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GPs fear they are fighting a losing battle in bids to secure proper funding for local enhanced services, as wranglings with trusts rumble on into a second year.

Escalating financial problems mean GPs have had to acknowledge they have no hope of securing money to develop new services. In many other cases GPs are carrying on providing services for free.

Dr Relton Cummings, Newcastle LMC chair, said enhanced services were 'something of a lost battle', with PCTs commissioning cheaper alternatives to GPs.

'The problem is PCTs are in significant debt and as long as they are spending up to the floor it doesn't really give you much scope to develop anything new,' he said.

In Birmingham, GPs are reluctantly providing services free that should be paid for as enhanced services. These include giving Zoladex injections, near-patient testing, wound management and minor injury work.

As well as resisting under-pricing the LMC is also continuing to resist moves by some trusts to underspend for a second year running.

Sussex LMC is to hold crunch talks with Sussex Downs and Weald PCT later this month in a bid to secure funding for services, including MMR for over-16s, phlebotomy and a drug misuse service at a nearby prison.

Dr Clarissa Fabre, a GP in Uckfield, Sussex, said: 'We are now into the second year of this and there is still nothing for us.' She said GPs were facing attempts by the same PCT to reduce its floor.

In Avon, LMC chief executive Steve Mercer accused trusts of 'blackmailing' GPs into continuing to provide services even where funding was inadequate, such as drug services in Bristol, or non-existent. 'The PCTs know GPs will not withdraw their services lightly,' he said.

Dr Paul Roblin, chief executive of Berkshire, Buckinghamshire and Oxfordshire LMCs, was exasperated that arguments are still ongoing over the definition of enhanced services, with attempts to include family planning clinic funding.

Dr Rob Hughes, Greenwich LMC co-chair, said enhanced services funding had disappeared into 'a black hole'.

GPC deputy chair Dr Laurence Buckman said he had some sympathy for GPs but added they had themselves to blame for providing under- or unfunded services.

By Joe Lepper

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