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GPs hampered by PBC 'roadblock'

Hospital trusts are acting as a roadblock to practice-based commissioning by threatening consultants with disciplinary action if they set up services in the community.

The trusts are trying to protect their income because a growing number of consultants are banding together and offering NHS services at below hospital tariffs.

Consultants are trying to take advantage of PBC and the Government's policy of moving more services into community settings. But hospitals' resistance could scupper GPs' efforts to alter care pathways and save money.

Carole Heatly, chief executive of Kingston Hospital NHS Trust in Surrey, has warned consultants 'formal action' could be taken if they 'compromise the trust's streams of revenue'.

Professor Paul Jarrett, a former medical director of the hospital trust and a member of Southern Medical Partners – one such consultants grouping – said there was no conflict of interest. He said: 'There is only a conflict if the patient would otherwise be seen in the trust and that clearly is not the case.'

Dr Jeremy Harris, chair of Kingston and Richmond LMC, said GPs wanted to commission consultants who could undercut the hospital tariff.

He said: 'GPs are very keen to work with local consultants and are watching this space.'

The BMA said it was aware of several hospitals in the north of England and one in Gloucestershire that had taken a similar stance to Kingston.

Dr Jonathan Fielden, chair of the BMA consultants committee, said private practice had become 'a grey area'.

He said: 'Because new pro-viders are doing NHS work there is a potential for commissioners to refer elsewhere. If trusts want that work the consultants in that trust cannot work for that provider.'

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