Exclusive GP practices in one area of England were unable to avail of promised funding last year because the local ICB had not commissioned FIT testing for all patients.
Practices across Leicester, Leicestershire and Rutland (LLR) were not able to access FIT testing for under-60s until January this year, meaning they missed out on income from the investment and impact fund (IIF) for 2022/23.
The indicator for FIT testing last year, CAN-01, rewarded practices for achieving a certain percentage of lower GI two week wait cancer referrals accompanied by a FIT result.
However, LLR LMC chair Dr Grant Ingrams said the unavailability of FIT testing for under-60s for three quarters of the year has meant there are ‘practices that are thousands of pounds out of pocket through no fault of their own’.
He estimated the average amount of lost income per practice would be around £1000, but said ‘at bigger practices it would be a lot more money of course’.
LLR ICB recognised GP practices missed out on income due to the delay, so in February ‘following liaison with NHSE’ a ‘support payment’ was made to all PCNs which ‘equated to 50% of the total IIF funding opportunity’.
The ICB confirmed this payment was half of the IIF indicator’s upper threshold payment that practices would have received if they achieved 80%.
However, the LMC is seeking full compensation for the potential IIF payment because they argue that if FIT testing had been available practices would have achieved more than this 50% payment.
Dr Ingrams said: ‘Practices would have achieved 100% because once the pathway changed, you can’t refer people without having done [a FIT].’
He also said the contractual IIF arrangements for 2022/23 did not allow practices to exception report in the case that the service is not available to them.
The guidance for last year listed no exclusions for the CAN-01 indicator, and the only personalised care adjustments were when the FIT kit is declined, or when patients have anal ulceration or anal or rectal masses.
A solution has not yet been reached after Dr Ingrams raised the issue with the GP Committee England (GPCE) who then took this to NHS England.
He said: ‘According to the GPC exec, NHS England told them they had been reassured that every ICB area could do [FIT testing], which was obviously not true.
‘Because of that, they didn’t include the ability to exception report when the service is not available.’
He added: ‘It’s a principle – giving someone a contract they can’t deliver on, it’s unfair’.
NHS England’s operational planning guidance for 2022/23, which set out the priorities and financial arrangements for the year, included the provision of FIT tests as a priority action.
It stipulated the ‘provision of sufficient commissioned capacity so that every urgent suspected lower GI cancer referral is accompanied by a faecal immunochemical test (FIT) result’.
However, the LLR ICB admitted there was a delay in setting up this lower GI pathway for all adults.
A spokesperson for the ICB said: ‘Leicester, Leicestershire and Rutland was one of the first ICBs to introduce FIT testing prior to lower GI referral, some three years ago.
‘However, following guidance from the BSG and other national bodies, it was decided to extend this to include patients aged over 18, rather than the previous threshold of age 60 and over.
‘This, however, took longer than anticipated, due to the complex overhaul of cancer 2 week wait lower GI pathways, which was also undertaken at that time. FIT testing for over 18s became available in January 2023.’
‘The ICB recognised that, due to the delay, practices were unlikely to meet the targets of the IIF cancer indicator and, following liaison with NHSE, in February 2023 all LLR PCN’s received a support payment which equated to 50% of the total IIF funding opportunity.’
NHS England did not respond to Pulse’s request for comment.
Last month, a new GP contract was imposed with changes for 2023/24, which included reducing the number of IIF indicators from 36 to five, which are now worth £59 million.
The lower threshold for the indicator, now called CAN-02, has been increased from 40% last year to 65% this year, while the upper threshold remains at 80%.
LLR ICB said: ‘The new IIF Cancer Indicator is very similar to the previous requirement now that we have FIT testing available to all adults over 18.
‘We are not expecting any further access issues for practices to reach their targets, and we now have improved outcomes for our patients, with earlier and faster diagnosis.’
The rationale for the indicator also now includes details of the British Society for Gastroenterology (BSG) and the Association of Coloproctology of Great Britain and Ireland (ACPGBI) guidance, which advised GPs to downgrade some urgent colorectal cancer referrals based on new FIT thresholds.
In October, NHS England said GPs should implement the BSG/ACPGBI recommendations in full as part of advice and guidance (A&G) pathways.
And earlier this month, Pulse learned that NICE is expected to update its bowel cancer referral guidelines in the Autumn to incorporate this guidance.