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GPC advises 'keep PBC savings for yourself'

GPs can keep practice-based commissioning savings to pay themselves and their staff, the GPC is advising.

In new guidance released last week, it says the Government's rule that savings can only be used for 'activity which supports the continued delivery of objectives' is vague and leaves the door open for GPs to claim the money as pay.

GPs have shunned commissioning in part because ministers have insisted savings have to be reinvested in services.

But the opportunity to keep some or all of the 70 per cent of savings available increases the financial appeal of the scheme.

Dr Chaand Nagpaul, chair of the GPC commissioning subcommittee, said all directed enhanced services allowed for paying GPs and staff and practices should follow this precedent.

He said: 'The whole idea of putting restrictions on the way money is used runs contrary to the definition of enhanced services. It's a DES ­ and putting criteria on component two [of the DES] falls outside the way all other DES are paid.'

Dr James Kingsland, chair of the National Association of Primary Care, said he was already challenging to use the money to reward staff. He said: 'There has been so much muddying of the waters around this DES ­ it must just be seen as a catalyst for practice-based commissioning.'

Dr Phil Taylor, a GP in Axminster, Devon, who has conducted research into commissioning, said PCTs would be 'foolish' not to allow savings to be used in this way as GPs would refuse to do the work. He added that either PCTs or practices would have to take some short-term financial risk.

He said: 'To be able to pay for GPs and staff time you have to take it on the chin or get the PCT to pay for it upfront.'

Some GPs warned that taking an aggressive approach with PCTs would lead to more disputes over upfront costs.

Dr Brian McGregor, a GP in York and member of a commissioning consortium, said: 'I think there is going to be a lot of tension.'

Contrary to Government guidance, GPs were still entitled to the second 95p 'achievement' component of the DES if they achieved their plan objectives but did not make savings, the GPC advice also stated.

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