One ICB has proposed to introduce ‘fairer’ GP funding models for deprived practices, but its controversial plans to cut services at local GP out-of-hours and walk-in centres have sparked criticism.
Norfolk and Waveney ICB is currently consulting on proposals to make cuts to both the Norwich walk-in centre and its GP out-of-hours centres, in a bid to address the £280m deficit in its local health services budget.
As part of these proposals, the ICB wants to redirect some of the savings to its ‘lowest funded’ surgeries, which would ‘help close the gap between GP practices that receive the most money per patient and those that receive the least’.
The ICB highlighted that the current GP funding arrangements – dictated by the Carr-Hill formula – mean that the amount of money local practices receive per patient ‘varies considerably’, from £94 to £217.
As part of a public consultation, open until the end of May, local commissioners have proposed closing the Norwich walk-in centre after its contract comes to an end in March, and to reduce the number of face-to-face OOH bases across Norfolk and Waveney.
The walk-in centre currently costs £1.78m per year, meaning its closure would see an extra £1.5m invested in general practice while saving the ICB £280,000.
In return for this money, which would mostly be directed towards urban practices, GPs would be asked to focus on addressing specific conditions that their patients are more likely to experience, such as heart disease and diabetes.
The ICB emphasised that this is additional funding, meaning ‘no GP practices would lose any funding’.
However, the consultation acknowledged that closure of the walk-in centre – which currently provides 6,000 appointments per month – would result in increased pressure on practices.
It said: ‘There would be additional requests for appointments at some GP practices. Most people (65%) using the Walk-In Centre are already registered with one of the 22 Norwich GP practices, so they would be more likely to be impacted.’
Out of the two options presented, the alternative proposal is to keep the walk-in centre open but reduce its opening hours, which would mean an additional £750,000 for more deprived practices, rather than £1.5m.
Norfolk and Waveney LMC did not provide a view on these proposals, telling Pulse it cannot comment on an issue which is currently out for public consultation.
But some local councillors have expressed serious concerns about the plans to cut the walk-in centre, as well as the ICB’s proposal to reduce the number of face-to-face OOH bases.
The three options put forward for OOH would result in savings of between £75,000 and £120,000 per year for the ICB – but this money would not be redirected to GP practices.
The ICB justified its proposals for OOH by highlighting that the overall number of patients needing a face-to-face appointment at a base has fallen from 55,000 in 2019 to 39,000 in 2024.
Norfolk county council’s health overview and scrutiny committee (HOSC) has recently voted to ‘call in’ the consultation to health secretary Wes Streeting, arguing that it is ‘not fit for purpose’.
The call-in power allows the health secretary to intervene in NHS service reconfigurations ‘at any stage’ where a proposal exists, and take any decision that previously could have been taken by an NHS commissioning body.
Green party councillor Lucy Galvin told Pulse: ‘The cross party members of Norfolk’s HOSC voted unanimously to call this consultation in to the Secretary of State because it is not fit for purpose.
‘The options are unclear, the structure poor, there is a lack of supporting information, access issues and a lack of care regarding the wider picture.
‘The consultation overarches and covers three services: the walk in centre, the out of hours service and the vulnerable adults service.’
She added that the situation is ‘exceptional’ due to the large number of patients involved and their vulnerability, and there is ‘ongoing confusion’ over commissioning of these ‘vital’ services.
She added: ‘It is also exceptional as the options put forward in this substantial reconfiguration of service may end up costing more and delivering adverse patient care.
‘As this is a service that was consulted on just two years ago there is also an important duty of care to the public who rightly do not expect recent decisions to keep services to be overturned in short order without clear rationales, explanation and information.’
The consultation is open to the public until 25 May and a final decision will be made by the ICB in July.
In a statement on the consultation, ICB director of primary care Sadie Parker said they are ‘always looking’ at how to ‘get the best value’ from public money.
She continued: ‘We know that changing how and where services are provided has a real impact on people, and we take these decisions seriously.
‘This is why it is vital we hear from local people about the options we are considering before we make any decisions.’
Recent modelling by two ICBs found that implementing a new GP funding formula based on population need – replacing the Carr-Hill formula – would cost just £333m in England.
Last year, the RCGP called on the Government to ‘radically’ reform GP funding in England, highlighting that the Carr-Hill formula disadvantages patients in poorer areas.
Good luck with that then, ICB. Patients will know where to go for F2F OOH services, the shiny palace on the hill with the lights on and the ambulances queuing outside. Interesting the LMC isn’t commenting but may have done so privately as part of the consultation.
As with GP services, nobody needs a GP OOH service until they find out how much it costs not to have one.
Seen this in the past when a PCT tried to get a cut price OOH service. It did not work very well and cost them an awful lot more to sort out in about 12 months. The local GP Co-op had dissolved so there was no alternative OOH provider to fill the gap.
It is too late once the service collapses
Absolutely, Fay.
OOH is always seen as the “Cinderella Service”, which I guess makes the ICB …