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Government plans incentives for GPs to refer within primary care

The Government wants GPs to refer more within primary care, such as to GPs with special interests, to cut hospital referrals and to involve GPs in service reform.

Under the new plans for practice-led commissioning, GP practices will be able to hold budgets for secondary care outpatient procedures and planned operations and keep some of the savings.

A source close to the Department of Health told Pulse the aim of practice-led commissioning was to speed the development of a GP-led health

service and encourage better primary care access.

Primary care organisations will devolve to practices the

responsibility for identifying health needs, planning services and reviewing them.

But practices will not hold contracts, to avoid repeating the paper trail that resulted from fundholding, and PCOs will administer the actual cash.

The department has yet to decide on how and when practice-led commissioning will be implemented. Options under consideration include piloting the rollout across one PCT in each strategic health authority area; to extend it to all willing PMS practices; or to extend it to willing GMS and PMS practices, the GPC's favoured option.

North Bradford primary care trust, which has already piloted practice-led commissioning, will be portrayed as an 'exemplar' scheme.

Julie Winterbottom, assistant director of commissioning at North Bradford PCT, said the scheme that has evolved there would typically see a practice with 11,000 patients hold a budget of £3.5 million, with which GPs 'think twice' before referring.

'It's about devolving accountability, authority and responsibility to practice level, empowering them,' she said. 'You would be forgiven for thinking it's fundholding in a different name but it's taken the bureaucracy away.'

Dr David Jenner, spokesman for the NHS Alliance, said: 'We support developing decisions below PCT level as a good way of engaging local clinicians. But people must not be incentivised to do nothing or undertreat, and budgets must be based on the right population size.'

By Ian Cameron

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