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At the heart of general practice since 1960

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Practice-based commissioning has got off to a miserable start because of apathy and PCT bureaucracy, GPs report.

Practices have been put off by PCTs' insistence that they band together, rather than take on a commissioning budget on their own.

GPs also cited doubts over payments to cover management costs, change fatigue and an absence of incentives to make savings for the lack of enthusiasm.

Up to 25 per cent of practices had been expected to take on the initiative from April, according to an NHS Alliance survey in March, but evidence from GPs suggests the figure so far is much lower.

Dr James Kingsland, chair of the National Association of Primary Care, said feedback from 500 GPs at meetings around the country revealed 90 per cent had little or no knowledge of commissioning or interest in it.

Dr Kingsland said there was 'an awful lot of misunderstanding among GPs and PCTs' about the scheme.

He said: 'The main thing we've got to get to grips with is the information exchange.'

Dr John Chaterjee, secretary of Kirklees and Calderdale LMC, said few practices in the region had applied to take on a commissioning budget because the scheme was 'unattractive'.

Another issue had been a lack of clarity over payment for management costs.

He said: 'There is no

great enthusiasm for such a

poorly thought out initiative.'

Dr Mark Hunt, a Department of Health adviser and GP in Frome, Somerset, admitted he was being frustrated in his attempts to take on commissioning. He still had not received his indicative budget, despite applying for it before April 1.

'Nothing much has happened,' he said. 'We've applied to do practice-based commissioning with two PCTs across our different sites. One is much further on than the other. There's the added complication of having to negotiate things twice.'

Steve Mercer, chief executive of Avon LMC, said debt-ridden PCTs in the area were keen to get GPs to take on commissioning but were too focused on getting them to make savings rather than improve services.

'We've had some PCTs that are pushing things more than people like,' he said.

Further problems were reported in East Kent and

Wessex.

By Rob Finch

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