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Do only what you are paid to do on commissioning

GPs should do just enough work to qualify for the first tranche of practice-based commissioning enhanced service money, but no more, the GPC is advising.

GPC negotiators said the Government's failure to give GPs funding to cover management costs meant it was not worthwhile for practices to engage fully and do work such as redesigning local services.

The advice came after GPC members voted last week not to 'commend' the DES for commissioning in protest at the lack of money and the potential for PCTs in deficit to keep all savings made by GPs.

The damning motion prompted an immediate concession from the Government over savings, with ministers promising GPs would keep 70 per cent of savings to reinvest.

But negotiators said this did not alter their position.

Dr Hamish Meldrum, GPC chair, said: 'It is helpful for us to have that ambiguity removed but that still doesn't get round a lack of engagement among PCTs and the question of deficits.'

GPs should 'only do what they are resourced to do', he added.

In addition to the lack of cash upfront, Dr Meldrum said a further problem was that PCTs could cut back deals they had already made to the minimal levels set out in the DES.

Practices will also have little financial motivation to implement service redesign.

Dr Meldrum defended the GPC's decision to agree the DES despite knowing about the problems, arguing it was 'better than nothing' in areas where nothing was being offered.

Nevertheless, GPs said it was still nowhere near enough.

Dr Dinah Roy, GP and PEC chair of Sedgefield PCT, said even the Government's concession that GPs could keep 70 per cent of savings to reinvest was not as good as the original promise of 100 per cent.

She said: 'At the moment it is like offering people the carrots without offering the tools to do the job.'

Commissioning DES details

  • Part 1: Worth 95p per patient as practice income. Paid for drawing up plan to redesign patient flows in agreement with PCT. Agreements should ideally be made by the end of April.
  • Part 2: Worth 95p per patient or 70 per cent of savings, whichever is higher. For reinvestment in services only. Paid on achievement of plan objectives, but with caveats for events such as major changes in practice population.

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