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Practice-based commissioning uptake exaggerated, say GPs

Published on 07/07/06 at 12:01pm

Doctors' leaders have challenged claims by the government that as many as 40% of GPs are engaged in practice-based commissioning, a key component in health service reforms.

Practice-based commissioning aims to give GPs greater influence and control over how money is spent on services, switching decision-making from PCTs to frontline clinicians.

The government has set a target of 100% for uptake of practice-based commissioning (PBC) in England by the end of 2006. But the BMA says problems with payments to doctors and lack of enthusiasm among some doctors means uptake has been slower than claimed.

The government says around 40% have signed up to the incentive scheme for PBC, but Dr Hamish Meldrum, chairman of the BMA's GP committee says this does not mean doctors are using PBC yet.

"The government's statement might lead people to infer that more GPs are commissioning services for their patients than is the case. The incentive scheme is there to encourage practices to put a toe in the water of PBC, but does not mean that actual commissioning is under way."

He suggested the government's announcement was "disingenuous" and pointed to some obstacles which remained to wider uptake of PBC.

"Implementation of PBC is very patchy at the moment. While we support it in principle, we hear of far too many barriers being put in the way of GPs taking on a commissioning role."

"If the government seriously wants PBC to get off the ground in all parts of the country, it needs to take a close look at these barriers, which include significant PCT deficits, and instruct local NHS bodies - primary care trusts - to work with and support practices instead of blocking the way ahead."

Government figures for May 2006 show that 3,454 practices out of 8,433  (41%) - of GP practices in England, had taken up an incentive payment to participate in practice-based commissioning.

The proportion of practices taking part was highest in London, with south east London (79%) and south west London (75%) having almost twice the national average percentage of practices involved in practice-based commissioning.

The government has also pointed to some early evidence that PBC is helping to save money in the health service.

A report published by the NHS Alliance suggests that a number of PCTs are projecting savings of over one million pounds for re-investment in additional services as more practices adopt PBC.

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