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CCGs start to reverse GP investment decline with £2m LES boost

Exclusive GP commissioners have begun to arrest the decline in primary care investment by significantly boosting local enhanced service (LES) budgets during their first year of commissioning, a Pulse investigation has revealed.

Figures obtained from a Freedom of Information Act request have shown that CCGs in England have commissioned the equivalent of £1.6m in additional funding via LESs in a development welcomed as evidence of more ‘intelligent’ commissioning from April.

The move goes some way to addressing the reduced investment in LESs by PCTs over the past few years, but experts warn that the increased investment came before the controversial competition rules governing the use of any qualified provider came into force.

Out of a total of 81 CCGs responding to the request, a fifth (18%) went against official NHS England advice to carry over all LESs unchanged in 2012/13 unless there was ‘compelling evidence for adopting a new approach’.

While many cancelled LES agreements with practices or renegotiated their value, with overall cuts of £668,000 across the 81 CCGs, those reductions in funding were more than made up for by new LES agreements introduced and increased spending on existing LESs.

Overall budgets increased by £1.3m - equating to a net increase in investment in primary care of £626,000 by the 81 CCGs. Extrapolated across all 211 CCGs in England, that would translate to a net increase in funding for GP practices of £1.63m since April.

The funding boost comes after GP practices suffered a large drop in LES funding from a peak of £336m in 2009/10 to £269.6m in 2011/12. A Pulse investigation last year concluded that LES funding was largely flat, although there were cuts of nearly 50% in some areas.

Elderly care was a particular focus of new investments, with a number of CCGs starting LESs for care home or nursing home visits, including North Staffordshire CCG which introduced a new LES worth £333,000 to practices. Meanwhile, a new LES for surveillance of PSA levels and prostate cancer follow-up is worth £204,000 in Coastal West Sussex.

One of those prioritising investment in primary care is South Worcestershire CCG, which invested an additional £45,000 in a new LES for sigmoidoscopy, replacing a less lucrative menorrhagia LES.

Dr David Farmer, a clinical lead at South Worcestershire CCG and a GP in Evesham, says the additional investment is because the CCG believes ‘very strongly’ in primary care.

He says: ‘Primary care certainly provides better prevention for illness and serves for a more equitable distribution of health.’

The GPC said it hoped the figures were the early signs of a shift to address the anomaly of the shrinking proportion of overall NHS funding that primary care receives – currently around 8%.

GPC deputy chair Dr Richard Vautrey said: ‘The proportion of funding has dropped and we need to drastically increase that if practices are to be able to do all the work they are expected to.’

But GP leaders warned that cuts may still be on the horizon as of 1 April next year when all CCGs will have concluded LES reviews under the new section 75 competition regulations which mean GPs are no longer preferred providers.

Dr James Kingsland, national clinical lead for the NHS Clinical Commissioning Community and a GP in Wallasey, Merseyside, said: ‘Evidence of greater investment in LESs is welcome, but the biggest ticking time bomb is that, from 1 April next year, GPs will not be the preferred provider.

‘A risk is that general practice is not well geared to go into a competitive market and we have got the independent and commercial sector coming in, [which are] much better skilled at bidding in competitive tendering procurement.’