Access to medical and rehabilitation services for a range of
disadvantaged groups could be affected by a funding shortage in
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
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
The new contract had been expected to improve services for these
groups because it rewards GPs for offering the services at local
surgeries (news, page 10, 3 July). GPs receive £1,000 a year
for each category of enhanced service they provide, plus a payment
of between £200 and £500 for each patient.
However, this depends 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
Alcohol Concern said if screening of patients for alcohol misuse
was not a core service “it will be missing the point”.
“There could be people drinking at hazardous levels who don’t
realise it,” a spokesperson said.
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 they were not adequately funded.