‘Removing atypical funding was the last straw’

A statement from spokesperson for Central Lakes Medical Group following the GP partners handing back the contract.

Central Lakes Medical Group (CLMG) covers an area of over 200 square miles in the Lake District.

Unusually for rural populations its weighted list is low, and 15% lower than the average Cumbrian rural practice.

It is also not dispensing due to the abundance of tourists making it viable for pharmacies to exist in rural villages, so funding cannot be made up through that route.

The practice is defined as atypical by both the national guidance but also locally by the former CCG.

In 2018, the CCG alongside NHS England took on board the practice concerns and provided it with atypical funding which kept the practice sustainable. They said at the time this would remain in place until alternative solutions were agreed.

Since then we have had commissioning changes – the CCG took on full commissioning responsibility and now we have ICBs. Covid also meant that that the work the CCG were meant to do never did get done – not unreasonable in the circumstances as there were other priorities.

In 2021 the CCG said they were going to withdraw the practice funding – £73,000. The practice put its case again that it needed the funding to remain viable.

The CCG persisted and on 23 June 2022 in advance of the ICB forming agreed to reduce the funding to £588. The practice nor PCN were able to review this document before it was submitted so inaccuracies in it could not be corrected. Particularly the atypical nature of the population was not just about tourism – it was around the lack of other services, the fact that the practice is often a walk-in centre for urgent treatment given no other local facilities, travel times and the inefficiencies in running a service across such a large area.

The CCG did though decide to take the funds and the atypical funding awarded to another practice and use it to pilot a service with greater funding across the larger part of the Lake District. That in itself was not a bad thing. However, the design of the pilot did not involve input by practices or PCN and the only funding available to practices was to provide additional sessions specifically for tourists which needed to be booked via the triage service. The practice would no longer control the triage of tourist access to its service.

CLMG were therefore faced with a reduction in funding at practice level which they could get some back by doing additional work and incurring additional cost. That is not a viable solution for a small practice and continued uncertainty meant it was left with no option.

This was the last straw really. The practice looked at alternative solutions and put in writing that they would withdraw their resignation notice if the new ICB agreed to support an alternative proposal put forward jointly with another local organisation. Tim Farron MP was involved in those discussions, as was the LMC.

At a meeting last Thursday the ICB rejected that proposal and pursued the route of putting the practice out to tender and immediately appointed a caretaker to take over once the practice six month notice had been concluded.

As this did not meet the conditions of the partners withdrawal of its notice they were left with no option but to follow this through.

One partner will leave on 30 September having decided to retire. The other two will leave on 31 December.

The partners have and will continue to put the interests of its patients first and will work with the proposed caretakers to ensure the practice is transferred and that services continue to be offered from Ambleside and Hawkshead. It was not their preferred route and any new incoming organisation will struggle with the funding on offer to provide the services needed in the area. Funding is needed for services for residents not just tourists. The cost to the NHS of pursuing the option of going out to tender is likely to exceed the cost of what was needed to support the practice to remain viable as a GP led partnership.

The partners have been thankful for the significant local support from patients, the support of its staff and the national support from many fellow professionals over the past few days.