ICB cuts income of pioneering provider by up to 10%

The Foundry Health Centre in Lewes, East Sussex, said it had lost 30 per cent of its previous income from “locally commissioned services”. This represented a cut in total income of 5-10 per cent of total funding in a single year.

The practice runs several surgeries, has a list size of around 30,000, and works as a single primary care network serving the town. Foundry was highlighted in both the 2022 Fuller Stocktake and the 2023 GP access recovery plan for its innovative model.

Sussex Integrated Care Board has sought to standardise its LCS contracts. As a result, funding for services including anticoagulation and pulse checking were cut and services such as coil fitting and minor surgery were reduced.

Foundry partner Phil Wallek said the provider had also lost additional funding for a dementia service, but would continue to provide it under the core contract.

Dr Wallek claimed Foundry had suffered disproportionately from the ICB review because it was providing a large number of LCSs. He said. “We’ve tried to take on board as many services as we can and because then we’re providing everything, when a cut like that happens, we are one of the ones that will be affected more significantly.”

The practice has made at least five members of staff redundant and is not replacing two partners who are leaving.

“The ICB were trying to ensure that everyone’s getting paid for the same things,” said Dr Wallek. “They were also going through a deficit period, so they were looking at ways to cap the amount of income that practices could earn within those services.”

The process created “distrust with the whole system”, Dr Wallek said, and practices’ relationships with the ICB have “suffered significantly”. 

“It created a lot of nitpicking, everyone looking very carefully at what’s gone on, about what’s been paid, what hasn’t been paid, and then getting quite defensive about it,” he said. “It’s been a significant drop [in income] for us.”

Dr Wallek said the process had also taken “an awful lot of work”, meaning ”all of the energies that you would otherwise take for doing improvement work or transformation work has all been taken, in trying to justify the income that we should be having”.

Separately, the ICB has also moved provision of an urgent care service in the town from the practice to the local community health trust. 

Foundry was formed from a merger of three separate partnerships in Lewes. Among other service changes, it separated access into streams of less complex urgent needs which do not require GP continuity, as distinct from more complex acute cases and ongoing chronic conditions care, which do require GP continuity.

A spokesperson for Sussex ICB said: “As part of harmonising LCSs across the ICB, which has been happening over the past two years to reduce unwarranted variation in activity, and as part of routine reviews of specifications, including assessment of affordability and value for money, NHS Sussex has made some changes to 13 (15 per cent) LCSs that GP practices may choose to provide for their registered population. In total, NHS Sussex commissions around 59 LCSs, totalling around £40m per year. 

“Changes to specifications may have an impact on some practice incomes. However, practices will continue to be paid for the work they do as part of delivering an LCS. The number of LCSs practices choose to deliver is a practice decision.”

The ICB said on background that it had not made an overall reduction in GP practice funding, which overall remained similar to the previous year.

It added: “The Foundry practice delivers 25 LCSs in addition to its general medical services contract, which means they may have been more affected by LCS changes than other practices which deliver fewer services. 

“We are working closely with the practice to support them to provide high-quality services to patients, and ensure that they continue to be paid for the services they provide.”