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Let's hold actual PBC budgets

Holding actual budgets would allow GPs to deliver integrated care, writes Dr Tim Richardson,

Holding actual budgets would allow GPs to deliver integrated care, writes Dr Tim Richardson,

PBC as it currently stands, with a notional budget, no incentives and the risk still held by the PCT, is very weak and is not being actively pursued by many practices. So although big changes are forced on the system – such as PCT reconfiguration and the new GP contract – little or no change occurs in patient services, which health minister Lord Darzi realises is essential both to improve patient care and get better value for taxpayers' money.

I propose, and am pursuing, the option of taking our PBC budget as an ‘at risk' managed care contract. We are offering to take the fair allocation of our patients' resources from the PCT as a binding contract. We would then deliver the widest range of care feasible through a primary-care-based, integrated professional healthcare team.

This team would comprise GPs, specialists, nurses, therapists and associated managers. We would then procure, where required, critical and acute care from the best performing, local, accredited specialist hospitals – but retain management control over our patients' continuing care.

We would do this in collaboration with a ‘world-class commissioning' organisation that would be expected to provide management support to ensure we are tracking and managing our listed patients' activity in real time, using latest worldwide research to develop best care pathways and to monitor and ensure clinical compliance.

Holding real resources, and driven by the need to deliver services that were more cost-effective than current acute care costs, would require and enable us to invest in new or refurbished local facilities – whether these are known as polyclinics, local care hospitals or modern cottage hospitals – closer to patients.

This would reduce the current inappropriate dependence on the acute sector and enable the reconfiguration recommendations made by Lord Darzi and various royal colleges, which would improve quality and safety for all patients with life-threatening acute conditions.

Dr Tim Richardson is a GP in Epsom, Surrey

Join in the debate over the future of PBC: email your views on this plan to or post your comments below

we want to take on our PBC budget from the PCT

We want to take on our PBC budget from the PCT

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