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GPs are being urged to issue ultimatums to PCTs that they will boycott unpaid work as evidence grows that the fiasco over enhanced services is going from bad to worse.

Trusts across the UK are refusing to spend enhanced services budgets, trying to get spending floors cut and even decommissioning services they paid for last year.

Others are trying to push through inappropriate services for the second year running or telling GPs they can't afford to commission because they have to find cash for quality pay.

LMCs reported that 'painful' talks intended to force trusts to use unspent money carried forward from last year were going nowhere.

The NHS Alliance said GPs in up to one-fifth of PCTs may have to issue ultimatums that they would quit services unless the trust paid for them.

Dr David Jenner, GMS contract lead for the Alliance and a GP in Cullompton, Devon, said: 'Practices should tell PCTs it's ''make your mind up time'' by the end of the first quarter.'

Dr John Canning, Cleveland LMC secretary, said wranglings over enhanced services had been 'a lot of pain for little gain'. 'If it's not recommissioned don't do it,' he said.

Birmingham LMC said three of its PCTs had revealed plans to underspend for the second year running.

Dr Robert Morley, LMC joint executive secretary, condemned a lack of sanctions in the deal struck by the GPC to allow trusts to shunt cash not spent last year into this year's budget.

He said: 'They will all underspend next year and may continue to do so the year after as well.'

Cardiff local health board is planning to decommission a number of enhanced services after an overspend of £633,000 last year.

It has pledged to meet its spending floor, but only by transferring enhanced services including violent patients and care of homeless people to a vulnerable groups budget.

Suffolk LMC is in dispute with three PCTs who are seeking to shore up quality money by not funding pre- and post-operative care.

One PCT in East Sussex has requested its floor to be lowered, arguing it was set too high, while LMCs in South Staffordshire, Cornwall, Essex and Kent said PCTs were trying to include inappropriate services.

Philip Grant, a GMS negotiator for NHS Employers, admitted PCT performance was variable.

'There are areas where financial constraints are having an impact on PCTs' ability to commission enhanced services,' he said. He added that enhanced services were being discussed in the contract review.

Enhanced services


Cornwall ­ attempt to include Choose and Book

Birmingham and Wessex ­ underspends for second year

Cardiff ­ services decommissioned

East Sussex ­ PCT tries to lower floor

South Staffordshire, Norfolk ­ PCTs reported to GPC

Kent, Essex ­ funding of inappropriate services

Suffolk ­ basket deals continue

Highlands ­ no services at all

South Lancashire ­ nothing for pre and post-operative care

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