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Commissioning dilemma: Your PCT has set up an incentive scheme based on the quality premium, but you think the GPC might not like it

As part of moves for your CCG to take on a real prescribing budget, the PCT has set an incentive scheme modelling on the quality premium, including money for quality improvements, but which is only earned if the budget is in balance, and which is paid to practices.

You personally approve of the scheme, but you suspect the GPC might not like it. Dr Stewart Findlay advises on what to do.

The GPC guidance is very clear. GPs should not place themselves in a situation where they could be seen as being rewarded for diminishing patient care.

However GPs also have a responsibility to their population as a whole and this includes the efficient use of available resources. We also have to remember that extra work undertaken by practice staff is not a "free good" and also has to be funded.

In the situation above, the incentive scheme is focusing on quality improvements and the practices are undertaking that work without any guaranteed income. This is a win win situation for the PCT/CCG but has the potential to damage the relationship between GPs and individual patients.

If the scheme is a good one, the shadow CCG will have to support practices in their delivery of the scheme and protect them from unfair criticism.

They must be able to demonstrate to the public that the payments to practices are reasonable and good value for the NHS.

In order to do this the CCG must involve patients, through established CCG and practice based groups, in the initial decision to take up such a scheme.

The scheme must be published and open to public scrutiny.  It is important to seek approval from the LMC, and in future one may also want to make sure that such schemes are approved by the Health and Well Being Board and your local Health Watch. They must be seen as part of the annual commissioning plan and not looked at in isolation.

Finally, the GPs on the CCG board must declare their interest in the scheme and should not take part in any vote on the scheme. They may wish to ask a neighbouring CCG to provide external scrutiny to the scheme and the decision to implement it.

Dr Stewart Findlay is chair at Durham Dales CCG,  a GP in Bishop Auckland and NHS Alliance clinical commissioning lead for the north east region

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