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By Rob Finch

Groups of pioneering practices are surging forward with plans for practice-based commissioning.

Several ambitious schemes have taken a leap of faith

and begun appointing managers and staff to aid service

redesign and handle administration. Some have decided to fund management costs themselves.

But the GPs' optimism is tinged with anxiety over whether upcoming Government guidance will instruct primary care trusts to provide adequate 'pump-priming' funds and management costs.

One group has warned it will 'walk away' if Government directives for funding are not sufficient to cover costs.

Practices in Selby and York have formed a PCT-wide consortium, involving 130 GPs and headed by a 10-strong management team consisting of GPs and practice managers.

The practices joined together to protect services during the forthcoming round of PCT mergers and to maintain GPs' influence in commissioning decisions.

In south-west London, the Nelson Commissioning Group has appointed a chief executive, secured by PCT funding.

A group in neighbouring Merton is also about to appoint a PCT-funded commissioning chief executive to a £60,000 part-time position.

In Leeds, around a dozen practices have agreed to split savings equally with Leeds North East PCT in return for £2 per patient upfront management costs.

Dr Brian McGregor, public liaison lead for the Selby and York consortium and a GP in Acomb, said GP cynicism had been overcome by a 'sense of unity'. But he warned that its own money will only cover GP backfill costs for four months.

'If it's funded [by the PCT] there are some huge opportunities. If it isn't it will die and there's no illusion that we will walk away.'

Dr Ian Harper, a GP in Wimbledon and member of the 10-practice Nelson group, said it intended to take on more management staff once they gained control of budgets.

'When we take the budget on in April we'll need someone to look after it all,' he said.

Dr Brendan Hudson, a GP in Sutton, Surrey, is leading the Sutton Horizons Group, whose intention was to extend its activities into services such as out-of-hours. 'It will be far-reaching, even beyond practice-based commissioning,' he said.

rfinch@cmpinformation.com

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