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Gold, incentives and meh

Huge rise in referrals of 'poorly performing' GPs

Six months on, Emma Wilkinson and Rob Finch discover that PCTs are grappling with a variety of problems caused by contract implementation

Error cuts budgets by a quarter

Coventry Teaching PCT is under pressure after GPs complained their budgets had been underestimated by as much as 25 per cent.

Dr Grant Ingrams, a member of the professional executive committee, said the PCT had 'made a big cock-up with finance that had put everyone's back up'. He claimed calculations of his own budget had been out by £8,000 a month.

Dr Chris Taggart, a member of Coventry LMC, said the trust was now having to claw back money from other parts of the budget.

'It doesn't entirely surprise me and they're probably not the only trust to have made the error, but it has made it difficult to work,' he said.

The PCT said the issue of confidentiality during quality visits had also been 'a pain', although 'good progress' had been made.

'We would usually want complete data confidentiality maintained, but this makes it difficult to be rigorous,' said Peter Hodder, director of primary care for the PCT.

The trust hopes to gain informed consent from a cohort of patients for the use of their notes during visits.

But in key areas of GP concern, the trust seems to be bucking the trend.

The out of-hours service went live in April and may expand to provide on-call nurses and mental health workers. And while there have been problems agreeing intrapartum care between primary and secondary care trusts, all other enhanced services are up and running.

The trust has used money from the LIFT scheme to merge 10 practices into three sites and, according to Dr Ingrams, the GPs are happy.

No progress on enhanced services

Six months have passed and Central Liverpool PCT has yet to make progress in setting up enhanced

services.

GPs have accused the PCT of a 'fudge' after it admitted it was still paying a retainer and collecting information, and had not yet reached the negotiation stage. But a meeting is planned later this month to kick-start the process and GPs are optimistic that an improvement in the financial situation next year will see enhanced services commissioned from April 1.

The PCT will take over responsibility for out-of-hours from November 1 after finally resolving the issue with GPs.

'GPs haven't got any choice, but they are happy it's not January 1 so they can sleep on Christmas Eve,' said Dr Rob Barnett, secretary of Liverpool LMC.

The trust has announced it will not be scrutinising levels of exception reporting in the first round of quality visits after acknowledging it was 'too early' to put GPs' records under the microscope.

It has also ironed out issues on confidentiality of records, implementing a computer system to allow access to anonymised information and using clinical governance GPs as assessors.

The trust remains on track to achieve a £500,000 under-spend.

It has established its LIFT company and work is under way to build four new premises, with work commencing recently on the first, in Everton.

'People are hopeful that things will move at a sensible pace ­ in the past it has taken an inordinate amount of time to get off the ground,' Dr Barnett said.

Pilot irons out exception reporting confusion

South Cambridgeshire PCT has taken a pre-emptive strike on exception reporting by running pilot quality and outcomes visits to iron out any problems.

'There was confusion on exception reporting,' said Jeremy Wallman, services development manager for the PCT. 'But we ran a pilot quality visit on September 14 and we've since issued guidance to GPs.'

Mr Wallman said exception reporting would be the main focus of attention for the quality and outcomes assessors, although he acknowledged there would be some variation.

South Cambridgeshire PCT has recently merged with Cambridge City PCT and this along with the rapidly growing population has put extra pressure on services. 'Most practices can cope,' he said. 'But there is another new housing development that may cause problems.'

Dr Matthew Hunt, a GP in Willingham, Cambridgeshire, said Saturday morning out-of-hours slots had been taken over by the 'enthusiastically staffed' co-op. 'It was rather nice and relaxing,' he said.

Confidentiality row delays quality visits

Central Manchester PCT has deferred quality and outcome visits as discussions continue over how to resolve the issue of confidentiality.

The trust has yet to confirm whether it will be asking GPs to obtain consent from patients or taking a 'light-touch' approach.

'We are advising that we see it as the PCT's responsibility to gain consent from patients,' said Dr Allison Hutton, LMC chair and a GP in the city.

Six months into the contract, the issue of enhanced services also continues to frustrate GPs.

One bone of contention has been the delay in commissioning an enhanced service for contraceptive implants.

Dr Hutton described the hold-up as shortsighted. 'We have the highest teenage pregnancy rate in the country,' she said.

But enhanced services have been commissioned for minor surgery, near-patient testing, drugs misuse and amber list drugs. The LMC now wants the PCT to ask practices what new enhanced services are needed.

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