Earlier this week an article was published in Pulse that said CCGs faced with large deficits are looking to make cuts to GP enhanced services in order to find extra savings.

Three CCGs – all recently rated ‘inadequate’ because of financial failings – are currently reviewing their GP enhanced service contracts, with a view to making savings and even decommissioning some altogether, the article said.

Services under threat from the cuts include near-patient testing, phlebotomy, care home advanced schemes and practice-based counselling, amongst others. Throw into the mix the potential removal of the unplanned admissions service from April 2017, which is currently under discussion, and could we be about to see the end of enhanced services all together?

The struggle

“I think we’ll struggle to fund enhanced services in our practice going forward as there are already signs our CCG is looking to save money,” one Practice Manager told us. “Given the GP Forward View promised investment in enhanced services, yet cuts are still being made, I don’t see enhanced services being a priority from next year onwards.

“The problem, as I see it, is that it’s a slippery slope. After funding is withdrawn I reckon it’ll be difficult to get it back. Plus, the workload of practices will spread to fill the gaps created by the removal of services making it tough to reinsert it.”

Threats to practices

As enhanced services are cut, it obviously leads to funding problems for practices. Another PM told us: “Practice finances are so finely balanced that losing sometimes profitable revenue from enhanced services could tip practices over the brink. As one of my fellow practice managers said at a recent meeting, if you remove a service you can’t easily find cost savings. It’s not like you can make redundancies very easily just because a service that only takes a few hours a month is cut.”

As well as cuts to services, GP practices are also under threat from alternative providers of enhanced services. For example, an NHS England regional team earlier this month opened up the DES for practices to administer flu and pertussis vaccinations for pregnant women to competition from trusts. NHS England has asked hospital trusts across the West Midlands if they will sign up to carry out the DES, offering the same tariff price as GP practices receive (£9.80).

This is a double blow to practices – not only does it potentially reduce the number of people paying for the service, it also makes it harder to accurately order vaccines, increasing the risk of having leftover, wasted supplies.

Local enhanced services are also being taken over by local councils who have devolved powers, further cannibalising potential revenue, which has led to more than one PM saying that practices may even benefit from enhanced services being scrapped. “I for one would probably be glad to see the back of enhanced services so that we know where we stand. There’s so much uncertainty surrounding the income, and so much paperwork to complete that I’m at the point where I question the actual profit we make as a practice. I would rather invest the time in making more money from our private activities.”

Positive news

Despite the above, it’s not all bad news surrounding enhanced services, which further complicates the matter for Practice Managers.

Just as some CCGs are making cuts, others are ploughing more into enhanced services. In fact, a freedom of information request by Pulse answered in full by 48 CCGs revealed that spending on enhanced services increased from £59m in 2013/14 to £103.5m this year.

Initiatives invested in include annual physical health checks for patients with mental illness and practices creating admission-prevention plans, and investment has been made by CCGs up and down the country. Whilst much of the funding has been eaten up by GP federations and additional admin, some is at least filtering down into practices.

All-in-all, the national picture regarding enhanced services is a messy one that varies from CCG to CCG. What will happen in the future is anyone’s guess!

What do you think about the future of enhanced services? Have you had a funding cut or an injection of cash? If so, what for? Please comment below or in the forum thread here.

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Warring Staff