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Deficit-hit CCGs target GP enhanced services in new cost-saving drive

Exclusive CCGs faced with large deficits are looking to make cuts to GP enhanced services in order to find extra savings this year, Pulse has learned.

Three CCGs – all recently rated ‘inadequate’ because of financial failings – are currently reviewing their GP enhanced service contracts, with a view to making savings and even decommissioning some altogether.

Commissioning leads at the CCGs said they had to consider making the cuts in order to deliver financial savings and get back on a sustainable footing.

But local GP leaders condemned the proposals, which they said were ‘short-sighted’ and ran counter to NHS England pledges in the GP Forward View to invest more in primary care.

The potential cuts include:

  • NHS Kernow CCG is reviewing all GP enhanced services as part of plans to make £42m worth of efficiency savings;
  • NHS Walsall CCG, which has to make £22m efficiency cuts by the end of the year as part of its financial recovery plan, is reviewing the future of locally commissioned services including near-patient testing and phlebotomy;
  • NHS Shropshire CCG, which is tackling a £14.5m deficit, is proposing to decommission a Care Home Advanced Scheme – a GP enhanced service previously singled out for praise by the CQC – along with a number of other local services, including GP practice based counselling.

These threats comes after Pulse revealed that CCGs in some areas have ploughed extra funding – worth a total of nearly £200m this year – into innovative new enhanced service contracts with GPs, in line with NHS England’s stated aims to bring extra investment into general practice to help stabilise the NHS.

But GP commissioning leads warned that cash-strapped CCGs are simply not able to afford to invest in this way for the long term.

There are also fears that Sustainability and Transformation Plans (STPs) currently being drawn up across England - with little insight of grassroots GPs - could lead to further cuts to services.

Cornwall LMC executive member Dr Beth McCarron said NHS Kernow CCG's review was 'causing considerable conern among GP practices', many of which are 'hanging on by their fingernails'.

She said: 'Even relatively small shifts in funding away from general practice can destabilise [these practices].'

Dr McCarron, who recently stepped down from the GPC executive, added: ‘We were supposed to be getting extra investment in enhanced services with the GP Forward View. It is something the LMC is fighting really hard to prevent - it is completely short-sighted and unnecessary in my view.'

NHS Kernow CCG said it was forced to plan for 'financial sustainability' because it was 'facing a serious and challenging financial position'. A spokesperson said this included looking at GP enhanced services to ensure they 'provide the best possible clinical outcomes and value for money, based on the needs of the population and the money we have available to spend'.

Meanwhile, in Walsall, the review comes as the CCG recently pulled a LES worth over £1m collectively to local practices, without any warning.

Walsall LMC medical secretary Dr Uzma Ahmad said: ‘[The CCG has] highlighted one or two that are high-paying, some they don’t want to continue, others they want to look at the pricing or bundling – as part of the plans to deliver the QIPP savings.

‘This will really impact on our funding. For example, they have flagged near-patient testing and phlebotomy as two high-paying contracts where they can make savings – but they don’t appreciate the impact of that on the hospital and patients.’

An NHS Walsall CCG spokesperson said that the CCG was 'currently reviewing' all the GP enhanced services but no decisions had been taken.

Dr Julian Povey, chair of NHS Shropshire CCG and a GP in Shrewsbury, also stressed that his CCG had not reached any final decisions.

But he added: ‘If we don’t tackle these issues now, our deficit is going to increase and that means money will be taken away from other areas of the health service. We cannot afford to keep spending money we don’t have.'

Desperate times, desperate measures?

The majority of CCGs recently rated ‘inadequate’ on finance by NHS England have told Pulse they are still in the process of agreeing what action they will take, but if the proposal by NHS St Helens CCG (to halt all GP referrals into their local hospitals over the winter) was anything to go by, CCG leaders could resort to desperate measures.

Although that plan was swiftly canned after GP leaders condemned the move, the CCG is continuing to consult on rationing IVF and cutting back on prescribing of over-the-counter medications and gluten-free foods.

Elsewhere GP leaders have warned CCGs are being more covert in introducing rationing measures, sich as NHS New Devon CCG's scheme to 'streamline' urology referrals by letting GPs pick them up themselves.


