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Fears over GPs' financial risk amid PBC shakeup

By Gareth Iacobucci

GPs are being asked to take on hundreds of thousands of pounds worth of financial risk as part of a radical restructuring of practice based commissioning.

The Department of Health has signalled its intention to see more high-performing PBC groups being handed real budgets, with practices able to use any savings they make, but being held more accountable for any losses incurred.

The DH is urging trusts to follow the example of Bexley Care Trust, south London, where a consortium of five GP practices has made £4m worth of savings after being given real budgets for prescribing.

But some PBC groups have warned cash-strapped PCTs are refusing to hand over the big savings GPs are making.

A new DH document released under the World Class Commissioning banner makes clear to PCTs that it wants them to begin ‘devolving areas of their budget'.

The Bexley scheme, led by 26 GPs across the borough, covers around 210,000 patients, and has been hailed as a blueprint for devolving real budgets, after PBC activities freed-up £4m in resources, which are now being used for local incentive schemes and to pay staff for PBC work.

But if the project had not generated savings, the GPs would have been responsible for 54% of any overspend, which could have run into tens or even hundreds of thousands.

Dr Joanne Medhurst, a GP in Sidcup and lead for the Bexley PBC federation consortiums, said: ‘PBC was thought to be a way of helping to control expenditure in the trust and to bring us back into financial balance. For two years running it has achieved that.'

But despite the success of some schemes, evidence is emerging that other trusts are holding back savings in order to balance the books.

Gerry McLean, PBC consultant and chief executive of Mac2 Consulting, said two PBC groups he was working with had saved around £700,000 and £600,000 respectively but had been refused access to savings because of their PCTs' financial deficits.

NAPC chair Dr Johnny Marshall, a GP in Wendover, Bucks, who last week headed up an emergency PBC summit to try and breathe new life into the scheme, said the DH was right to focus on delegation of real budgets, but warned that any trusts holding back savings risked permanently disengaging GPs from the process.

‘Reward must follow if you've delivered what is asked of you. If the reward is removed, that could be potentially demotivate and disengage GPs.'

Dr Jonny Marshall: Trusts holding back savings risk permanently disengaging GPs Dr Jonny Marshall: Trusts holding back savings risk permanently disengaging GPs The Bexley case: How PBC made huge savings

- Practices took on real prescribing budgets. If they make savings they are free to invest them, but are accountable for any losses.

- Areas of focus have included examining NICE guidance on the use of glucose testing strips in stable diabetic patients, and whether generic prescribing rates could be higher for asthma and anti-hypertensive drugs.

- One practice invested in Scriptswitch software, to make generic substitution easier

- PBC federation members sit on PCT board, and GP clinical leads are consulted on all major service issues.

- Other PBC schemes have included a cardiology service, where virtually all non-surgical work is carried out in the community.

- To date, PBC activities have resulted in freed up resources of £4m, which is being used for local incentive schemes and to pay staff for PBC work.

PBC Masterclass

PBC Masterclass: Regional events

What: These regional PBC events are designed to equip you with the sophisticated skills needed to overcome barriers and push on towards PBC success.

When: 10 individual events running from October 2009 to January 2010

Where: 10 different regions throughout England. Each event has been tailored to address the learning priorities highlighted by practice-based commissioners in that area.

Next steps: Find out more and book

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