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Investigation: GPs face battle to retain LES income



In less than four months’ time the protective doors on general practice will be blown off. Some practices could lose as much as 10-15% of their funding at a stroke, as local enhanced services are for the first time put out to competition.

A Pulse investigation reveals that CCGs and local authorities are planning to put local enhanced service funding worth millions of pounds out to Any Qualified Provider (AQP) or full competitive tender from 1 April.

GP services such as anticoagulation clinics, spirometry and minor surgery will be thrown open to the vagaries of the NHS market, in what could represent a feeding frenzy for private companies.

With just months to go, more than half of CCGs have yet to decide whether they will put their LESs out to tender, prompting the GPC to warn that GPs will have very little time to prepare any bids.

Under NHS England procurement rules, CCGs have to put all their LESs out to tender or procure them under AQP unless they can prove the service can only be offered by a single provider. Recommissioned LESs will be rebranded as ‘community service contracts’ (CSCs).

Pulse approached every CCG in England, asking them how they planned to recommission their LESs, and also approached dozens of local authorities to ask what they planned to do with their public-health LESs. Some 48 CCGs replied, with 23 having made a decision so far. Of these, nine plan to put some or all of their LESs out to tender (see map). The services put out to tender in those nine areas are collectively worth an estimated £2.025m. Extrapolated across England, these figures suggest around £18.6m worth of services could be opened up to the market. And this could be just the beginning.

In addition, two local authorities confirmed they will be putting enhanced services out to tender, out of 12 who confirmed to Pulse they had made a decision.

Meanwhile, Pulse can reveal private providers are keeping a watchful eye on the potential to pounce on the contracts on offer, with Alliance Boots, BUPA and Celesio UK – which owns the Lloydspharmacy brand – among those to express interest. 

Enhanced services are a vital source of income for practices. As GPC deputy chair Dr Richard Vautrey says, the current LESs ‘are worth around 10-15% of the average practice’s income – and this is a time when GPs have to make every penny count’.

So what can GPs expect come April with their first direct dealings with the new competition regulations?

Pulse’s investigation reveals CCGs are interpreting the competition regulations in varying ways.

In Essex, three CCGs – Basildon & Brentwood, Castlepoint & Rochford and Thurrock – are putting all their current LESs, worth a total of £753,000, out to tender via the AQP route.

They claim they are doing this to avoid ‘potential conflicts of interest’, saying: ‘It was considered that the AQP process was a fair and transparent way of commissioning these services long term.’

NHS West Leicestershire CCG, meanwhile, is putting 10% of its LESs out to AQP, although it is unable to say what this will be worth. Neighbouring NHS East Leicestershire & Rutland CCG is putting 12% of services out to AQP.

Meanwhile, NHS Stockport CCG could put 40% of its LESs out to full tender (see case study, right). Local GPs’ bottom line could be hit to the tune of £383,200.

At the other end of the scale, 14 CCGs have already decided to extend existing GP-held contracts. NHS Rotherham CCG will be publishing a voluntary transparency notice on the Supply2Health procurement portal to allow potential competitors to come forward for future consideration. For now, its LESs – worth £616,000 in total, including an anticoagulation service, an aural care service, a blood monitoring service and a scheme for secondary care services provided in primary care – will continue to be provided by local GPs without the need for a competitive process.

NHS Isle of Wight CCG is another that plans to keep services with GPs.

It said of the decision: ‘The majority of our services are small but vital. All GP practices are providing them, there are high levels of patient satisfaction, and we can demonstrate clear cost-effectiveness.’

The CCG took advice from procurement experts and it feels ‘the costs of tendering would outstrip any benefits our patients would have gained and in all likelihood would have cost us more’.