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Revealed: GPs face losing public health funding under DH guidance for local authorities

Exclusive GPs face having to compete for many of the public health services that they currently provide under new Department of Health advice to local authorities that urges them to put most local enhanced services out to tender when they come up for renewal.

In advice published last month, the DH advised local authorities that GPs should not be given ‘preferred provider status’ and they should use ‘appropriate procurement approaches’, that under current rules, legal experts claim will result in the majority of LESs being put out to a full competitive tender.

This means practices providing services - such as cardiovascular screening, sexual health services and smoking cessation services - are likely to become embroiled in a long-winded and labour-intensive administrative battle to preserve their income.

It comes as LMC leaders warn that local authorities are preparing a large-scale review of the way they spend the £5.45bn two-year public health budget they will control from April, and that smaller practice-led services might be overlooked.

Pulse can also reveal that after concern from GPs over the impact on their funding, the GPC is currently preparing guidance on how they can combat the shift in responsibility to local authorities.

The new DH guidance says: ‘Once the transferred contracts expire, local authorities should commission services from providers in a manner which ensures delivery of high quality public health services and which supports continuity, integration and easy access to, services.

‘Primary care contractors and other providers do not have preferred provider status for any newly commissioned public health services by local authorities and appropriate procurement approaches will need to be used.’

Why are local authorities subject to different rules to CCGs?

  • Unlike CCGs, local authorities are not subject to the Health and Social Care Act, which has its own procurement rules in the form of Section 75, itself the subject of debate.
  • Local authority procurement processes are governed by EU law - under Article 81 of the Treaty of Lisbon, non-health public bodies cannot do anything ‘which in any way prevents, hinders or distorts competition’.
  • Under UK law – in the form of the Local Government Act 1999 – councils must achieve ‘best value’, and providers are able to take them to court if they do not feel the EU and UK principles have not been adhered to.

Janet Roberts, director of the procurement advisory service Tendering for Care, said in practice local authorities will run a full tendering process for the public health LESs to cover themselves from possible legal action.

She said: ‘The easiest way to demonstrate that the principles have been employed is actually to run a tender process.

Click here to read Jane Roberts’ full quotes

‘If I am going to go to court and stand there in the witness box and answer a challenge, the safest thing to do is to say “I ran a compliant tender process”, job done. So that is why the local authorities will do it, after doing a risk assessment and ensuring that they comply with their standing orders.’

GPC deputy chair Dr Richard Vautrey said: ‘We are in the process of finalising guidance which will address all of these issues and we hope to issue it shortly as we know practices and LMCs need this information as soon as possible.’

GPC negotiator Dr Chaand Nagpaul added: ‘There was always a concern about public health services falling under a local authority remit and the fact that local authorities have operated a competitive tendering process.’

LMC leaders have warned of an emerging picture on the ground where the default position is for all contracts to be reviewed and strong indications that they will be put out to full competitive tender.

Sefton LMC chair Dr Andrew Mimnagh said: ‘With regard to the competition element it is difficult certainly because the tendering specification process is to favour large formats, and I suspect as individual practices that is quite difficult to do. It may be one of the drivers on federated working.’

Dr Nigel Watson, chief executive of Wessex LMCs, urged local authorities to use their legal ablility to procure for best value to continue effective services in primary care.

He said: ‘There may be some services which are best provided outside the practice but local authorities are perfectly able to, within the law, to look at the overwhelming reasons to why they should commission certain services to GPs. They need to think: is there an overwhelming  and compelling reason why I should replace these services [provided in primary care] with some other, external service.’

‘The sort of stuff that they will be tendering for, it will be far too complicated and far too expensive to go through a full tendering process. Based on our discussion with some of the public health teams, they don’t yet have a full understanding of the extent of the services we are providing. Are we concerned about what might happen? Absolutely.’

He added: ‘I do think practices do need to prepare for a process of tendering.’

A DH spokesperson said: ‘It will be for local authorities to decide how best to procure public health services from April 2013. The decisions they take should be in line with the priorities set out in their joint health and wellbeing strategies. They will have a duty to take appropriate steps to improve the health of their local communities and they will be accountable to local people for the quality of the services they arrange.’

The DH set out its ring-fenced budget for public health in January, with the 2013/14 budget set at just under £2.7 billion and the 2014/15 the budget rising to just under £2.8 billion.

 

 

Readers' comments (18)

  • This is the end of GP as we know it. I can see that GPs of the future (probably nurses) will be care of the elderly merchants with the odd cough and sore throat thrown in. Dear medical students and GP trainees-DONT GO INTO GP.

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  • So "services are likely to become embroiled in a long-winded and labour-intensive administrative battle to preserve their income". Just like any other NHS provider then?

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  • No, GPs do not necessarily have to learn how to tender. Procurement of many of the services which have fallen under the LES heading is not new to local Authorities or specialist providers. During the period from 1st January 2010 and 1st March 2013 the tendering exercises for the following services have been undertaken by Local Authorities:
    •Alcohol prevention and treatment 162
    •Drug misuse prevention and treatment 119
    •Sexually transmitted diseases 76
    •NHS Health checks 14
    •Substance misuse 160
    GPs can link up with providers experienced in tendering for thee services and sub-contract their services. Many providers will welcome approaches of this kind - a real practical link up of health and social care.

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  • We only need to provide the public health services to subsidise the core GP services which are seeing people who are ill or believe themselves to be.

    If our funding reduces and practices are no longer viable then the government will have to pay GPs the market rate for the core services . This is what we are trained for and if capacity is a problem is what we should concentrate on. Let the other services be provided by someone else, just make sure our practices are properly remunerated for the work they do.

    The alternative is that the rest of the NHS grinds to a halt.

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  • "just make sure our practices are properly remunerated for the work we do. "

    Obviously !

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  • Nhsfatcat

    Fragmentation of services is still a worry (Railways are cheaper and more efficient aren't they!)
    The public, fuelled by HMG and the media, still see the GP as the back-stop for all things health. We will have to accept reduced funding and the patients will get reduced service. #No' is now a word to learn and use.

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  • As I said before, some of the funding for my nurses and HCAs comes from doing such tasks. If we loose the income stream, they'll have to go as well (naturally. How can I continue to pay their wages when the very job they are employed to do is disappearing). Along side with this, non-incentivised work they also do will also not be done. So patients loose out.

    Whats more, how can we have a streamlined review process when different agencies are involved? My nurse spots high BPx3, she'll make appointment and organize usual bloods and ECG. I'll see the patient and discuss treatment. In the new world, AOP sees high blood pressure, tells patient to make appointment with GP. I'll see the patient, no bloods, ecg (and likely no crrespondances from AOP) - so patient will then have to have this done and reviewed again (one extra GP appointment). Only as I will no longer have nurse to do ECG, Pt will have to wait for app at cardiac unit (costs more).

    I'm convinved Jeremy Hunt is puttng these measures in place to destroy primary care.

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  • How is this good for patients? My GP practice has improved immeasurably over the last few years as it has expanded the service it offers beyond traditional consultations. Everything is in one place, information flows well, and the place seems to be more professionally run. But if all these extra services end up being tendered out to random suppliers, all that benefit is lost

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  • Nhsfatcat

    Three cheers for Anonymous 2:26pm!

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  • Most of the les are unaffordable to do anyway. I doubt any private provider could make any profit from it.
    The only reason gps do it because the setup costs are already there,
    Most of the leses are funded according to expenses and running costs and do not take in to account capital costs or setup costs. There is no profit in it at all.

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