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Oxfordshire - financial survival dominates

PBC in Oxfordshire is being derailed by a financial crisis, meaning there's no prospect of GPs freeing up resources, or keeping the money if they do.

PBC in Oxfordshire is being derailed by a financial crisis, meaning there's no prospect of GPs freeing up resources, or keeping the money if they do.

Most practices in Oxfordshire are in consortiums with a small number of non-aligned practices, of which Dr Prit Buttar's practice is one.

According to Dr Buttar, member of Oxfordshire LMC and GPC representative, PBC locally is being derailed by a financial crisis.

‘Last year pretty much everyone managed to generate fairly respectable freed-up resources and were very positive as they felt they could do an awful lot with them, but this year there is no prospect of any – and even if there were the PCT has come to an agreement with the main consortiums that they won't be split 70:30 because the PCT needs the cash.'

Dr Buttar feels that, as last year's freed-up resources came from money that would otherwise have gone to hospitals, hospitals have now become much more adept at ensuring the money goes back to them. He says: ‘The PCT has seen a huge increase in its hospital costs for the current year.

‘As a result, the PCT finds itself back where it was a couple of years ago, facing the very real threat of major deficit. All thoughts of service redesign are pretty much academic at the moment – it's more a matter of financial survival.'

Dr Buttar says there are few tangible benefits to be seen from PBC as the system does not contain the medium- to long-term financial guarantees needed for any serious service redesign. ‘In order to see benefits you have to have sufficient money on a recurring basis in order to put alternative services in place,' he says.

Dr Buttar also sees a problem with the way commissioning is carried out by the PCT. ‘Locally we were looking at patients attending the hospital diabetes clinic.

By sending one of our nurses and one of our doctors off to do a diabetes diploma we could get that expertise in house, patients wouldn't have to travel and we could do it cheaper.

‘The problem is the PCT won't commission that service with us because they've been negotiating with the hospital to improve the service there and they don't want to undermine it by setting up a rival service. Unless we can fund such a scheme out of freed-up resources – and even then we're back to being only able to fund it for this year – we're stuck.'

Sarah Bright, however, feels things are happening in Oxfordshire, in particular locally designed DVT services.

‘Quite a few of our consortiums are doing things with DVT and local near-patient testing. They've introduced local D-dimer testing to ensure that people who don't have a positive test don't need to go to secondary care. That's working very well in Oxfordshire and there have been notable reductions in referrals into secondary care in those consortia that have introduced these services.'

Yet Dr Buttar says: ‘Given the amount of effort that goes into PBC, the level of innovation is frankly rather disappointing. PCTs are so risk-averse because they're terrified of the financial impact on their balance sheet they won't take any innovative actions.'

Oxfordshire - financial survival dominates

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