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DoH allows GPs to undercut hospital tariffs in guidance aimed at kickstarting failing scheme

New rules aim to boost PBC

GPs have been given the green light to undercut hospital tariffs under a new set of practice-based commissioning guidelines.

The guidance, released this week by the Department of Health, aims to speed up the shift of services into the community and kickstart practice-based commissioning.

The department has called on PCTs to set up local enhanced services from next April which give GPs more incentives to redesign care and make savings. GPs will also not have to tender to provide services unless they would hold a monopoly in their area.

In addition, each quarter the department will invite a sample of practices from each PCT to report on how well their trust is supporting them.

The guidance follows speeches by Health Secretary Patricia Hewitt and new NHS chief executive David Nicholson last week in which they called on PCTs and practices to make commissioning work.

But reaction from GPs to the new freedoms has been mixed, with support for 'unbundling' of the tariff, but concern that incentives were not backed by new money.

Dr Mike Dixon, chair of the NHS Alliance, said: 'The aim is first of all to encourage GPs to want to take on practice-based commissioning and also to make sure it's effective. I see it as a rebalancing between frontline commissioning and PCT commissioning.'

But Dr Richard Vautrey, GPC negotiator, questioned whether the new incentives would work: 'The reality is that unless there is a clearly identified new resource to support management issues, nothing will happen.'

He said practices needed a 'clear management allowance' that they knew they could use.

Asking practices for their views on their PCT could become a 'bureaucratic paper exercise' unless the results had teeth, he added.

Dr Mark Sanford-Wood, a GP in Barnstaple, Devon, who is trying to establish a PBC consortium, welcomed the ability for GPs to undercut hospital tariffs.

He said: 'Markets work through competition on price.

'Not allowing it would be like walking into Dixons and finding that every television costs the same but some might be better than others.'

David Nicholson told the NHS Alliance annual conference held in Bournemouth last week that GPs should 'make trouble' in their areas and 'root out poor performance'.

hcrump@cmpmedica.com

PBC changes

• PCTs asked to set up new LESs from April to incentivise GPs to redesign services and save money

• Payment by Results tariff will not apply to services provided in primary care

• Budgets next year to be set no more than 10 per cent above or below 'fair share' figure

• Department to survey practices on how much support their PCT is giving

• Each PCT to have a PBC committee

•PCTs must approve GPs' plans within four weeks

• Practice plans to be made available to public

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