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Buckinghamshire - deficit hampering progress

PBC in Bucks is being severely restricted by the PCT's multi-million pound deficit, even though the financial strictures should be having exactly the opposite effect.

PBC in Bucks is being severely restricted by the PCT's multi-million pound deficit, even though the financial strictures should be having exactly the opposite effect.

Dr Annet Gamell is a GP in High Wycombe and chair of Buckinghamshire Primary Care collaborative, which covers 34 practices. She says the problem in Buckinghamshire is that the PCT has a significant financial deficit of several million pounds.

Work is being done that will set the ground work for service redesign in the future, but the financial situation is to a large extent dictating what is happening.

‘If Buckinghamshire PCT was in the black, the partnership for GPs and PCTs to work towards PBC would really be able to fly, but at the moment the imperative is financial recovery so that overrides everything else. What GPs find very frustrating is hearing: "Yes it's a good idea but we don't think we can afford it at the moment".'

There have been developments – the most important, says Dr Gamell, is a move towards integrated working. ‘We're working towards an integrated patient pathway-led NHS for Buckinghamshire. We have developed a board bringing together our main provider trust, the PCT and the collaboratives, so that everyone is pulling in the same direction.

‘In theory this should have a big effect at ground level but in practice the overriding consideration is the financial one – would you choose to go in the direction that's going to work in the long term or would you choose a different direction because that's going to be best financially in the short term?'

Other innovations include a prescribing initiative last year, under which practices are liaising with the PCT prescribing team to get efficient graphical comparative data. This reduced the collaborative's prescribing outturn by £2m (5.22%) in nine months.

The collaborative is also involved in ‘collegiate working': treating the collaborative as one ‘supersurgery' and using GPs' expertise. ‘We're not talking about GPSIs or clinical assistants but, for example, if in my practice there was nobody who injected shoulders, but in a neighbouring practice there was someone who did, then rather than refer to secondary care for a specialist treatment we would refer to that neighbouring practice,' says Dr Gamell.

She feels the general view in the county is that there doesn't seem to be much happening in terms of new development. ‘The PCT's willingness to do things is overridden by the financial problems they have – it's hampering progress.'

But Sarah Bright, strategic programme lead for PBC at South Central SHA, feels that where PCTs are having financial problems PBC can be very effective in turning it around. ‘It's not just about the finances, it's about activity going to the wrong places. The opportunity to be proactive gives PBC an even greater push to make a difference.

I don't think a PCT having difficulty in their financial position should get in the way of making PBC really work.'

Buckinghamshire - deficit hampering PBC progress

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