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How to: make a successful PBC bid

Like it or not, practice-based commissioning has arrived and GPs must not shy away from the challenge ­ Dr John Couch shows how to make the most of the opportunity

Like it or not, practice-based commissioning has arrived and GPs must not shy away from the challenge ­ Dr John Couch shows how to make the most of the opportunity

While participation in practice-based commissioning (PBC) is currently voluntary, compulsion will become the norm within a short space of time.

Many practices have decided to take part, although motives cover a wide spectrum, from the enthusiastic to the wearily resigned. There are benefits for both patients and practices, so it is worth making plans from the outset.With fundholding, practices held their own budgets. With PBC, budgets will be indicative; the PCT will pay the bills and also pay up if budgets are exceeded (at least for the first three years). The critical list size in terms of financial risk is around 20,000 patients. This means most practices will have to link with their neighbours in order to achieve critical mass.

This also makes sense in terms of efficiency. Since management budgets will not be as generous as in fundholding, it makes sense to have one management group for several practices, especially as local strategies are likely to be similar.As revealed by Pulse (10 December), GPs will get £1.90 per patient for taking part in practice-based commissioning.Under the one-year deal, 95p per patient will be given to practices for developing a plan detailing how they will save money. The other 95p per patient will be given on achievement of the plan, but only if savings made by the practice are swallowed up by PCT deficits.

A large group of practices will command more negotiating strength when care is commissioned. It seems that large will be beautiful as far as PBC is concerned. In fact many groups have already begun this process, with some at a very advanced stage. General practice has always been good at producing its 'first wavers'!

What are the incentives?

On paper at least, practices get to keep 50 per cent of their savings to be used to improve patient services. With downward pressure already being exerted on the extra money pumped into the NHS, there is concern that these savings may replace the current system of grants, incentives and 'extra' payments practices have become used to over the last few years. Therefore one of the dangers in not taking part in PBC may be a reduction in income stream.

Another incentive is the increased chances in maintaining or improving a range of service and facilities that will retain current patients and attract new ones. Whatever may have happened to old GMS we still have, in effect, a capitation-based payment system. Therefore practices losing patients face a downwards spiral of declining patient numbers, profits and viability.

Of course, the converse is true for those practices making an early success of PBC.Much will depend on how management costs are funded. It is vital that costs form an early part of negotiations and agreement with the PCT. The stated intention of the Government is to move ever further towards a patient-led service so you must bear this in mind.

Local needs will be paramount so an early step in preparing for PBC must be to discuss these with the PCT. In this way all services can be carefully integrated. Choice will be critical for making savings. In this respect there can be little doubt that conurbations will be better placed than rural areas.

Areas with more dense populations are likely to have more than one NHS trust and several private hospitals within reasonable travelling distance for patients. Practices in this situation must maximise the competition for contracts.

Bidding war likely

Many current GPs and their staff have experience of fundholding which can be used to good advantage. The use of block contracts with a percentage of no cost overshoots will produce savings. There is likely to be more bidding for services from private companies and hospitals, all eager for a share of Mr Brown's extra NHS cash.

Ensure contracts are carefully drawn up by using good legal support and standard contracts. Avoid contracts greater than 12 months to ensure competitive bidding every year.

Also monitor the indicative budget monthly to allow some fine-tuning during the course of the year. Many practices and commissioning groups have already worked out that there are great opportunities for new providers in PBC. Private companies will certainly be bidding to offer services, so why should GPs be left out?

Unless GPs respond to the challenge of PBC someone else will. History suggests GPs are unlikely to step away.

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