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A CCG in the East of England has agreed to cut nearly a third of its general practice budget despite national requirements to invest additional resources in primary care networks (PCNs).
Board papers published last month revealed that NHS Cambridgeshire and Peterborough CCG has to find £1.5m savings through its local enhanced services (LES) and its quality and efficiency fund (QEF), which incentivises referalls management and efficiency in prescribing.
Cambridgeshire LMC said the cuts represent between 25% and 30% of the discretionary budget the CCG spends on general practice – equivalent to a full-time member of staff for average practices – at a time when all CCGs have been mandated to find extra funding in their core budgets for the newly-formed networks.
According to the board meeting papers, Cambridgeshire and Peterborough STP is predicting a deficit of £192m for 2019/20 and will have to find a saving of £1.5m from its planned investments for this year as part of the quality innovation productivity and prevention (QIPP) scheme.
The papers state: ‘QIPP of £1.5m will need to be found from CCG investments in 2019/20 through a review of local enhanced services and the quality and efficiency fund.’
In its latest bulletin, Cambridgeshire LMC said the cut amounts to a reduction from the QEF/LES income of a ‘full-time team member’s salary’.
It said: ‘On 3 July, the governing body noted the budget approved earlier in private, including a £1.5m QIPP saving from the general practice budget of the discretionary funds spent on primary care. Compared with cuts to other sectors, this may feel moderate by comparison.
‘But let us be clear – this represents 25-30% of the entire discretionary budget that the CCG chooses to spend on general practice – at a time when NHS England is calling on the CCG to make additional, new investments into PCNs over and above existing funding.’
It added: ‘To an average practice, this would represent a cut from the QEF/LES income of a full-time team member’s salary. So your LMC will continue to be involved in some very challenging discussions around the 19/20 QEF/LES schedules.’
It is estimated that the CCG’s discretionary general practice budget is between £5-6m.
The LMC added that Cambridgeshire has one of the worst health economies in the country, with the CCG continuously overspending its budget over the past three years.
It said: ‘GPs have been repeatedly been told by the CCG over the past few years, of the parlous financial state of the local system. This is not yet another warning. This is a notice, informing you that that state of Cambridgeshire’s health economy is now officially one of the worst in the entire country. The CCG is in an invidious position.
In April, NHS England and NHS Improvement wrote to the five STPs and ICSs in the East of England regarding the financial challenges faced by the region.
As a result, the STPs and ICSs agreed to lend Cambridgeshire and Peterborough STP around £5m, which, according to a letter seen by HSJ, will be ‘repaid within three years’.
But Cambridgeshire LMC pointed out this is a temporary measure and the area will have to cut cloth according to means.
It said: ‘Each STP in the East of England has been asked to lend our CCG £5m. £5m from other STPs whose waiting lists may even exceed our own – to achieve financial balance for the region. Those STPs will expect their monies returned at some future point, and so this problem is not going to disappear. We will have to cut our cloth according to our means.
‘How this will translate into patient outcomes and the impact on an already stretched to breaking point general practice remains to be seen but we can take an educated guess. Investing in general practice leads to longer term system savings. Cuts to general practice are a false economy.’