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CCG agrees cuts to non-patient facing GP work but rejects plans to slash LES cash

A CCG in the East of England has dropped plans to review local enhanced services (LES) that would have left practices unpaid for extra work, but it has approved cuts to funding for non-frontline GP activities.

NHS Cambridgeshire and Peterborough CCG agreed to cut nearly a third of its discretionary general practice budget over the summer, in a bid to find £1.5m savings, by reviewing its funding for LES work and a quality and efficiency programme.

Last month it revealed it intended for practices to no longer be paid for LES work based on levels of activity, and instead funded in line with budgets from the previous year.

Following pressure from Cambridgeshire LMC it has dropped the controversial proposals, but has agreed to go ahead with cuts to non-patient facing GP work, by removing programmes from its funded quality and engagement framework (QEF) for the remaining six months of 2019/20.

Local GPs have labelled the move a ‘backward step’ and stressed that practices ‘have come to depend on this essential additional income’.

At a governing body meeting held this week, the CCG decided to remove:

  • Funded engagement –  funding for GPs to attend CCG meetings, being paid for involvement with GP Forward View activities and engaging with the CCG primary care dashboard;
  • Demand management – work to manage referrals into secondary care by utilising alternative pathways for patients if appropriate, and engaging in local demand management review processes;
  • End of life care – the majority of this work provided funding for the utilisation of a business intelligence dashboard and identifying a GP clinical lead. Quality indicators have been included in QOF for 2019/20, hence the decision remove from the QEF;
  • Serious mental illness health checks – has been removed from QEF but commissioned as a LES to support the national mental health requirements;
  • Dementia – practices working towards the dementia friendly status last year (not direct patient facing activity). There are dementia indicators included as part of QOF so patients will not see a change in service provision.

An NHS Cambridgeshire and Peterborough CCG spokesperson said: ‘When making savings to meet this challenge, our focus is always on protecting frontline services as a priority.

‘This is why we have agreed to make reductions to non-patient facing elements of our quality and engagement framework, which includes engagement and demand management.’

The spokesperson claimed the ‘overall budget’ for primary care had risen by 5.5% this year, from £139m to £147m, and that the £1.5m saving ‘needs to be taken in that context alongside the commitment by all system partners to begin to bring our system into financial balance’.

But a GP and former CCG board member, who wished to remain anonymous, said: ‘To claim that primary care is having extra investment betrays either a lack of knowledge about primary care or [the CCG] has knowingly conflated two separate budgets – money going to primary care networks (PCNs) versus money going to individual practices.’

They added:  ‘I realise the financial challenges facing the CCG are significant but this is completely the wrong way to go about restoring fiscal balance. They really should be investing in general practice and encouraging practices to extend their offering, with improved access, a greater range of services, extending the range of employed heath care professionals etc.

Cambridgeshire LMC chief executive Dr Katie Bramall-Stainer said: ‘The intolerable financial pressures of the Cambridgeshire & Peterborough system are jeopardising the CCG’s ability to engage with practices. Likewise, it also places the PCN and integrated neighbourhood agendas in a precarious position.

‘This feels a backward step, when the NHS long-term plan sees ensuring a safe and sustainable general practice as the essential foundation upon which PCNs will operate.’

 She added: ‘For the LMC, we see the day to day pressures of our practices who have come to depend on this essential additional income, which is used to support staff and patient care. Practices will have some very difficult decisions to make over the winter months ahead.’

Cambridgeshire and Peterborough STP is predicting a deficit of £192m for 2019/20 and is expected to deliver the £1.5m saving from its discretionary funding for primary care, with that figure set to double to £3m next year.