'Emergency referral threat to GP funds'
Despite being one of the top-performing PCTs in the country, South Cambridgeshire has been grappling with the tight deadlines inherent in the contracting process.
The trust decided to take a realistic approach to service commissioning after concluding there was insufficient time to take a more strategic view.
Ian Burns, director of primary care at the PCT, said its efforts had been focused on ensuring GPs continue to get paid for providing services they already offer because of the 'high degree of risk' to the PCT and patients if practices pulled out.
But he made clear practices would be expected to tinker with the services to bring them in line with the contract specifications.
Both GMS and PMS practices will be able to bid for the national enhanced services on offer, including near-patient testing, anticoagulant monitoring and intrauterine contraceptive device fitting.
Cutting delayed transfers and emergency admission rates remains the trust's top priority.
Mr Burns warned: 'To achieve this the PCT recognises that much more chronic disease management and care of older people needs to take place in primary care. On the other hand if our practices are unable to reduce emergency admissions then money will follow patients into secondary care and we will have less to invest in primary care.'
Dr Guy Watkins, chief executive of Cambridge LMC and a GP in Melbourn, said a 'payment by results' scheme to reduce delayed transfers and emergency admissions had put too much pressure on funds to support chronic disease care. But he hoped the good relationship between GPs and the PCT would help them reach a compromise over the next few weeks.
Three-star PCT S. Cambridgeshire
Number of GPs/practices 64/17
GPs opting out of out-of-hours Anticipate 100%
Average practice Q&O target 850 points
Prescribing overspend 2003/4? Yes £23,000
% of practices in PMS 41%
% of GMS practices needing MPIG 100%