More than £1 billion of primary care funding could be stripped from GP practices and funnelled to private providers under any qualified provider, after the Department of Health refused to rule out opening up all enhanced services to the market.
New DH guidance suggests services currently procured through local enhanced services could be provided under any qualified provider (AQP) in future.
The guidance says GPs will be able provide services under AQP where they are qualified - but suggests the market could also be opened up to other providers, with practices potentially losing valuable funding as a result.
Enhanced service funding currently accounts for roughly 12% of the total £10 billion general practice budget.
In response to a question asking whether services currently commissioned as LESs would be procured through AQP, the DH said: ‘Enhanced services are part of GP contract arrangements.'
‘Subject to the Health and Social Care Bill, the NHS Commissioning Board will in future be responsible for the commissioning of primary care services through the GP contract and will need to decide on the most appropriate arrangements for the future of local enhanced services.'
The guidance also said GP commissioners will have to negotiate with providers to set local prices for services not covered by national tariff, with commissioners required to engage the market and determine the appropriate service specification, pathway, referral protocols and outcomes before running an AQP opportunity.
Commissioners are warned not to set prices too high or too low, as this will affect choice, innovation and potential cost savings.
Dr Jane Lothian, secretary of Northumberland LMC, and a GP in Ashington, said she would be ‘extremely concerned' if enhanced services were taken out of the general practice setting.'
‘Services would fragment. Enhanced services are best delivered in the practice where patients get the rest of their care,' she said.
‘It could de-skill primary care, and I can't see how it would be more efficient.'
Dr Brian Balmer, chief executive of Essex LMC, and a member of the GPC's commissioning and service development sub-committee, said the policy risked destabilising primary care and straightjacketing commissioners.
He said: ‘If they're going to restrict what practices can provide then the new system isn't going to work.'
‘I'd like commissioners to have the freedom to do local deals with sensible providers that they know and trust. The danger is this becomes some sort of enforced thing and the freedom to commission is reduced.'