in favour of taking the action in February. It came in response to the Special LMCs Conference in January, which first mooted the possibility of GPs signing undated resignationsa move recently shot down by the GPC.

GPs in the region indicated they would not be willing to submit resignations, so the LMC proposed for members to stop doing unfunded work as a means of highlighting the pressure GPs were under.

Dr Kieran Sharrock, medical director of Lincolnshire LMC, told Pulse: ‘Our practices were feeling the pinch. We arranged a meeting in February to find out what sort of industrial action they wanted to take.

‘They didn’t want to strike or sign a mass resignation letter because they didn’t want to take any action which could harm patient care so they decided that they would look to stop offering non funded extra services.’

He added: ‘Staff felt that they shouldn’t be offering these services if they haven’t been commissioned to do so and wanted to ask commissioners to find alternatives. They don’t want to withdraw services but they cannot do everything.’

Dr Sharrock said that these services were already being commissioned elsewhere in the county, but that some GPs had been offering the services to benefit patients without being commissioned.

He added: ‘The ideal situation would be that the practices get commissioned to provide the services themselves because that would be better for patients. The GPC has been pushing for practices to refuse to do unfunded work. Most of the stuff which we are not being funded for should be funded – it is in other areas. These services should be standard across the country.’

Gary James, accountable officer of NHS Lincolnshire East CCG, said: ‘As CCGs we are talking with our member practices and the LMC in an effort to address practices’ concerns and find suitable solutions.

‘This may take time to work through, however, patient safety is always our first priority and we want our GPs to be able to continue to offer Lincolnshire patients a safe and high quality service.’

CGs with large deficits have been looking to cut local enhanced services offered by GPs in a bid to save cash.

Pulse found that three CCGs rated ‘inadequate’, NHS Kernow, NHS Walsall and NHS Shropshire were reviewing enhanced services in order to save extra cash this year.

Readers' comments (36)

  • Already kicking up a fuss about ear syringing wound care and bloods

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  • 2.53, interesting because we were advised the inverse by our LMC (Wessex). Ie that if it had been offered anywhere else as a LES then it wasn't 'core GMS'. Google is your friend here. There are LESs in parts of the country for all kinds of things; DVT pathways, ABPM, wound care to name a few, all of which we were (and largely still are) doing for nothing.

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  • Anonymous12 Sep 2016 8:38pm

    Quite agree with your point! I think the problem lies with NHSE structure - if your AE is sympathetic and agrees with you, it'll be ok. No consistency what so ever and I look to GPC to define this so that we know what we don't have to do.

    Oh wait, GPC's chair will just get another honors and we'll be told everything is "core".

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  • Wessex LMC is correct.
    If it has ever been offered as a LES/LCS then it is not core.
    CCGs must resource GPs to provide, or pay secondary care prices.
    we are currently looking at a whole range of services, ear syringing, follow-up of gestational diabetes, monitoring haematological disorders. All need to be funded or handed to the hospital

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  • It's beggar's belief that these GPs were doing these things unfunded till now. If you want to get trampled by turtles, who can save you?

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  • anything more than a prescription would or should be funded !

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  • Surely it would be in our interests for us to collate all the info re: LESs/DESs across the country so we can have a more solid grounding in saying 'NO'.

    This will help define the current GMS contract, as it is such a woolly thing in its current format making it difficult to say no for a lot of people.

    I think resilient GP/GP Survival might be able to help here.

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  • re 0800hrs - BMA have already done that

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  • The whole point of any industrial action is to "hurt" the employer. Lincolnshire LMC won't take industrial action "because of patient safety ". Twaddle. How will refusong to do ECGs or 24 hr blood pressure monitoring help patient safety. No, they won't resign because it will cost them money. These highly intelligent people have invested all in businesses that service just one customer, the NHS. Imagine the gwarfs of derision that would face any applicant in "The Dragons Den" were they to ask the "Dragons" for cash toward a business proposal that had one single customer. That customer is playing hard ball. It is too late for these GPs. Their business model was insafe fr the outset. Their only course of action now is to resign enmass and form a direct commercial relationship with their patients. Then, perhaps, we will get a system of General Practice that is responsive to patient demand and lead by doctors rather than Civil Servants.

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  • Why not go the whole hog and give up and do something else since being a doctor and doing your own investigations is not what you want to do. Do you want to be paid for washing your hands ?

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