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Guidance on PBC will kill scheme

GPC condemns ministers for messing with enhanced service, but Warner defends policy.

New Government guidance on practice-based commissioning could 'kill' the scheme stone dead, GP leaders are claiming.

GPs said the much-delayed guidance had 'messed with the directed enhanced service' for commissioning and would see many practices getting little or no reward for saving money.

The guidance stated that PCTs can 'as a last resort' use savings made by practices in order to cover budget deficits. The decision means GPs would get only half of the £1.90 per patient DES for commissioning.

GPs can also only 'access and redirect' savings, not keep them. This means savings would not be counted as practice income and GPs would have to get PCT approval for how they spent the money.

Dr Peter Holden, GPC negotiator and chair of the BMA professional fees committee, launched a furious attack on the Government, claiming it wanted to scupper the scheme.

He said: 'The new guidance sent to us last night will kill practice-based commissioning. I'm not doing it for only 95p.

'The Government has lost its bottle on PBC because they're broke. They need to listen more and dictate less to the profession.'

Dr Holden said all GPs' costs should have been covered because the commissioning work was 'displaced' rather than 'core activity'.

The Government claimed the guidance was agreed after consultation with the GPC. But negotiators are so angry they are to put out their own guidance once the enhanced service details have been agreed.

Dr David Jenner, NHS Alliance lead on practice-based commissioning and a GP in Cullompton, Devon, said the enhanced service 'was a bit of a mess.'

He said: 'Perhaps it does redefine what a DES means, but that still seems rather misplaced.'

He also warned that PCTs may scupper practices wanting to commission by top-slicing too much from their indicative budgets as a contingency fund.

The guidance stated that PCTs could take between three and five per cent.

Dr Jenner said five per cent would be appropriate only in a few cases.

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