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NHS managers begin squeeze on enhanced services budgets

By Gareth Iacobucci

Exclusive: Thousands of pounds is to be stripped from GPs’ enhanced services funding as clusters of PCTs centralise enhanced services budgets, with LMC leaders warning the move could destabilise practices and derail the QIPP agenda.

NHS bosses in one of the country’s first PCT clusters have tabled proposals to centralise enhanced services at a sector-wide level, as part of moves to merge their functions ahead of the switch to GP commissioning in 2013.

But GPs have warned the plans will slash budgets in areas that have historically received higher levels of enhanced service funding, effectively creating sets of winners and losers among local practices and jeopardising services for patients.

PCTs have until June this year to cluster, with individual trusts retaining their boards and statutory responsibilities, but operating under one single chief executive.

Five PCTs in the capital – Barnet, Camden, Enfield, Haringey and Islington have already clustered together under the banner NHS North Central London.

Londonwide LMCs estimates that there is currently a four-fold variation in enhanced services funding in the area, putting funding levels at approximately £17 in Camden, £14 in Islington, £11 in Haringey, £9 in Barnet and just £4 in Enfield.

In a joint letter to the CEO of the cluster, the chairs of five LMCs said: ‘Any attempts to centralise enhanced services and their expenditure could be destabilising to practices in areas with the highest expenditure.’

‘In addition, the loss of a local focus could result in the application of the inverse care law and a loss of continuity, accessibility and choice of services for patients.

‘The loss of enhanced services will inevitably lead to increased referrals into secondary care, which will undermine future GP commissioning roles and the ability of individual PCTs and the sector to achieve the QIPP agenda.’

A spokesperson for NHS North Central London said a meeting had been arranged next month to discuss LMC leaders’ concerns.

Dr Brian Balmer, chief executive of Essex LMCs and a member of the GPC’s commissioning and service development sub-committee, said the moves were ‘bound to happen’ elsewhere as PCTs looked to squeeze enhanced service funding.

‘They’re looking at squeezing enhanced services everywhere,’ he said.

On the one hand they’re saying ‘let’s redesign the health service and move stuff into primary care’, but on the other they’re saying, ‘we’re broke, let’s cut primary care as well’. The illogicality of that hasn’t quite dawned upon them.’

Dr Brian Balmer, chief executive of Essex LMCs Variation in enhanced services funding

Enfield -£4
Barnet – £9
Haringey – £11
Islington – £14
Camden – £17
National average – £15

Source: Londonwide LMCs