The majority of ICBs (31) increased their local enhanced service (LES) funding for general practice last year, a special report on this issue has found.
According to data obtained via Freedom of Information (FOI) requests by our sister title Pulse, 31 ICBs increased their total funding for all local enhanced services between 2023/24 and 2024/25.
FOI data from the 40 ICBs that responded to the request revealed huge variation in LES budgets over the last two years, including the number and type of services commissioned.
Seven ICBs reported that the funding for LES had decreased. One ICB (South Yorkshire) maintained its LES budget at the same level, one ICB (North East London) said that despite their FOI response indicating a drop in funding, the total discretionary GP funding actually went up, but the figures could not be provided.
Funding boost
GPs in some areas appeared to see huge increases in their LES funding, such as in Buckinghamshire, Oxfordshire and Berkshire where the ICB said its budget jumped by 71% from £8.8m in 2023/24 to £15.1m in 2024/25.
This rise is well above CPI inflation, which was 3.2% over the 12 months leading up to March 2024.
But the ICB said that the figures provided for 2024/25 may not represent the ‘full spend’, and that it had introduced ‘revised’ locally commissioned service specifications following a review to ‘reduce variation in both funding and clinical outcomes’.
‘A nominal budget of about £15m was made available during 2024/25 to support the roll out of the new services,’ a spokesperson confirmed. The ICB did not provide its full-year spend as of March 2025.
Practices in Coventry and Warwickshire also saw a substantial boost to their LES funding, by 30% from £4.8m to £6.2m.
The ICB said that these budgets are ‘indicative’ and that the funding rise is due to an increase in enhanced service activity and unit payment. It also said this forms part of its full review of enhanced services.
Of the ICBs that increased their LES funding, eight did this by less than CPI inflation.
FOI data from Mid and South Essex ICB had previously indicated a drop in LES funding of almost 8%, but local commissioners later clarified that the final figures at the end of 2024/25 actually showed an increase of 28%. This was partly due to the introduction of an additional service mid-year.
The ICB said that this substantial increase was driven by the harmonisation of LESs across the former CCGs, growth in demand, and increased awareness of LESs among GP practices.
ICB director of primary care William Guy said: ‘Local Enhanced Services form an important part of the local discretionary funds we invest in general practice [….] We also operate additional schemes that support GP practices to deliver a wide range of supplementary services that are helping to meet the needs of their patient population.’
Shifting budgets
In their FOI responses, both Bedfordshire, Luton and Milton Keynes (BLMK) ICB and North East London ICB appeared to slash LES funding by 8% and 19% respectively. But local commissioners later clarified that total discretionary funding for GP practices had actually gone up, as funding under the LES budget in 2023/24 had moved into other budgets in 2024/25.
For practices in BLMK, total funding increased from £10.5m to £10.8m, despite a reduction in the LES budget. The ICB said it had introduced a ‘primary care framework’ in 2024/25, which is a ‘£6m investment in payments to general practice to support specific locally prioritised activity’.
‘For example, the LES funds used in 2023/24 for phlebotomy and multi-disciplinary working were moved into the Primary Care Framework in 2024/25,’ a spokesperson said.
North East London ICB said the the ‘raw funding data does not reflect the fact’ that some 2023/24 LESs are now commissioned under different primary care contracts, such as by PCNs.
‘It’s therefore not right to conclude that overall funding has been reduced, as it has not,’ the ICB said.
One example the ICB provided was for dermatology, where the contract was delivered by a primary care provider but not as a local enhanced service ‘as it was a procured planned service under an NHS contract’.
A spokesperson added: ‘We are working though these nuances and details in contracting as we continue to come together as one ICB from seven individual CCGs’ footprints.’
However, despite denying the drop in local GP funding, the ICB failed to provide full figures beyond the LES budget, and therefore have not been included in the table below.
