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Opening up LESs to competition will lead to mass GP redundancies, says LMC leader

Opening up local enhanced services to any qualified provider will destabilise practices and lead to mass redundancies of sessional GPs, the head of the UK's largest LMC has warned.

Dr Michelle Drage, chief executive of Londonwide LMCs, said she has urged the GPC to seek urgent talks with the Department of Health over recent guidance that said LESs should be put out to competition unless of ‘limited value' or GPs were the ‘only capable providers'.

She added the decision had to be a ‘mistake' as it was likely to lead to serious consequences for practice viability and patient care.

Dr Drage said the current guidance from the NHS Commissioning Board was ‘ripping up' the LES arrangements agreed in the 2004 national contract ‘without consultation' and that it would lead to a devastating reduction of income for GP practices.

She said: ‘Practices will see reductions in LESs. We're hearing anecdotally that practices are so dependent on their LES income that staff redundancies are always being considered.

‘It won't take much to tip them from just staying afloat to a situation that is actually to the detriment of patients. The LES income isn't included in MPIGs and practice income guarantees, which means it really is on the margins.'

The move could lead to staff redundancies, including sessional GPs, she said: ‘Sessional GPs are already experiencing pressure. We have and the BMA have examples of sessional GPs hours' being reduced.

‘Losing locums, losing regular appointments, all of that is going on, but nobody's counting. I think it could [lead to sessional GP redundancies].'

She added that LMCs should have consulted before the announcement and she has alerted the GPC to this issue: ‘LMCs are certainly worried about it because LMCs weren't mentioned on the fact sheet.'

‘We are working with the GPC and we hope the GPC is working with the NHS Commissioning Board to correct what can only have been a mistake by the department. I can't possibly think they would want to disenfranchise GPs at this time as providers of extra services.'

A spokesperson for the NHS Commissioning Board said: 'The NHS Commissioning Board Authority wants clinical commissioning groups to be able to commission a wide range of community-based services, including primary care services.'

'The proposed arrangements are designed to give CCGs the same flexibility that PCTs currently have to commission enhanced services from GP practices, and are to all intents and purposes the same as the current LES arrangements.  It will obviously be good practice for CCGs to engage with LMCs when proposing to commission services from GP practices.'

Click here to watch the Big Interview with Dr Drage