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GPs may take on cancer treatment and dialysis

By Gareth Iacobucci

GPs are to be handed the chance to take on a raft of hospital services, including cancer treatment, after the Government signalled its intention to accelerate the shift in funding from secondary to primary care.

Parts of the care pathways for patients requiring chemotherapy, radiotherapy, specialist palliative care and rehabilitation will be available to be commissioned in the community for the first time under the ambitious proposals.

The Department of Health is set to proceed with reforms to the Payment by Results tariff system, which was heavily criticised by the Audit Commission just this month for sucking funding away from general practice into hospitals.

After a wide-ranging consultation, the department is to move to unbundle the tariffs for a series of services that are currently provided exclusively in secondary care, allowing commissioners to pick bits off for primary care provision.

The move follows a generally favourable response to the proposals from SHAs, PCTs and other commissioners and providers. Of 164 respondents who were asked for their views on unbundling, almost half were either positive or strongly positive, with just one fifth negative or strongly negative.

From 2009/10, the department will apply costings to individual parts of the care pathway, to expand the potential for ‘new clinical settings'. Tariffs for chemotherapy, radiotherapy, renal dialysis, rehabilitation and radiology, among others, will be unbundled under the system.

The plans drew a mixed response from GPs. GPC negotiator Dr Peter Holden said unbundling was essential, as community hospitals were being ‘hammered' under the current system.

But Dr David John, a GP in Bristol who is a member of a PBC cluster, said the Government had gone about ‘three steps too far'.

He said: ‘I'm quite enthusiastic about unbundling tests – that would increase the influence of primary care. But I can't really see how things like renal dialysis are going to be helpful at all. They have got to be in specialist units.'

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