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GPs threatening legal action over OOH 'blackmail'

What is practice-based commissioning?

GPs are given indicative budgets by their PCT to commission elective surgery, outpatient care and diagnostics. The budget will initially be based on practices' past spending but the intention is to move to a weighted capitation formula.

What's behind it?

It is part of the Government's ongoing drive to keep people out of hospital. Ministers

also say it will give GPs power to redesign local services, giving them control over how they are provided and by whom.

What's in it for me?

The Department of Health says that by giving GPs control, they can ensure patients get quicker access to care than if they they were referred for costly hospital appointments or stays. Patients' and GPs' frustrations with NHS delays will therefore be eased.

Is that all?

GPs will also be able to keep half of any savings they make, which must be ploughed back into services.

That sounds like a return to fundholding

There are clear similarities. Ministers insist it is different because practices involved are not given any extra money. PCTs will also hold and administer the budget, place contracts and remain legally responsible. Also, because of Payment by Results, there will be no haggling over the costs of procedures. Guidance insists savings 'must not be used for individual's profit'.

What can GPs spend the savings on?

Employing specialists, including nurses, allied health professionals or consultants to run clinics. Pay for GPs to train to take on a special interest and handle more cases. Employ case-managers to look after

vulnerable patients. Set up one-stop clinics for certain conditions. Establish urgent care centres that combines out-of-hours services with dispensing, lab testing, crisis resolution.

Still sounds like fundholding. Surely GPs can earn more money by doing all these things?

Advocates admit this is possible. If services improve and patients are better managed then it could be easier to hit quality targets and take on more enhanced services. But PCTs piloting the scheme say they would not let GPs spend the savings on a practice extension or equipment that they would then own.

How much will practices be able to commission and how soon can they start?

It is up to practices to decide what they commission ­ it could be for a limited or total range of services. Practices' right to hold an indicative budget becomes live in April 2005

How can you make savings?

By cutting hospital referrals and creating alternative services so more patients are treated in the community. Practices will have to examine referral patterns, identify their most expensive patients and work out whether any referrals are unnecessary and whether follow-ups could be done in primary care.

What if I don't make any savings, or even overspend?

Practices have three years in which they are expected to at least balance the books. Overpends in one year can be offset against savings in another. Any overspends are met by PCTs, not practices. But GPs are likely to lose their right to hold a budget if they do not make savings.

So where does this leave PCTs?

PCTs still commission primary care from GPs, specialist hospital services and other primary care services such as dentistry and eye care. They will commission secondary care where practices do not decide to take on commissioning rights. PCT will also administer the budgets and remain legally responsible for spending.

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