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Funding for GP clinical services cut 'to fund federations' operational costs'

Exclusive An LMC has hit out at its local CCG after it decided to reduce the spend on clinical enhanced services halfway through a two-year contract.

NHS Camden CCG has reduced payments to practices for direct oral anticoagulant (DOAC) initiation and monitoring, services for the homeless, planned care and high-risk drug monitoring.

At the same time, it has invested £180,000 in 'strengthening federations', and has told practices that it would unilaterally serve notice on the contract if they don't agree - despite there being a year left on the contract.

Camden LMC says it is 'disappointing' that the CCG is removing money for patient care in order to fund 'operational costs'.

However, the CCG claims that the money for federations has come from previous budget overspends, and that the total funding for general practice has remained the same. 

The CCG had reduced the money set aside for federations from £280,000 to £180,000 based on 'the feedback' it received.

Camden LMC chair Dr Farah Jameel, who is also a BMA GP Committee executive member, said: ‘We are extremely disappointed that it has come to a situation in which GPs are being told they must sign a contract despite their clear concerns over its impact on patients.

‘While we recognise the financial pressures facing all CCGs, patient care and safety cannot be compromised in order to balance the books.

'It is now clear to us that Camden CCG’s approach to these negotiations has been completely financially driven.'

Regarding the decision to set aside £180,000 for federations, Dr Jameel added: ‘We welcome the CCG’s acknowledgement of the role of at-scale providers and the need to pump prime these.

'However the decision to invest in federation infrastructure by reducing funding that has historically been invested in services and available at a practice level is disappointing.’

NHS Camden CCG primary care lead Dr Kevan Ritchie said the clinical services payments had to reduce 'because the rates we pay are significantly higher than most other boroughs pay for similar services'.

Stressing that the overall CCG budget for primary care would remain unchanged at £2.8m, Dr Ritchie added that the 'payments will remain at the top end or above benchmarked rates and all of the money saved will be reinvested into new primary care services'.

He said: ‘The CCG will invest £180,000 in strengthening our GP federations so that they can provide effective support to Camden general practices.

‘This is not being funded by moving money from patient-facing services. Instead, we are using previously underspent budget.’

The two-year ‘Universal Offer’ contract, which was meant to run until April next year, saw the CCG funding GP practices to provide planned care, high-risk drug monitoring, direct oral anticoagulant (DOAC) initiation and monitoring, services for the homeless, end of life care, post-operative wound care, asthma service for children and young people, and seasonal influenza and childhood immunisations.

But the CCG has now decided to stop funding for DOAC monitoring altogether, stating that they now consider this covered by the core GP contract requirements, and reduce funding for DOAC initiation, planned care and enhanced care planning, high-risk drug monitoring, and homeless services.

In addition:

  • DOAC initiation payments have been reduced from £138 in 2017/18 to £80 per patient in 2018/19.
  • High risk drug monitoring have been cut from £30.40 to £20 per patient monitored per quarter for Methotrexate, while for Azathioprine it's dropped from £27 to £15, and for Sulfasalazine it's decreased from £20 to £10.
  • Homeless health check payments were previously listed as £75 per patient on homeless register if 50% of checks were completed and £135 per patient if 75% of checks were done, but the CCG has now said they will pay just £65 per health check.
  • Planned Care payments have also seen a number of changes, including payments for patients with three long-term conditions dropping from £160 to £125.

In an email sent to all Camden GPs last month, seen by Pulse, the CCG urged all practices which had not signed the new contract to 'now do so' or it would 'serve notice on the current contract’.

Readers' comments (12)

  • simples doac refer to anticoag clinic, high risk drug monitoring goes back to speciality to monitor, homeless probably remain on the list but ? whether they have separate checks done - a shame that this group is having funding cut and increased hospital admission and ED attendance.

    planned care stops happening for 3 or more conditions and ? referred back into hospital.

    reduced finding for general practice = activity transferred back into the acute at much higher price.

    CCG's call. if there is a worsening financial position at the end of this, the board and accountable officer should be held responsible and asked to resign. also it would be worthwhile to see who in the CCG has made these calculations and who has decided it and this should then be made public so that they can also be held accountable too.

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  • No shared care, no medicines optimization and the unnecessary audits - you get a penny, the CCG keeps the pound and it is all pumped into federations and alliances run by CCG and LMC Managers. GPs are lower in the foodchain than patients:)) And all this, because the government agenda has to implemented over dead bodies if required. The usual tactics in corpos is that you give the Manager a 200k salary and make him slave drive workers to achieve results. Our CCG and LMC people have learned to do the same. Any Practice that joined a Federation or Alliance been given a penny of the £5 given per patient to LMCs or funds given to CCGs to encourage Practices to join these hubs? I doubt it - unless they are also Practices run by these cardiagnas themselves.

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  • Cobblers

    A lot of mealy mouthed utterances going on here. I would say lying but would get censored by Pulse. It applies to the verbal drivel coming from the CCG.

    If DOACs are part of a LES then they are non contractual. So no nonsense about it being core.

    A contract is a contract. Was there a get out clause in it for the CCG? If not then impose it on the CCG. If there was then all inclusions within that contract get passed to the secondary sector.

    Take a breath and have another look at what you are doing. Consider RLE (Retire, Locum Emigrate)

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  • 1 - stop doing the items that are no longer funded. For example pull out of shared care agreements and pull out of DOAC initiation and monitoring.

    2 - Vote of no confidence in the CCG board. They are supposed to represent you (GPs) and you have the right to vote them out if they are looking after federations more than patients.

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  • A vote of no confidence in the CCG would go a long way.

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  • CCG v LMC is Never a Pretty Sight! Divide and Conquer has worked as a Strategy since The Raj!!
    Whilst Primary Care Agencies fall out, Government and Secondary Care Smile On!

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  • Time to vote out the CCG and let the real power behind the bullying come out into the light.

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  • Is a contract not legally enforceable?

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  • Mid contract fund withdrawal is a fundamental integrity issue. We lost funding after doing the work for 75 care. Trust is a precious commodity, more when there is already so little of it!

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  • And wasn't the 5 Year Forward View funding supposed to be there for just this: Is the promised money not there?

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