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GP commissioning returns but PCTs will hold purse strings

Published on 07/10/04 at 05:39pm

General practices will be able to commission care and services directly from suppliers from April next year - a move the government hopes will motivate primary care clinicians and accelerate progress towards patient-centred care.

The system has similarities with GP fundholding, a system considered to have many positive aspects but widely criticised for having serious flaws. Patients with fundholding GPs were often able to receive treatment faster than those with other GPs, creating a two tier primary system.

Labour abolished the system a year after it came to power in 1997, but says the new GP commissioning will be different because PCTs will retain control over budgets.

PCTs will remain legally responsible for the contracting process, but any savings made from managing referrals more efficiently will be shared between practices and PCTs, with all savings reinvested into patient care.

The scheme will be entirely voluntary and no targets will be set for its uptake, but the government hopes it will be popular with any healthcare professionals keen to rebuild services around patient needs.

"This will enable GP practices and other groups to play a bigger role in commissioning services for their patients and local populations. It will mean greater flexibility for GPs to deliver services tailored to their patients' needs," said Health Minister John Hutton.

"PCTs and practices should see Practice-led Commissioning as an opportunity to change the NHS from the bottom-up. Money freed through Practice-led Commissioning will be ploughed back into the delivery of patient services, therefore increasing investment in primary care."

The plans will be road tested with the NHS over the coming weeks, with a number of practices such as North Bradford PCT already involved in Practice-led Commissioning.

Dr Ian Rutter, a GP in Bradford, said: "Our experience of offering Practice-led Commissioning has been immensely positive. It has achieved greater involvement of clinicians and practices with their patients in decisions about care.

"We have been able to deliver improved quality and better use of resources by empowering primary care to manage secondary care budgets."

Mike Dixon, chairman of the NHS Alliance, the main representative organisation of PCTs in England, said: "Practice-led Commissioning should reignite the enthusiasm of frontline GPs and practices who want to have a greater say in improving the range and quality of services available to their patients."

He added that the scheme will make PCT commissioning 'more sensitive' to individual patients and decisions they make with their GPs and practice nurses.

"Its success will depend upon local practices and the Primary Care Trust developing effective working relationships that enable them to provide the right services, which meet the choices that their patients wish to make," he concluded.

The BMA has also welcomed what they called "interesting and potentially very far-reaching" plans but Dr Hamish Meldrum, chairman of the BMA General Practitioners Committee sounded a note of caution, saying:  "There are concerns about the absence of clear national guidelines and because of this we will want to issue detailed guidance to practices and Local Medical Committees as to how they should take this initiative forward."

He added: "If it is to be successful, this scheme must ensure both equity of access and quality of service for all patients and fair rewards for the practices that will take responsibility for managing these complex processes."

The DH says that when a practice requests the right to an 'indicative budget' in April 2005, the sum will be based on historical spend for the year 2003/4 with the 'appropriate uplift'.

Any overspends will be met by the PCT, but practices will nevertheless be expected to balance their books over a three year cycle. Those that are unable to do this will be barred from the scheme except in exceptional circumstances.

 

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