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GPs deride advice to haggle over enhanced services payments

GPs have rubbished claims by contract negotiators that they will be able to haggle with primary care oganisations for higher than benchmark pay for enhanced services.

GPC negotiator Dr Simon Fradd told Pulse GPs disgruntled over the pricing of directed and national enhanced services could always bargain for a better deal.

But GPs have met his suggestion with derision. They claim that in reality many GPs are more likely to face a pay cut for enhanced services ­ if they get paid at all ­ as many cash-strapped PCTs have admitted the funds are just not there.

Even if some LMCs did succeed in negotiating higher rates in their area it would mean GPs forfeiting their preferred provider status, Dr Fradd warned.

Groups of specialist GPs clubbing together as sole pro-viders of a service would risk investigation, he added. 'If you were seen to be holding a PCO to ransom because you were working as a closed shop, they could call in the Monopolies Commission.'

Dr Fradd said: 'There may be specific circumstances in which the PCT won't be able to find someone else willing to provide a service and will have to negotiate upwards.' But he added no practice had the 'absolute right' to force prices up.

Cambridgeshire LMC chair Dr Ian Dumbelton said: 'There is always a possibility a service is so politically necessary from the PCT's perspective they would be prepared to subsidise it from other areas. But they have so many must-dos they are not going to be able to give more than they have on offer.'

Dr Dumbelton, a GP in St Neots, Cambridgeshire, warn-ed GPs seeking to negotiate higher rates: 'If somebody comes in using cheap labour and undercuts you, you're stuck.'

Dr Mike Knapton, primary executive committee chair at Cambridge City PCT, said dropping pay rates for any GP currently paid over benchmark levels would be an option. 'We have to spend our money as wisely as possible,' said Dr Knapton, a GP in Cambridge. 'What we would say is, this service needs to be done in the most cost-effective way?

'We'd have to make a judgment: if they don't want to take a cut in income, would there be anyone else around?'

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