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One year into the new contract, Nerys Hairon asks PCTs from around the country how well they have been coping

Central Liverpool PCT and two neighbouring trusts have struck a pioneering deal to package together enhanced services and commission them for the next three years.

The trusts have agreed prices with Liverpool LMC for three years, up-rated by inflation, for a number of directed, national and local enhanced services. Services being commissioned until March 2008 include those for childhood flu, minor surgery, violent patients and MMR vaccines for under-25s.

There are not yet deals on services for minor injuries, alcohol and depression, but GPs will be paid on a retainer basis pending agreement.

Central Liverpool PCT said quality visits had gone well though they had been a 'big undertaking'.

But Dr Rob Barnett, Liverpool LMC secretary and a GP in the trust area, said premises remained a problem.

'There is no money in the pot for premises. It means practices that want to develop and do things are struggling.'

Coventry GPs feel they have not been adequately compensated for the extra work of achieving quality points in inner-city practices.

Practices in the city have scored an average of 845 points ­ better than expected but fewer than in the more affluent surrounding areas.

Dr Grant Ingrams, a GP in Coventry and secretary of West Midlands LMC, said: 'The redistribution hasn't occurred and we have not seen the practices with higher workloads better off.'

But Dr Peter Hodder, director of primary care in Coventry PCT, said the 65 practices in Coventry had surpassed expectations.

Enhanced services have been rolled over until July while the PCT decides what to commission.

Dr Hodder said the trust had finally reached agreement on confidentiality in quality visits after huge problems.

'We have agreed to pick three practices at random and send out letters to 200 patients asking if we can look at their records and then pick 50 of those.'

South Cambridgeshire GPs have averaged over 1,000 quality points ­ but their achievement is exacerbating the trust's deficit.

Dr Jonathan Higham, PEC member and a GP in Bottisham, Cambridgeshire, estimated as many as two-thirds of practices had scored over 1,000 points.

'I am sure the trust will pay it but it's not going to make [the deficit] any easier for them,' he said. 'They have a huge deficit and primary care is contributing to that.'

Cambridgeshire LMC said the trust had under-spent on enhanced services last year.

Dr Guy Watkins, LMC chief executive and a GP in the trust area, said: 'Having an underspend is not satisfactory but we will be working with the PCT to resolve it.'

Clare Morris, the trust's assistant director of primary care, said some new enhanced services were planned for next year on Zoladex, Implanon, and intensive case-management of older people.

Premises funding remained a problem.

Manchester GPs are frustrated with the slow development of enhanced services.

Central Manchester PCT said all current enhanced services would continue, but that there were no plans for any new ones this year.

Dr Ivan Benett, former PEC chair at the trust and a GP in Manchester, said: 'GPs are relatively happy with contract implementation, but they have concerns about enhanced services: that the PCT is not able to fund them sufficiently and has been a bit slow implementing them.'

The trust has identified funding to cover quality payments. A new LIFT scheme will provide a £5.75 million health centre for four practices in Brunswick.

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