Local GP leaders concerned about ICB’s ‘clinically incoherent’ LES offer

Exclusive GP practices in one area are being asked to take on a ‘clinically incoherent’ bundle of services in order to access money for ADHD shared care.

North East and North Cumbria (NENC) ICB has offered practices an ADHD LES, worth £117 per eligible patient per annum, but only if they accept a large Medicines LES basket, according to the chair of Gateshead and South Tyneside LMC. 

Dr Paul Evans said his LMC is concerned about practices being asked to accept so many services ‘bundled’ into one basket in order to access the ADHD enhanced service. 

The Medicines basket, worth £2.87 per patient per annum, includes services like monitoring antipsychotics, shared care arrangements, and injectables services. 

According to LMC documents seen by Pulse the ADHD LES appears to include new ADHD shared care arrangements excluding private shared care. 

The ICB has set a 6 February deadline to respond to the offer, and the LMC is currently surveying GPs on whether to accept it, though Dr Evans said the LMC ‘would be hard-pushed’ to recommend the LES to practices. 

‘We would be hard-pushed to advise any practice to undertake any contracts which did not clearly define workload and resource in order that they could weigh up accurately the expected workload, the risk, both clinical and financial, what they would be taking and delivering this contract.  

‘This LES is by design undefined and loose and offers finite resource with potentially infinite workload and risk’, he said. 

He also raised concerns about the lack of guarantees on inflationary uplifts for the Medicines LES offer, which would be funded with £10.24m next year as a single, ICB-wide specification, including £4.8m of ‘additional investment in general practice’, according to NENC ICB. 

But Dr Evans said that, in contrast to GMS, ‘there’s no guarantee at all that the ICB will uplift the £2.87 each year – there is no commitment on their part to doing so. They have committed to review it each year, but not to actually uplift it each year, by any marker – CPI, RPI or DDRB.’ 

He also raised clinical concerns about the proposed contract including giving the ICB the right to reclassify injectable drugs from ‘red’ (secondary care-only) to other statuses without GPs having the power to veto the reclassification. 

While the ICB said LMCs would be involved in ‘open consultation’ on the red-amber-green status of medicines, Dr Evans said there were neither assurances that GP practices would be listened to, nor that adding new drugs would come with financial uplift for practices.  

‘The ICB has also said that additional drugs were put into the into the Medicines LES, then it would at the end of each financial year review the financial impact of this and, if there were resource available, it would consider uplifting the less for the next financial year. But that, to me, does not equate to a commitment to either LMCs the right to say, “no, this thing isn’t suitable”’, he said.  

Dr Evans suggested that instead of ‘one massive, clinically incoherent’ group of services, the ICB could break it down into smaller baskets each with a clinical theme.   

Pulse has put these concerns to the ICB, who said that the Medicines LES funding envelope ‘already reflects significant new investment’.  

However, the ICB did not comment on the condition it put on practices to accept the Medicines LES in order to access the ADHD one.

It told Pulse it had ‘no intention’ to change the status of medicines ‘other than in exceptional circumstances relating to urgent patient safety’.   

A spokesperson said: ‘NHS North East and North Cumbria ICB has confirmed a total financial envelope of £10.24m for the Medicines LES. This includes £4.8m of additional investment in general practice in 2026/27, alongside the consolidation of previous local arrangements into a single, consistent ICB-wide specification.

‘Decisions on the RAG status of medicines are made through established governance processes, which include clinical oversight, Local Medical Committee representation and open consultation. The ICB has been clear that there is no intention to make in-year changes to the scope of medicines covered by the LES, other than in exceptional circumstances relating to urgent patient safety. Should any such change be required, this would be considered through the appropriate governance routes and with corresponding review of the LES funding arrangement.’

The ICB added that it ‘does not operate a punitive or performance-managed approach to shared care or injectable activity’.

‘Shared care and injectable services are seen as part of a broad, clinically integrated offer – not discrete chargeable activities. Decisions to accept or decline shared care remain a clinical judgement for individual practices and clinicians. Practices are asked only to record decisions and rationale in the patient record to support continuity of care. The ICB does not require practices to submit data on refusals and there is no routine clawback mechanism linked to such decisions.

‘The Medicines LES funding envelope already reflects significant new investment, including the £4.8 million uplift referenced above. Local budgets have been uplifted accordingly, including replacement of historic local arrangements with a unified specification, The per-weighted-patient funding model is intended to provide stability and predictability for practices, while supporting equity across the ICB footprint.’

Pulse has reported extensively on how LES funding varies across England.