England GP leaders have voted against a proposal to call for an end to local enhanced services at today’s annual conference.
A range of delegates spoke emphatically against the motion and more than 90% voted against.
They also overwhelmingly rejected a proposal to remove QOF from GP workload; as well as adding funding for some enhanced services – including phlebotomy, spirometry and ECGs – to core GP funding.
Proposing the motion, Dr Lee Salkeld from Avon LMC said: ‘Locally enhanced services crate a postcode lottery in terms of access to care and unwarranted variation of funding for clinical activity. Why don’t we just stop signing up to LESs, the likelihood is they were frugally funded in the first place and with increase inflation may not be financially viable.
’There are 101 different LESs listed on the BMA website. Think how much clinical activity we could stop if en masse, all practices stop providing non core contracts.’
Speaking against, Dr Eimear Byrne from Cambridgeshire LMC said: ‘I believe these proposals impose an unwelcome lack of flexibility on practices in a one size fits all fashion. Transferring this work to the core contract risks GP practice being further exploited as a work sink for non GP services.’
She added the current approach allows practices to sign up or not and make informed business choices.
Also speaking against scrapping LESs, Buckinghamshire LMC’s Dr Stefan Kuetter said his ICB started paying GPs to ECGs in surgeries after they threatened to stop doing them.
He said: We have a number of such LESs that we think are good for patients and are appropriately funded and if they’re not then we have the power to change this or stop.’
Dr Steve Patterson, from Bradford and Airedale LMC, added: ’If everything goes into core it will remove practice choice, ability to control workload and will pass the responsibility of providing services to practices. We need a blended contract as we have now.
‘We do need better core funding and enhanced services to be funded at a level to encourage practices to take them on.’
England LMCs are meeting in London today and tomorrow to debate policy direction for the profession in the country, with the proposal to scrap LESs one of the more unexpected proposals.
Motion in full
That conference demands that general practice funding is consolidated into the GMS payment and calls for:
(i) the cessation of all locally enhanced services in England – NOT PASSED (92% against)
(ii) the removal of QOF from GP workload – NOT PASSED (75% against)
(iii) additional funding in the core contract for services such as phlebotomy, spirometry and ECGs. – NOT PASSED (79% against)
For as long as I can remember, enthusiastic GPs have pushed beyond the boundaries of “core” GMS and developed their clinical interests to provide additional services for their patients. In the days of “old” GMS and the Red Book those initiatives were entirely without recompense. LES payments seemed to offer a mechanism to reward additional work and effort. But maybe LES payments have become divisive? With core GMS now so poorly rewarded, only those with the staff and resources to participate and benefit from LES payments will survive?