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PCTs dump floors for enhanced services

One in six PCTs has no fixed enhanced services spending floor, a Pulse investigation has found.

Half the 61 PCTs surveyed underspent on their floors in 2005/6, and 14 per cent anticipate underspending this year.

Although there is no statutory requirement for PCTs to maintain enhanced service floors, a spokesperson said the Department of Health expected them to be met.

'Ministers made a firm commitment in writing to the GPC that this was the minimum level of expenditure each PCT would spend on enhanced services in a given year.'

GPC negotiator Dr Richard Vautrey said although there was no legal obligation for PCTs to keep to the floors, 'that's what we would regard as good practice'.

But he admitted that the lack of a statutory requirement to spend to the floor meant that PCTs with deficits would be tempted to dip into enhanced services funds.

'It seems to be short-term cost-cutting that will have long-term implications for primary care,' he said.Dr Charles Zuckerman, medical secretary of Birmingham LMC, said GPs in his area had repeatedly complained about enhanced services spending.

The LMC covers Birmingham East and North PCT – one of the 10 PCTs found by Pulse not to be operating an enhanced service floor for 2006/7.'The whole thing has been an absolute shambles,' Dr Zuckerman said.

'Enhanced services were never enforceable, they were always merely guidelines,' But he doubted that the GPC could have done much about it.

'The GPC can bleat about it until the cows come home,' he said. 'PCTs have been given carte blanche by the department to do whatever they want.'The department disputed that half of PCTs underspent last year, saying only 66 PCTs had forecast underspending for 2005/6.

But figures showing how much had actually been spent were not available, a spokesperson said.Dr Laurence Buckman, deputy chair of the GPC, said his own research for the technical steering committee backed up Pulse's findings.

Dr Greg Place, chair of Nottinghamshire LMC, said the local PCT, which had no floor, had proposed more than 30 enhanced services schemes.The schemes, such as drug addiction services, were not what GPs would classify as enhanced services and were not taken up as a result, he said.

'They're quite happy at the PCT because they haven't needed to spend the money.'

GPC guidance published this week said that uplifts for enhanced spending floors had yet to be agreed for 2007/8. This year they were frozen at last year's levels. However, PCTs are expecting a 9.6 per cent increase to their total funding allocations following a 9.2 per cent uplift for 2006/7.


PCTs with no enhanced service floors for 2006/7PCTs with no enhanced service floors for 2006/7 PCTs with no enhanced service floors for 2006/7

• Barking and Dagenham
• Birmingham East and North
• Bolton
• Bournemouth and Poole
• Bromley
• Kirklees
• Nottinghamshire County
• Telford and Wrekin
• Wakefield District
• Waltham Forest

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