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Lack of GP incentives threatens PBC future

Primary care trusts are failing to set up local enhanced services for practice-based commissioning, with just weeks to run of the current national incentive scheme.

The Towards PBC directed enhanced service is due to finish in under seven weeks and the lack of local replacements threatens to destroy GP engagement.

GPs have warned that without a short-term incentive, all but the most enthusiastic practices will lose interest.

The Government told PCTs in guidance last November that a local incentive scheme was a 'key expectation'.

Dr James Gillgrass, chief executive of Surrey and Sussex LMCs, said the fallout from PCT restructuring meant it was difficult 'actually finding people from the PCTs who can come down and discuss possible incentive schemes with us'.

He warned: 'Where they might struggle is where they've struggled to get PBC off the ground and suddenly there isn't that incentive.'

Dr Richard Vautrey, GPC negotiator, said he could not see things resolving in the next few months.

'It's going to leave both practices and consortiums in limbo until the PCT has got the capacity to support them,' he said.

Dr Paul Roblin, chief executive of Thames Valley LMC, said he had not seen any forth-

coming incentive scheme for practice-based commissioning. 'I have no confidence that practice-based commissioning as it is currently organised has a long-term future,' he said.

Dr Richard More, a GP in Somerset and founder of PBC consultancy Xytal, said: 'Many practices will find it hard to understand why they should engage without short-term benefit. Unless PCTs nurture these organisations, they'll fall away.'

Dr Mike Dixon, NHS Alliance chair, said he understood some trusts were considering rolling over the DES and attaching further conditions.

But he said the lack of continued incentives would be

'an enormous concern' even though they weren't that generous anyway: 'Look at the long- term consequences – if general practice doesn't take on PBC, it's finished.'

Ministers would take 'a very dim view indeed' of trusts that were unable to offer an incentive scheme, he added.

What PCTs were told in November

• Focus on 'clinically appropriate, affordable and cash-releasing' local incentive schemes

• Schemes should be regarded as income by practices

• Focus on targets like 18-week wait and the NHS Modernisation Agency's 10 high-impact changes

• Payment size to be locally determined, with regard to PCT affordability, and dependent on practices not overspending indicative budgets

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