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GPs fear deficits will stymie PBC

GPs in the vanguard of practice-based commissioning fear that they will not be supported by cash-strapped PCTs, according to a survey.

GPs in the vanguard of practice-based commissioning fear that they will not be supported by cash-strapped PCTs, according to a survey.

Nearly 90 per cent of GP respondents said they believed their PCTs were more interested in financial balance than redesign of services.

More than one in 10 (14 per cent) of GPs said investment bids for redesigned services under PBC had been rejected because of their PCT's deficits.

The national incentive scheme introduced to engage practices – the Towards PBC directed enhanced service payment – was also criticised by more than eight in 10 respondents as not being enough.

The survey of nearly 100 GPs drew responses from doctors with a high level of PBC involvement, including around 37 PBC practice leads and 11 chairs of PBC consortiums.

Dr James Kingsland, chair of the National Association of Primary Care and a member of the Department of Health's PBC implementation group, said PCTs were under so much pressure to balance the books in this financial year that most were fundamentally missing the point of PBC.

‘Cutting expenditure is incredibly shortsighted and short-termist'

PCTs were not investing in GPs' innovative ‘invest to save' plans, but were instead opting for ‘slash and burn' schemes that simply cut expenditure.

‘It's incredibly shortsighted and short-termist. It shows the lack of understanding of the potency of what PBC should be. PBC is the way to achieve financial balance.'

Nearly two-thirds of GPs also revealed that they did not feel fully engaged in PBC. Only one in five felt they were more connected to the delivery of healthcare than they were two years ago, when PBC was introduced.

Dr Kingsland, a GP in Wallasey, Merseyside, said a sea-change in PCTs' attitudes was needed in the next financial year to capitalise on the potential of PBC before GP enthusiasm turned to scepticism

Dr Michael Dixon, chairman of the NHS Alliance, said the survey findings mirrored his own experience of a lack of engagement at the frontline.

‘Given that 100 per cent of practices [according to the latest Department of Health data] should in theory be doing PBC it shows we're still in the starting blocks in many areas and improvements are going to be needed,' Dr Dixon said.

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