GP collective action in Somerset has highlighted several gaps in services, leading to an additional £2m investment from the local ICB, the LMC has said.
Somerset LMC told GP practices in its area that it has finalised a funding agreement for 2025/26 with the ICB, with new arrangements around GPs providing funded services for ADHD, minor surgery and bariatric surgery monitoring.
This will ‘address gaps in service’ that have been ‘highlighted through collective action’, the LMC added.
The ICB has agreed to £2m extra funding and said that this includes uncapped funding for inclisiran, denosumab, and pessary fittings.
In a joint letter to practices, Somerset ICB director of primary care Sukeina Kassam and LMC chair Dr Tim Horlock said: ‘The ICB invested £1.5 million in 2024/25 and will add another £2 million in 2025/26.
‘The additional investment has enabled gaps in service to be appropriately resourced. These include, ADHD (children and adults), MGUS, CLL, polycythaemia, coeliac disease, NAFLD, and bariatric surgery follow-up after two years.’
As part of its guidance for GP practices, the LMC said: ‘Somerset LMC and ICB have now finalised the agreement for New Funding Framework (NFF) for 2025/26. This will address gaps in service that have been highlighted through collective action.’
The ICB told Pulse that it is adding uncapped funding into the minor surgery DES to ‘support additional locally agreed elements’ – including inclisiran, denosumab, and pessary fittings. While the DES is nationally directed, ICBs have the flexibility to determine which procedures are delivered locally.
‘These additions have been identified through local discussions with our GPs, as necessary to address local commissioning gaps and are therefore being funded through the NFF or local arrangements within the national DES scope,’ an ICB spokesperson said.
The ICB has also committed to reviewing the locally commissioned elements of the minor surgery DES.
As part of the new arrangement, GPs will only be expected to prescribe ADHD medication for patients on an agreed shared care agreement with Somerset Foundation Trust.
The letter added: ‘ADHD will follow a shared care agreement with Somerset Foundation Trust (SFT) but will not include prescribing under “right to choose” or from a private provider. If medication becomes unavailable, patients will be referred to secondary care for review.’
The ICB also acknowledged that:
- GPs should not be responsible for health monitoring of all patients with eating disorders ‘on grounds of safety’;
- Prescribing for patients with gender dysphoria is a specialist service;
- Bariatric surgery follow-up in the first two years after surgery should be a secondary care responsibility.
The letter also pointed out that last year ICB funding targeted health inequalities using a deprivation factor, moving away from the Carr-Hill formula which ‘does not reflect deprivation’ or ‘compensate enough towards the additional costs’ that practices serving a deprived population incur.
It added: ‘This additional funding will continue. The national funding framework also contains a small practice premium for practices with fewer than 5,000 patients, recognising the vital role of small rural practices in serving our dispersed population.
‘The 2025/26 contract will continue hypertension optimisation, particularly for those not covered by the QOF and will also prioritise dementia and frailty coding.’
Pulse has previously reported on GPs in several areas coming together to serve notice to their ICBs on unfunded work as part of collective action, including various services and shared care arrangements, such as PSA monitoring, phlebotomy, ring pessaries and ECGs.
In Cambridgeshire, the action has led to the introduction of a new commissioned serviced for PSA monitoring after the ICB acknowledged the service gap.
In an update to practices, Cambridgeshire LMC said: ‘There is no doubt that your collective withdrawal from PSA monitoring has had an impact. It directly led to the introduction of the new PSA LES, with our ICB acknowledging the commissioning gap and properly contracting for this work.
‘The LES wording is clear in defining why this work sits outside GMS, ensuring appropriate recognition and funding.
‘The committee also reviewed progress on other locally commissioned services, and was encouraged to see that the ICB has listened to LMC feedback. Changes are being made, including a shift towards tariff-based funding, which better reflects the true costs of providing these services.’
Practices have taken action serving notice on any underfunded services, which has produced a financial impact in some areas, including Humber and Yorkshire, where both local ICBs said they had to provide an extra £1.6m to mitigate against practices servicing notice on locally-commissioned services.
The BMA has most recently advised GP practices to continue refusing unresourced work from local commissioners. Following the 2025/26 GP contract deal, collective action is still in place but aimed at ICBs rather than the Government.
Last month, GP collective action in Kent led to an agreement from the ICB to fund new locally-commissioned services, including for CVD and ADHD.
‘Several gaps in services’, from the point of view of disgraceful distances to be travelled by many, many patients to get the services that were once provided by Goole Hospital, when it closes down: this is going to be much worse than just an inconvenience and will affect many services, including services involving many women having to travel a far greater distance to receive maternity care, such as having to journey to much further-away Scunthorpe, Harrogate or Doncaster, on return journeys. When will Goole Hospital finally close its doors ? Whatever became of ‘patient choice’ or ‘putting patients first’ or even our once-great NHS as a whole? Bad decisions by Hull and Yorkshire ICB ( by people who are not affected personally by service provision), or has this decision been reversed yet? or decision continuing by salami cuts to services? The Goole wider area does not want service gaps; they want more provision, and convenience of provision, for their better health, surely.
While the issues of larger and less convenient acute and specialist services are an issue for many patients, this report was about the un/underfunded activities being dumped on GPs and how collective action is slowly bringing about change. Well done Somerset GPs, LMC and ICB for doing something about it.
Well done. It shows how much unpaid work we are being dumped on. There are much more still unfunded.
Tameside LMC have given the ICB 3 months notice of cessation of unfunded activity.
The ball is very much in the ICB’s court now.
Glossop practices in a bizarre situation, part of Derbyshire but working to the Tameside enhanced service package.