GPs told to stop ‘subsidising’ minor surgery as part of collective action

GPs have been told to stop providing minor surgery as part of collective action, after one LMC calculated that underfunding means practices are ‘subsidising’ the NHS by up to £43 for each procedure.

Leicestershire, Leicester and Rutland LMC said it negotiated an uplift in funding for the service with the ICB last year, since it had warned that the amount of money GPs received had reduced by 28% since 2019 due to inflation.

But, in a recent update to practices, LMC chief executive Dr Grant Ingrams said he was ‘shocked’ to learn that the ICB has now decided not to go ahead with increase.

He said that the ICB has ‘knowingly’ made a decision to ‘undervalue’ general practice and to offer a rate of pay ‘significantly below the cost of delivering the service’.

The LMC calculated that because of the inadequate funding GP practices are subsidising the NHS by £42.90 for each incision or excision, and by £21.78 for each injection.

Following this U-turn from the ICB on funding, practices were advised to ‘calculate how much they are subsidising the NHS each year’ for this service and consider stopping it completely and refer patients to secondary care instead, as part of collective action.

Alternatively, the LMC said that practices should ‘cherry pick’ procedures, only providing those which ‘take less time or experience’ and so can be provided within the funding provided.

They should also refuse to sign up to the minor surgery enhanced service for 2025-26 until the LMC advises ‘it is appropriate to do so’.

The BMA has previously told GPs to ‘stop supporting the system at the expense of your business and staff’ and to serve notice on services that plug local commissioning gaps as part of its menu for collective action options.

Dr Ingrams said: ‘I have been surprised and shocked at the ICB’s handling of negotiation of minor surgery specification and pricing.

‘Almost a year ago the ICB agreed that the pricing needed to be updated. Since then a proposed costing was proposed by an ICB clinical lead and after discussion with the LMC a final version was agreed with the ICB.

‘After being promised that it would definitely be signed off and go live from October, the ICB then advised that they had changed their mind.

‘The ICB is cynically hoping that enough practices will continue to pay for the privilege of providing the service to patients.’

The ICB told Pulse that their payments to practices for minor surgery are ‘consistent with those in other areas nationally’.

An ICB spokesperson told Pulse: ‘Leicester, Leicestershire and Rutland ICB is strongly committed to supporting primary care and commissioning services that meet the needs of our local population while addressing the significant health inequities across our area.

‘Our approach to minor surgery payments has been guided by the East Midlands specification, ensuring pricing is aligned with this standard. A comprehensive benchmarking exercise has also confirmed that our payments are consistent with those in other areas nationally.

‘We are currently awaiting the outcome of a national review of the minor surgery Directed Enhanced Service (DES) and are committed to looking at the implications of any future changes.

‘In the meantime, we have taken proactive measures by investing in multiple previously unfunded areas through our local Community Based Services (CBS), enabling us to deliver high-quality and inclusive services in general practice across LLR.’

Meanwhile, LMC leaders are asking GPs to stop prescribing ADHD medication for patients who have been diagnosed elsewhere as part of collective action.

Pulse exclusively revealed earlier this month that more than four in 10 GP practices are now limiting appointments as part of collective action, while 70% of England’s GPs are currently taking some form of action.

And last week, England’s LMCs called on the BMA to ballot the GP profession on taking ‘more significant’ industrial action.