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GPs to be handed real budgets under new PBC schemes

By Lilian Anekwe

Exclusive: GPs are to be handed control of real budgets from prescribing and referrals to secondary care under innovative new commissioning deals at a series of PCTs.

Entrepreneurial practice-based commissioning clusters are negotiating with PCTs to step up from managing indicative budgets, in what some will bill as a return to fund-holding.

Pulse understands that in at least one scheme, GPs will share at least a proportion of responsibility for any overspends incurred, in what the PCT is describing as a ‘risk-sharing' arrangement.

Savings made under the plans would be split 70:30 as with most PBC schemes.

NHS Northamptonshire is considering a pilot of real budgets for drug prescribing and referrals to secondary care, to be managed by the largest practice-based commissioning group in the county - representing 61 practices.

Elsewhere, a PBC group in the north east of England is in discussions with NHS County Durham to manage the real budgets for prescribing and hospital referrals.

A pilot of delegated prescribing budgets is also due to be launched in NHS Bexley.

Dr David Brown, a GP in Corby and member of NHS Northamptonshire's clinical executive committee, said it was ‘about time' GPs were given responsibility for real budgets.

‘There is a move within the PCT to start risk-sharing of real budgets in activities like prescribing and secondary care referrals. At the moment the PCT picks up all of the tab, but GPs must share the risk for the totality of the budget.

‘Individual practices have been doing it for years. It's another level entirely for a PBC cluster to assume that responsibility but we have to show that we're fit to govern.'

Dr Dinah Roy, a GP in Spennymoor, County Durham and chair of the Sedgefield PBC group, told Pulse the group's proposal was for each practice to hold its own real budget to manage drug spends, and the management of hospital outpatients with diabetes and other chronic conditions in primary care.

‘We will hold the real budgets on a practice and PBC level for things like diabetes and outpatient care. We can provide these services at a lower cost and one of the main objectives will be to make a saving on prescribing.

‘The saving will stay within the cluster but if there is an overspend we will have to draw on a contingency budget, which is ultimately underwritten by the PCT.'

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