Evidence of greater investment in LESs is welcome, but the biggest ticking time bomb is that, from 1 April next year, GPs will not be the preferred provider.
This will put pressure on CCGs to do what they can to keep this funding with their member practices, without breaching competition regulations. They should be focusing on how it is deployed in their current member practices, but they will have to do it so that it doesn’t look as though it is a monopoly arrangement.
They have to come up with some sophisticated ways of saying: ‘Not only are we using the legacy LES money, but we are going to invest more.’ They will have to prove they are taking money from ineffective outpatient or urgent care services and are investing it in member practices.
A risk is that general practice is not well geared to go into a competitive market and we have got the independent and commercial sector coming in, [which are] much better skilled at bidding in competitive tendering procurement.
Another risk is that, if CCGs say LES funding has to go into their baselines to meet the current pressures in hospitals, I will be concerned about the future viability of the NHS as it is dependent on a strong primary care system.
Dr James Kingsland is national clinical lead for the NHS Integrated Clinical Commissioning Community and a GP in Wallasey, Merseyside
