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A faulty production line

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

    I think that there are some CCGs who "think" that they can withdraw funding and GPs will carry on doing the work for the sake of the patients. Let us be stronger than that. We have to be resolute - the funding is withdrawn, then the service is withdrawn. For example phlebotomy - send all the patients to the local path lab to be bled and wait for the howls of "we aren't commissioned to do this". Ultimately, it is the CCG/NHSE responsibility to make sure that decommissioned services are reprovisioned. Good luck, chaps and chapesses.

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  • how does cutting near patient testing and phlebotmomy add up to savings - if it were me - these patients would simply have to attend the hospital for the service - which I am absolutely sure would cost far more than paying GPs to deliver the service - in fact phlebotomy actually costs more already to deliver than it gets in income via the lcs but cutting it all together would i am afraid would be the red rag to the bull to stop doing it in primary care

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  • Work to rule.

    Only 12 consultations per session.
    All secondary care work refused - no follow up bloods, no monitoring and prescribing of methotrexate, sulphasalazine, mycophenolate, no monitoring of mental health, no methadone prescribing
    Monitor every letter coming back from hospital and refer back PRN
    No bloods done in primary care, apart from QoF, if this still applies - refer to hospital
    Refer to out-patients or A+E for everything that requires investigations
    Prescribe branded rather than generic drugs
    No home visits if patients can travel in a vehicle / taxi

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  • In purely financial terms income from enhanced services has become a vital, finely balanced, and significant portion of practice funding. If a practice were to lose say 10k due to an ES or two being cut, then one couldn't simply make redundant the "enhanced service X nurse" as of course no such post exists. In reality the money will come out of the business and/or simply put yet more pressure on resource for patients. Not a good idea given that so many practices are already on the brink of closure. I'm sure the leaders will have thought all this through carefully though and made it part of the "sustainability plan"

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  • And these 'experts 'in charge wonder why Gps get upset.
    This is just another nail in the coffin
    Cant see it attracting too many new doctors into GP land

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  • The difficulty is that if a service is no longer funded, it will then be withdrawn. It can be very difficult to get the personnel / infrastructure back again if it is subsequently funded again, so the cost to the NHS is inevitably increased

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  • Anonymous | GP Partner|24 Aug 2016 11:05am

    Work to rule.

    So you think that it's acceptable to take your anger out on your patients?

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  • work to rule - yes is a message to our managers.

    Well the CCG taking away vital services for our patients and a work to rule is just about not doing unpaided work or work inadequately funded. e.g INR work done costs more than what is paid to us. etc etc.

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  • @ 1:57 pharmacist

    I don't think work to rule comes out of anger. Just a realisation that the benefits or harm for patients has to come from those organising and funding care, NOT the goodwill of professionals.

    I am fairly sure if the pharmacy contract for flu jabs was withdrawn, pharmacies are not going to continue to give it.

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  • I';ve yet to meet a pharmacist who gives out their medication for free. Even one tablet is charged to the CCg.

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