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GPs to face pressure over their ECG skills

GPs are facing a repeat of last year's battles over enhanced services as PCTs try to push through unsuitable schemes for the second year running.

LMCs are reporting a number of trusts trying to include services in their minimum spending floors that GPs already rejected last year.

GPs also said trusts were showing no interest in developing new services because of mounting pressures on budgets caused by practices' high quality scores and expensive out-of-hours services.

Dr Rob Hughes, co-chair of Greenwich LMC, said PCT managers still did not understand what could and what could not be included in their enhanced services floor.

Greenwich PCT was attempting for a second time to rebadge PMS growth funds as enhanced service spend, he said.

'The Department of Health and the GPC make clear growth money is not to be rolled into enhanced services to falsely raise it above the minimum threshold,' he said. 'But they are trying to do it again because they are concerned about over-performance.'

Dr Charles Zuckerman, medical secretary of Birmingham LMCs, said one of his PCTs was putting forward four 'daft' schemes. He predicted the matter would 'blow up' in formal negotiations. He said: 'We went through it all last year. It took months to sort out.'

LMCs said PCTs' were devoting more management time to initiatives such as practice-based commissioning and ignoring the development of enhanced services.

This meant 'baskets' of Red Book services set up as a quick fix last year are being rolled over into 2005/6 rather than converted into individually-funded services.

Dr Harry Yoxall, medical secretary of Somerset LMC, said some practices wanted to stop doing certain services included in the basket.

'Next year we would hope to be more ambitious and accept that not every practice will want to provide all the services,' he said. 'But the assumption is that everything will roll forward.'

Dr Laurence Buckman, GPC deputy chair, said it was 'very sad' that the shift of work and resources from secondary to primary care was not happening. He added: 'Baskets were only intended as an interim measure.'

By Ian Cameron

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