| ICB | Patient population | Total 2023/24 budget (£) | Total 2024/25 budget (£) | Percentage change |
| Bedfordshire, Luton and Milton Keynes | 1,143,867 | 10,528,491 | 10,846,932 | 3.02% |
| Birmingham and Solihull | 1,642,498 | 19,231,000 | 19,509,000 | 1.45% |
| Bristol, North Somerset and South Gloucestershire | 1,093,139 | 12,410,812 | 12,926,716 | 4.16% |
| Buckinghamshire, Oxfordshire and Berkshire West | 2,010,883 | 8,839,382 | 15,130,189 | 71.17% |
| Cambridgeshire and Peterborough | 1,054,316 | 11,344,845 | 11,854,707 | 4.49% |
| Cheshire and Merseyside | 2,796,843 | 14,900,000 | 15,500,000 | 4.03% |
| Cornwall and Isles of Scilly | 606,149 | 5,264,000 | 5,903,000 | 12.14% |
| Coventry and Warwickshire | 1,117,407 | 4,764,243 | 6,203,186 | 30.20% |
| Devon | 1,298,157 | 9,065,246 | 9,905,769 | 9.27% |
| Gloucestershire | 695,335 | 7,650,889 | 8,923,707 | 16.64% |
| Greater Manchester | 3,296,854 | 49,376,758 | 49,424,765 | 0.10% |
| Hampshire and Isle of Wight | 1,971,063 | 18,853,127 | 24,993,326 | 32.57% |
| Hertfordshire and West Essex | 1,661,646 | 16,399,087 | 17,787,388 | 8.47% |
| Kent and Medway | 2,032,783 | 17,110,762 | 18,227,769 | 6.53% |
| Lancashire and South Cumbria | 1,864,626 | 39,791,531 | 39,942,325 | 0.38% |
| Leicester, Leicestershire and Rutland | 1,233,426 | 23,698,050 | 23,934,032 | 1.00% |
| Lincolnshire | 823,229 | 8,325,000 | 8,519,172 | 2.33% |
| Mid and South Essex | 1,290,956 | 5,276,000 | 6,750,000 | 27.94% |
| Norfolk and Waveney | 1,099,844 | 15,210,895 | 16,030,077 | 5.39% |
| North Central London | 1,830,429 | 16,248,000 | 17,002,000 | 4.64% |
| North East and North Cumbria | 3,228,859 | 34,315,557 | 35,808,988 | 4.35% |
| North West London | 2,906,910 | 68,381,000 | 73,353,000 | 7.27% |
| Northants | 847,576 | 15,632,842 | 16,231,232 | 3.83% |
| Nottingham and Nottinghamshire | 1,282,938 | 11,841,274 | 12,287,965 | 3.77% |
| Shropshire, Telford and Wrekin | 536,056 | 5,810,868 | 6,069,919 | 4.46% |
| Somerset | 607,936 | 9,020,000 | 10,177,000 | 12.83% |
| South East London | 2,121,697 | 3,397,936 | 3,438,408 | 1.19% |
| Staffordshire and Stoke-on-Trent | 1,204,644 | 18,468,732 | 19,010,525 | 2.93% |
| Suffolk and North East Essex | 1,076,582 | 5,777,155 | 6,784,000 | 17.43% |
| Surrey Heartlands | 1,147,706 | 15,500,000 | 15,800,000 | 1.94% |
| Sussex | 1,856,941 | 42,217,551 | 44,860,077 | 6.26% |
Cuts to funding
A total of seven ICBs cut LES funding, with Dorset ICB’s allocated LES budget decreasing by around 7%, from £11.5m to just over £10.7m.
The ICB also provided other primary care funds to GP practices, including for enhanced frailty and transformation. This total investment saw an even sharper drop (10%) between 2023/24 and 2024/25, from £21.8m to £19.6m.
Dorset ICB said that local enhanced services are reviewed in partnership with local GP leaders and PCNs, and are ‘commissioned to ensure that patients within integrated neighbourhoods receive the most appropriate care within primary care settings’.
ICBs where LES funding decreased
|
ICB |
Patient population |
Total 2023/24 budget (£) |
Total 2024/25 budget (£) |
Percentage change |
|
Bath and North East Somerset, Swindon and Wiltshire |
1,010,976 |
11,959,318 |
11,801,440 |
−1.32% |
|
Black Country |
1,339,732 |
21,747,851 |
21,666,364 |
−0.38% |
|
Derby and Derbyshire |
1,140,585 |
11,441,840 |
11,257,765 |
−1.61% |
|
Dorset |
833,011 |
11,500,000 |
10,739,000 |
−6.62% |
|
Frimley |
849,868 |
6,542,550 |
6,102,538 |
−6.73% |
|
South West London |
1,773,286 |
20,228,104 |
19,621,877 |
−3.00% |
|
West Yorkshire |
2,700,031 |
23,370,000 |
22,274,000 |
−4.69% |
West Yorkshire ICB cut its LES funding by over £1m last year – but local commissioners said that total investment in primary care, including ‘national contractual payments’ increased.
A spokesperson for the ICB said: ‘What is included in LES budgets will vary as they are often linked to activity undertaken and can’t be compared without knowing what each system includes in contracts.
‘For context, in West Yorkshire, the total investment in primary care increased by 7.5% from both national contractual payments and local commissioning arrangements between 2023/24 and 2024/25.’
In Bath and North East Somerset, Swindon and Wiltshire, the ICB’s budget for local enhanced services essentially remained the same, but actual cost of delivering those services differed, showing a reduction in spend on general practice.
LES funding in South Yorkshire saw a nominal reduction, but by only £79, meaning the budget was essentially maintained.
Herefordshire and Worcestershire ICB and Humber and North Yorkshire ICB did not fully respond to the FOI request.
Pushing back on ‘unfunded’ work has been a prominent feature of GP collective action, which began in August last year as part of the BMA’s dispute with the Government over contract funding.
This led to GPs in many areas collectively serving notice on some local enhanced services or shared care arrangements, such as PSA monitoring, phlebotomy, ring pessaries and ECGs.
LMCs argued that certain services are not properly resourced by ICBs, and many called for comprehensive reviews of the LESs on offer in their area. Some ICBs, such as Humber and North Yorkshire, have agreed to conduct reviews as a result of collective action.
Given that the BMA agreed to the 2025/26 contract changes in February, national collective action has been stopped, but GP leaders have urged practices to continue local action against ICBs.
A special report on this issue is available on our sister title Pulse’s website.
