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GPs braced for commissioning savings fight

Most GPs participating in practice-based commissioning expect their PCT to default on the deal to allow them to keep a proportion of any savings made.

Under the deal practices were to keep 70 per cent of savings to invest in their practice – but GPs believe the money will go to clearing PCT deficits.

The bleak picture emerged from a Pulse straw poll, which also showed that the majority of PCTs did not have a PBC local enhanced service in place for next year.

Nearly all GPs approached by Pulse who were participating in commissioning said they expected to qualify for both parts of the PBC direct enhanced service payments.

This DES entitles the practice to 95p per registered patient

upon agreement of a commissioning plan with the PCT, plus a further 95p per patient on achieving the plan's objectives.

But only six out of the 16

GPs who were taking part in practice-based commissioning thought their PCT would let them keep savings made under the scheme. Six said PCTs would not and four were unsure.

Dr Alex Muir, a GP from Southampton not expecting to receive savings, said: 'PBC has become fundholding without the fun. Indeed, with all the overspending it looks like it is fundholding without the fund.'

He said most GPs focused their time on the quality and outcomes framework to boost their income.

GPC negotiator Dr Richard Vautrey said GPs should contact their LMC and ultimately the GPC if they felt PCTs were trying to 'wriggle out' of agreements.

'This takes us back to discussions we had at the beginning of the year. Some PCTs were arguing their deficits had to be paid off first. But we do not believe that should be the case.'

Only one GP said his PCT had started work on a PBC local enhanced service for next year. Six said nothing was happening and seven did not know.

London GP Dr Shabir Bhatti is one of the few GPs expecting to be allowed to keep PBC savings. He said: 'So far there is not strict control on where you spend the money, so we can actually spend it whichever way we like in the practice – such as on new phones or new appointment cards for patients.'

Dr Richard Adams, a GP from Leeds, also expected practices in his area would be allowed to keep savings. But he added: 'I do not think there will be any.'

PCT begins first bout

A cash-strapped London PCT claims that GPs have agreed to take a pay cut to help clear trust debts.

But the bemused LMC has told Pulse no such deal has been struck.

Hillingdon PCT said that all its GPs had agreed to forego

savings against nationals tariffs from practice-based commissioning 'until the recurring deficit is cleared'.

The PCT expects this debt to be cleared by the autumn.

It faces an end-of-year deficit of £11m carried forward to 2007/8 and has a historic, non-recurring, deficit of £54m.

However, Dr Stewart Drage, Hillingdon LMC secretary and GPC negotiator, said: 'I have checked with other GPs and they are quite clear that there is no deal. It is just not realistic. This is a PCT that could not run a bath.'

Other PCTs facing deficit are in discussion with local GPs about distribution of savings.

Yorkshire PCT, facing a £10.2m deficit this year, says it 'has yet to form a view on how any savings will be managed'.

Leicestershire County and Rutland PCT, which faces a £33.8m deficit, is discussing how to 'enhance and progress' PBC. Norfolk PCT, with a likely deficit of £47m, also said it was in discussion with GPs, but that 'it is a challenge for us'.

'If GPs want to waive the

benefits we would not force it upon them,' the spokesperson added.

However, Somerset PCT said it intended to follow national guidelines for savings.

Nigel Edwards, chief executive of the NHS Confederation, predicted: 'These conversations will be happening in quite a few places.'

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