Funding shortage could hit GP services to vulnerable people

Access to medical and rehabilitation services for a range of
disadvantaged groups could be affected by a funding shortage in
primary care, writes Derren Hayes.

Family doctors may refuse to provide specialist medical services
for substance misusers, asylum seekers and the homeless if primary
care trusts refuse to fund them from next April.

Many PCTs, particularly in inner cities, are giving millions of
pounds to overspent hospital trusts to balance their books, and are
unlikely to have the cash to fully fund services for disadvantaged
groups.

Traditionally GPs have provided these “enhanced” services
without being paid the full cost of doing so by the government. But
under the new GP contract, agreed in June, doctors will be able to
“opt-out”.

The new contract had been expected to improve services for these
groups, because it rewards GPs for offering the services at local
surgeries. GPs receive £1,000 a year for each category of
enhanced service they provide, plus an additional payment of
between £200 and £500 per patient.

However, this is reliant on PCTs, which are responsible for
three quarters of the NHS budget, having enough funds and deciding
the groups are a local health priority.

If they decide not to fund the service at a practice level, PCTs
would instead be forced to fund a single specialist service
provided by one GP surgery or the voluntary sector.

Dr David Jenner, the professional executive committee lead for
the NHS Alliance, said: “It won’t mean that GPs will stop
registering asylum seekers or treating those with alcohol problems,
but it will be a real base-level service, such as making sure they
are otherwise healthy and having access to general advice.”

Enhanced services, by contrast, would include blood and urine
screening, drug testing and detoxification, and maintenance
treatment.

Andrew Dearden, chairperson of the British Medical Association’s
community care committee, said many GPs wanted to provide enhanced
services, but would opt out if not adequately funded.