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GPs are set to be paid around £2 per patient to take part in practice-based commissioning under an enhanced service to start next April, Pulse can reveal.

The Department of Health has reached agreement with the GPC to set up the directed enhanced service as an incentive to push more GPs into the flagging scheme.

Negotiations are still taking place between the GPC and NHS Employers on exact funding, but a department source said the figure was likely to be pitched at around £2 per notional patient.

The sum would mean an average practice getting £12,000 to take on commissioning.

The department source said amounts as low as 60p and as high as £5 per notional patient had been discussed, but Number 10 in particular was reluctant to give GPs more money so soon after major new contract income rises.

'I very much doubt it will be at either end,' the source said. 'There is a lot of debate about the figure ­ it will probably be more like £2. It won't be far away from that, although some strong-minded people may push it lower.'

Dr Mark Hunt, a GP in Frome, Somerset, who recently resigned as head of the department's strategy unit, said a DES ensured cash-strapped PCTs could not wriggle out of paying up.

'Funding will be at the lower end,' Dr Hunt added. 'The problem is GPs are seen to be getting a lot of money, therefore it sticks in the craw.'

The department is understood to be considering whe-ther a sliding scale of payments could be used to take PCTs' varying levels of progress into account.

A decision has yet to be made on whether the DES is funded by new money or cash rebadged from other areas, or whether it will include management costs.

GPs said £2 per patient was a 'starting point' but extra funding to cover management and infrastructure costs would still be needed.

Dr Brendan Hudson, joint chair of the Sutton Horizon practice-based commissioning consortium in Surrey, said £2 per patient would net it £186,000.

'I would have thought we needed £250,000,' he said. '£3 per patient would have been a good settlement and realistic.'

Dr James Kingsland, chair of the National Association of Primary Care, said £2 per patient was acceptable, but added commissioning was 'doomed to failure' unless PCTs found more for management costs.

Health minister Lord Warner told a conference this week that PCTs had to stop 'thwarting' commissioning. 'PCTs cannot afford not to work with primary care clinicians to take forward practice-based commissioning.'

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