What I call – “The Black Market”

Local Enhanced Services, Locally Commissioned Services, Local Integrated Service Agreements for diabetes.  Whatever we call them, these agreements are being taken up with gusto by primary care services who wish to support patients with diabetes to be managed in their local surgery rather than having patients traipse into their local hospital (with a tariff charge for each appointment). 

Do we know how much CCGs spend to fund primary care to take on more advanced levels of diabetes care for patients above and beyond what is funded in their standard contract/QOF?

The answer is no. 

In fact, generally CCGs next door to each other probably don’t know the content of their local service agreement or the payment.  It tends to be a closely guarded secret – what I call “The Black Market”.  You can imagine the potential fall out if GPs at the neighbouring CCG find out that they are being paid less for a very similar service.

I often get asked what should be in a good LES/LCS/LIS and it’s difficult to share examples, because, as I said, they are a closely guarded secret.

However, there are two things that I do ask CCG diabetes leads:

·         How do you know whether the local payment is sustaining or improving patient outcomes?  

·         Where do you advertise your local, structured, primary care diabetes healthcare professional (GP, Practice Nurse, Health Care Assistant) education annual programme?

Without these two things how can you be sure that the additional funding is making the blindest bit of difference to patient outcomes and is in fact safe and not detrimental to patient outcomes?  You don’t.

So make sure that all local agreements include:

·         Thou shalt submit data to the National Diabetes Audit once a year

·         Thou shalt evidence attendance at quality diabetes healthcare professional education

Oh, and how about a robust Local Diabetes Clinical Network to support monitoring and suggesting tweaks to support continuous improvement? 

I will be coming back to these points in later blogs.  Here endth the lesson for now.