Readers' comments (21)

  • Peter Swinyard

    oh dear, @ 1:57 pharmacist. No, we would not take out administrative anger on our patients. But you do not work for free. If a patient comes into your shop and wants a medicines review and you have not been funded for it - do you do it? No, thought not. If something has been an enhanced service, it is by definition not core. If it is not funded, should partners subsidise this and work for free? After a while, working for nothing wears a little thin. (DOI, our practice finances so cr*p earlier this year that I worked without drawings for 4 months. Yes, for free. Situation now corrected but not happy days. I still paid my salaried colleagues and my other staff but no - I do not wish to work for nothing).

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  • I think there are many people here who do not understand the NHSE rules.

    When a CCG indicates it will not meet the NHS business rules (i.e. achieving 1% surplus of the budget by end of the year), NHSE will initiate a recovery plan. This plan will be done at the cost to CCG and it will also need to appoint a turn around director (again, CCG will have to pay for this expensive position) - an exec who's sole intention is to achieve compliance with the business rule. That director will not care if it is sustainable, how it affects the local community or the providers. His/her only aim is to achieve that balance for that year.

    So I'm not surprised above CCGs are cutting expenditure like no one's business. Remember folks, it may not be the wishes of majority of the CCG members.

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  • GP Partner|24 Aug 2016 3:41pm Peter Swinyard

    One of the problems that Pharmacy has had is doing too much for free- Monitored Dose Systems being a particularly sore point.
    But point taken, especially regarding your drawings. Glad it's working out now

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  • Pharmacist

    So it looks as though we are all in the same boat (expectation to do more for less finance) by Government / DoH.

    The obvious answer is that we "all" set a future date when we will collectively not be doing.................................

    This then needs a lobbying company to get the message to the public (social network, mass media, lobbying MPs). We will need to very strong to cope with the lambastering by much of the press, who will try and turn the public against us.

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  • LCS withdrawn = work handed to secondary care = costs go up.
    Even my CCG is bright enough to realise that.
    Big problem we have is 'primary care commissioning committee' are a complete bunch of plonkers and fail to realise that anything beyond core contract has to be paid for

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  • I'm on a CCG governing body.
    CCGs are constitutionally membership organisations. This means that each member practice will have some formal mechanism to provide feedback on how the CCG is being run. CCGs also have a statutory duty not to exceed their allocated budget. We might not like this but it is the Health and Social Care Act. Without primary legislation it is not possible to change. (You/somebody voted for them).
    As GPs who are members of CCGs we have to recognise (as 5.16 says) that if we do not live within our budgetary constraints what will happen is some NHS 'hit squad' will be imposed which is sure to be far worse than any GP led leadership.
    Whilst I recognise that CCGs with deficit positions have difficult decisions to make the best thing that GPs who are not happy with those decisions can do is to get involved. Email your governing body members. Join in. Lobby your MP. Talk to NHSE. Whether we like it or not we have been handed the ball. Not playing the game is not an option without a major political shift...

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  • Anon at 10.42😂- WE have done all of the above and more and it's got us nowhere. Members are disillusioned as the situation is not what I voted for- we don't have a say in CCG decisions- that's blatantly obvious- the odd lip service event has a forgone and clearly pre established's another top down organisation which doesn't value members views and wastes enormous amounts of money itself but claws vital smaller amounts back from practices destabilising them without a care......

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  • 'some NHS 'hit squad' will be imposed which is sure to be far worse than any GP led leadership'

    Bad decisions are bad decisions. If it is a choice between the CCG organisation and making the right choice for the local health economy you must chose the later.

    Staff running Mid Staffs made those 'hard decisions' to achieve financial balance. The outcome of this approach was patient deaths.

    If the decision is impossible to make safely send it up the line. Ultimately the ruling government needs to gain a mandate from the public for a sustainable health service, perhaps modelled on successful European models where patients have better survival outcomes.

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  • Well said 11.30 pm. May I add that when it comes to "hard choices" they only apply to patient services, whilst the salaries of CCG governing bodies GPs and their managers are sacrosanct.
    I looked up the annual reports and ACCOUNTS of badly performing CCGs only to see that management expenses, varying from £4 million to £11 million, are untouched if not increased over the last two years. But NHS Is well known for rewarding failures and protecting vested interests.
    Perhaps, ordinary GPs should start looking up their CCGs' salaries and ask themselves whether their patients get value for money.

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  • A quite hilarious misunderstanding by these CCGs of what goes on. If funding is removed, we merely refer the work to secondary care where it is charged at at least twice the price in general. Our Enhanced services supplement core services which are funded below the cost of provision. If ES are cut then staff must be cut and waiting times for core services increased

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