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Local enhanced services worth millions to be opened up to competition from April

Exclusive CCGs and local authorities are planning to put local enhanced services worth millions of pounds out to tender from April, in a move which is set to force many practices to compete for a significant proportion of their existing funding, a Pulse investigation reveals.

Some practices could lose as much as 10-15% of their income at a stroke, with commissioners planning to put services such as anticoagulation clinics, spirometry and minor surgery out to full tender or under Any Qualified Provider – and GPs facing a mountain of paperwork if they are to have a chance of retaining the contracts.

It comes as several private companies including Alliance Boots and Bupa told Pulse they were interested in competing to provide some of the services.

Pulse approached every CCG in England asking them how they plan to recommission existing local enhanced services (LESs) from April. Some 48 CCGs replied, with 23 having a made a decision so far. Of these, nine said they plan to put some or all of their LESs out to tender – with the contracts collectively worth just over £2m.

Extrapolated across England the figures suggest contracts worth around £18.6m could be opened up to the market by CCGs.

In addition, two out of 12 local authorities who told Pulse they have made a decision are also planning to put services out to tender – for one council alone this represents services worth £500,000.

Under NHS England procurement rules, CCGs have to put all their LESs out to tender or procure them under AQP unless they can prove the service can only be offered by a single provider. Recommissioned LESs will be rebranded as ‘community service contracts’ (CSCs).

In Essex, three CCGs – Basildon & Brentwood, Castlepoint & Rochford and Thurrock – are putting all their current LESs, worth a total of £753,000, out to tender via the AQP route. They claim they are doing this to avoid ‘potential conflicts of interest’, saying: ‘It was considered that the AQP process was a fair and transparent way of commissioning these services long term.’

Meanwhile, NHS Stockport CCG could put 40% of its LESs out to full tender, potentially hitting local GPs’ bottom line to the tune of £383,200.

Dr David Gilbert, chair of Stockport LMC, said practices had major concerns over the move: ‘The competition regulations mean our CCG is worried that they are having to put services out to tender, despite wanting to keep the money in general practice.’

‘Obviously we’re not happy that the CCG is in this position, and it is money potentially lost to general practice in Stockport. But what we can do about it is another matter. The income we receive from LESs accounts for 10-15% of the practice’s income.’

Derby City Council told Pulse it is putting all of its LESs worth £501,000 out to tender, including £75,000 worth of contracts currently commissioned by NHS South Derbyshire CCG that will pass to the local authority in April. Neighbouring Nottinghamshire County Council is putting two of its six LESs out to AQP.

However some areas have ruled out opening up services to competition. NHS Isle of Wight CCG, which plans to keep all of its services with GPs, told Pulse: ‘The majority of our services are small but vital. All our GP practices are providing them, there are high levels of patient satisfaction and we can demonstrate clear cost-effectiveness.’

‘The costs of tendering would outstrip any benefits our patients would have gained and in all likelihood would have cost us more.’

Most of the CCGs and local authorities contacted by Pulse said they had yet to decide whether they will put their services out to tender. GPC deputy chair Dr Richard Vautrey said: ‘The longer CCGs leave these decisions, the greater the uncertainty for practices and the less opportunity GPs will have to plan for what happens if they want to maintain their services beyond April. Three months is a short time for them to jump through the various hoops that will be required.’

Meanwhile several private providers told Pulse they were potentially interested in competing to run the services.

Andrew Willetts, public sector and healthcare services director at Celesio UK, which owns the Lloydspharmacy brand, told Pulse the changes to enhanced services ‘give Celesio UK a unique opportunity to innovate and develop solutions for the NHS which not only enhance care for patients, but also provide efficient and cost-effective alternatives’.

Alliance Boots said it would looks at potential contracts ‘on a case-by-case basis’ to see if there is ‘anything close to our core offering of medicines optimisation services, screening and monitoring for patients with long-term conditions and public health services where commissioned by CCGs such as flu immunisation’.

A Bupa spokesperson said the company was ‘increasingly looking to work with the public sector in areas where we have expertise, such as out-of-hospital care and chronic disease management’, while Virgin Care would not rule out bidding but said that LESs were not its ‘main focus currently’.