LMCs demand fairer funding for GPs to provide local enhanced services 

GP leaders have demanded that commissioners properly fund local enhanced services (LESs) to account for the costs of providing the services. 

At last week’s UK LMC conference in Belfast, LMC representatives voted in favour of a motion which said payments to GPs should always include staffing, premises, and indemnity costs, and automatic uplifts for inflation. 

The motion also called for greater collaboration between LMCs and commissioners so that no LES would be withdrawn without assessing the impact of withdrawal. 

And GPs agreed unanimously that underspend in LES budgets should remain in general practice rather than being transferred to secondary care budgets. 

Proposing the motion, Dr Rupeysh Jha from Birmingham LMC said commissioners’ approach to LES provision was ‘eroding the foundations or primary care’. 

Dr Jha said: ‘For years, local enhanced services have been commissioned on the assumption that general practice can simply absorb the difference between what commissioners want and what they are willing to pay.’ 

He added: ‘Services are commissioned, amended, or withdrawn with no meaningful discussion or consultation with LMCs, and no assessment of workload impact on practices.’ 

Arguing for the motion, Dr Peter Kenworthy (Gateshead and South Tyneside LMC) shared how his ICB (North East and North Cumbria) had offered a medicines LES as a ‘basket’ of services. 

Pulse has previously reported on this case, where LMCs were offered an ADHD LES worth £117 per eligible patient per annum, but only if they accepted a large, ‘clinically incoherent’ Medicines LES worth £2.87 per patient per annum. 

Dr Kenworthy said the offer was ‘grossly underfunded, unsafe, and being candid, it includes some medications I’ve never even heard of’. 

He said his and other LMCs in the ICB area opposed rejected the offer and said this had ‘caused the ICB to find more attractive ways of encouraging GPs to provide the LES’.  

He said this proved that ‘change can happen with enough critical mass’ if LMCs collectively refuse to accept unfunded or underfunded LESs. 

The last part of the motion, which called for a ‘commissioning gap analysis’ across all four nations, was carried as a reference after GPs argued it would be difficult to carry out. 

Chair of the BMA’s Scottish GP committee, Dr Iain Morrison, said such an analysis ‘would require a huge amount of resource to do that at a pan UK level’, noting that it was ‘tricky enough doing it at a national level’. 

Pulse will be releasing a major investigation into how LES funding varies across the country next week.