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BMA under fire for undermining PBC

The BMA is failing to support practice-based commissioning and instead promoting policies which could bring about its downfall, a primary care group has warned.

The National Association of Primary Care (NAPC) said the BMA's plans were undermining PBC and could see GPs lose responsibility for commissioning to private firms.

Its comments follow a BMA 'green paper' report earlier this month which called for 'a move towards mature commissioning that diminishes the need for a purchaser-provider split'.

Dr James Kingsland, a Wirral GP and NAPC chair, said: 'The evidence of the past does not support the case for the BMA's proposal. The reality is likely to be that if PBC fails then we shall see more commissioning by non-NHS organisations.'

The NAPC claimed patients would ultimately get worse value for money if the NHS closed the purchaser-provider gap because money would be wasted on services not tailored to patients' needs.

Dr Kingsland said PBC would be most effective if GPs were given greater responsibility in directing patients to services.

Dr Rhidian Morris, a Devon GP and NAPC executive committee member, said: 'By 1990 the NHS was in a truly shocking state with clinicians not accepting responsibility for the NHS, and managers powerless to make improvements. I am saddened to see the BMA once again taking this tack. The proposal in our view should be unacceptable to present ministers and to the Opposition.'

The NAPC said the BMA's plans, if taken up, would lead to inevitable conflicts of interest if commissioners were buying services that they also provided.

However, GPC chair Dr Hamish Meldrum told Pulse: 'There has never been a totally pure divide – we can be both purchaser and provider, there is a degree of overlap. Of course we always want to see proper checks and balances. [If a GP practice purchasing also provides care] they would have to demonstrate they were providing it to the proper standards and have that process overseen.'

But he added: 'The NHS worked for quite a long time with no purchaser-provider split – a lot of people argue it helped to increase accessibility. A large number argue it adds to bureaucracy, creates artificial divisions, and doesn't allow a seamless joined-up approach.'

Dr Phil Taylor, a GP in Axminster, Devon, with a keen interest in PBC, said because patients trusted their own doctor they were often happy to be referred to a service involving that GP.

'It would be totally unacceptable, though, if PCTs were making incentive payments to GPs that refer patients to a certain service.'

The NAPC said if GPs want to refer to their own services then PCTs should be informed for clinical governance purposes. This would create transparency, allowing PCTs to involve other providers if they wish.

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