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'Dark forces' harm commissioning

By Helen Crump

Primary care trusts' unwillingness to let go of local NHS purse-strings is scuppering GPs' attempts to get practice-based commissioning off the ground.

GPs are reporting trusts adopting a heavy-handed approach, including insisting specific doctors take clinical lead posts and rejecting proposed groupings of practices.

Some PCTs have also demanded GP commissioning groups use a compulsory referral management system.

In London, budgets for commissioning have been set at 2004 levels and elsewhere PCTs have been advised to top-slice

3-5 per cent from budgets to act as a contingency fund.

Dr Robert Morley, executive secretary of Birmingham LMC, said two trusts in the

region were insisting on calling the scheme practiced-led, not

practice-based, commissioning.

North and Eastern Birmingham PCTs were also demanding practices use their referral monitoring tool and that GPs elected as locality clinical leaders sat on the trusts' professional executive committees.

Dr Morley said: 'Instead of having a loyalty to PBC, the clinical leads are going to have a corporate responsibility to the PEC.'

GPs in north Devon said their proposals for a commissioning consortia had received short shrift from their PCT.

Dr Mark Wood, North Devon GP forum chair and LMC member, said the PCT 'made clear in no uncertain terms that the consortium would be completely unacceptable'.

He said: 'What we got was an extremely heavy-handed "over our dead body" kind of response which left us all rather puzzled.'

GPs now plan do practice-based commissioning individually.

Dr Wood said: 'It will be fragmented and may not really achieve very much.'

North Devon PCT said it 'regretted' GPs' impression of its response.

Dr Hamish Meldrum, GPC chair, said there was 'in-

creasing scepticism, anger and frustration about the implementation' of commissioning.

Some PCTs still believed they did not have to offer the practice-based commissioning DES, he added.

Dr David Jenner, NHS Alliance commissioning lead and a GP in Cullompton, Devon, said 'dark forces' within the NHS were opposed to GP commissioning. He added: 'It must be given a chance to work before it's condemned.'

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