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GPs are unlikely to be given control of their own budget to buy services by PCTs until the Government's practice-level commissioning initiative is well established.

Giving practices 'fully devolved' commissioning budgets was one of the options announced by the Department of Health in its recent five-year plan for the NHS.

But GPs who advised the department on the initiative said ministers were keen to avoid accusations that they were reviving fundholding.

Letting GPs hold the commissioning budget, rather than PCTs giving practices an 'indicative' sum but keeping control of the money, is closest to the fundholding model.

Practices in England that want to take on commissioning from their PCT will be able to handle an indicative budget from April 2005.

Dr Mo Dewji, Department of Health clinical director for primary care contracting and a GP in Milton Keynes, said alternative models, including fully devolved budgets, would only happen when relationships between GPs and PCTs had matured.

Other models listed in the five-year plan are profiling and peer review, real budgets with PCT-facilitated collaboration between practices, partial real budgets and fully devolved practice budgets.

NHS Alliance GMS contract lead Dr David Jenner said there was no legal framework to devolve real budgets. 'And I'm not detecting the political will to reinvent fundholding or give practices money to commission services themselves,' he added.

The department will leave the decision of how to implement practice-level commissioning to PCTs and intends to issue guidance only on incentives for GPs.

The guidance is expected to state that savings from the scheme must be ploughed back into services.

By Ian Cameron

Practices to commission care for 'hot 100' patients

GPs in Cheshire West PCT are to take control of some of the primary care budget in a pilot practice-level commissioning scheme.

Five or six practices are expected to become involved in the initiative.

The move comes after the PCT identified its 'hot 100' most expensive patients to treat.

Dr John Hodgson, chair of the professional executive committee at the trust, said it hoped that encouraging GPs to devise their own referral schemes and preventive measures could cut £4million from the cost of treating these patients.

Dr Hodgson, a GP in Chester, said: 'It's not just about saving money but using it in different ways, giving choice closer to home and reducing the need for unnecessary admissions.

'Giving power to front-line clinicians to buy packages of care or investigations such as CT scans, if necessary through the private sector, would make sure patients got what they need closer to home.'

The PCT will hold the commissioning budget but practices will receive financial statements, monitor performance and may get to retain savings.

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