Pulse Investigation: The LES lottery – exposing variation in local commissioning

Pulse has launched an exclusive investigation into Local Enhanced Services (LESs), revealing how significant variation in local commissioning is creating a postcode lottery for both GP practices and patients across England.

Using Freedom of Information requests to Integrated Care Boards (ICBs), Pulse uncovered wide variation in the availability, funding and delivery of services such as spirometry, with some areas offering dedicated funding while others provide little or no support for the same activity. The investigation also revealed the use of funding caps, clawback arrangements and other contractual mechanisms that can limit practices' ability to provide services.

However, the investigation went beyond funding arrangements to examine a critical question facing general practice: why do practices continue delivering services that are underfunded or, in some cases, loss-making?

Pulse found that many practices continue to provide unfunded LES work because of patient need, clinical responsibility, local service pressures and concerns about gaps in care. GPs described difficult decisions between financial sustainability and maintaining services that patients rely on, highlighting the growing tension between national ambitions to move more care into the community and the resources available to deliver that care locally.

For healthcare organisations, commissioners and industry partners, the investigation provides valuable insight into the real-world barriers affecting service implementation and patient access. It highlights how local funding decisions can directly influence the uptake, availability and sustainability of services, creating significant variation in patient experience and outcomes.

The LES Lottery investigation forms part of Pulse's wider programme of data-led journalism examining how national policy translates into frontline practice. Recent investigations have explored issues including NHS Health Check commissioning, the misunderstood issue of GP access and the GP unemployment crisis. Through exclusive reporting, Freedom of Information investigations and expert analysis, Pulse continues to uncover the operational realities shaping primary care delivery across England.

Alongside its award-winning journalism, Pulse supports GPs and healthcare stakeholders with practical clinical content, commissioning and business analysis, educational resources and insight into the changing primary care landscape.

Pulse provides an indispensable and comprehensive range of trusted content that meets the needs of all GPs through political and financial news, exclusive investigations, clinical updates, practical business advice and expert analysis. Our journalism not only informs frontline clinicians but helps healthcare organisations, commissioners and industry partners better understand the challenges, opportunities and unmet needs across primary care.