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Four questions to ask before taking on a LES 

1. Does it have any quality or patient benefit?

At a time of stretched resources, GPs should not be diverting time and energy to activities that offer no benefit to patients or improvements in quality of services. Ideally a LES of limited value should be challenged by practices as members of CCGs, or via the LMC, with the hope of modifying it accordingly.

2. Are there any ethical concerns or perverse incentives?

A LES should not undermine good and appropriate clinical care – for example, schemes where GPs are paid for crudely reducing the number of referrals or cutting costs, or schemes that coerce GPs to manage or refer patients differently from their clinical judgment in the best interest of the patient.

3. Has the LMC been consulted?

The LMC is the statutory representative body of all local GPs and it will try to ensure that a LES is appropriate and has adequate remuneration. The LMC is available for advice and guidance if a practice has any concerns about a LES.

4. Is it cost-effective?

Remember that a LES is voluntary. At a time when practices are experiencing workload saturation and falling resources, they need to be financially viable. Practices should look at the work involved and its cost in terms of GP, nurse and staff time and other expenses.

Dr Chaand Nagpaul is a GPC negotiator and a GP in Stanmore, north London