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Acid suppression 'raises the risk of pneumonia'

The Government's NHS Improvement Plan is set to damage GPs' place at the heart of primary care and further weaken small practices, the GPC is warning.

In an official response to the plan, the committee said a pledge to increase the number of community matrons could 'undermine' patient care by moving too far away from a GP-led model of treatment.

Ministers want 3,000 matrons, across every PCT, to be caring for people with long-term conditions by 2008.

GPC chair Dr Hamish Meldrum said the policy went against the direction of most other countries.

He said: 'It would be strange if while many other countries are trying to move towards a GP-based model of primary care there are things here that would take us away from that.'

Singlehanders could be disadvantaged by practice-based commissioning because they did not have the management capacity to take it on.

Dr Meldrum said the scheme also risked continuing inequities between practices because it is based on historic funding for its first three years before switching to a weighted capitation formula.

He said it was imperative the GPC was involved in developing a new formula. 'Anything can get worse if it's implemented wrongly. We are more likely to minimise the risks if we are involved in developing the system.'

Practices taking on commissioning also needed an appeals mechanism to challenge 'perverse' rulings by PCT professional executive committees over their plans and how to spend any savings they made, Dr Meldrum added.

Dr Michael Taylor, chair of the Small Practices Association, said historic inequalities in NHS funding would continue to hurt small practices: 'We approve of practice-based commissioning big time but I'm certain we are going to miss out despite our patients' higher morbidity.'

Dr Peter Smith, vice-chair of the National Association of Primary Care, which helped draw up practice-based commissioning, said he did not envisage PCTs being 'over-zealous' in restricting GPs' spending plans. He added it was right to start with budgets based on historic funding because of the debacle over the Carr-Hill formula.

By Ian Cameron

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