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PBC enhanced service could stifle progress

The practice-based commissioning enhanced service could stifle development of the scheme and lead to poorly-designed local agreements, GPs are warning.

GPs said many PCTs were already showing little interest in designing commissioning agreements to suit local needs, preferring instead to use 'off-the-shelf' deals.

They said this practice could worsen now the £1.90 per patient national tariff had been set for incentivising GPs to take part.

Dr James Kingsland, chair of the National Association of Primary Care and a GP in Birkenhead, Merseyside, said there was a danger PCTs would view the directed enhanced service as their only spending requirement to launch commissioning. This would lead to a 'dumbed-down' version of the scheme.

Dr Kingsland said: 'There has been a concern the whole way through that we need to have a diverse way of commissioning. If we have a one-size fits all approach, it will fail.'

Dr Stewart Findlay, professional executive committee chair of Durham Dales PCT and a GP in Bishop Auckland, said imposition of inflexible rules by trusts would have dire consequences.

'From the practice's point of view they want a fair degree of flexibility in how they deliver on commissioning,' he said.

'If PCTs procrastinate the whole system will grind to a halt. There is a danger that if practices are tied up in knots with bureaucracy they will take a tokenistic approach.'

But Dr Mike Dixon, chair of the NHS Alliance and a GP in Cullompton, Devon, insisted that some constraints were needed in the infancy of commissioning.

He said: 'There is a danger PCTs and practices are lead by example, but if you don't have anything to show people they won't do anything on their own.'

Dr Safiy Karim, a GP in Nottingham who is part of a commissioning cluster, suggested PCTs offering poor options or trying to impose deals on commissioners should be 'named and shamed'.

He said: 'As far as I'm aware it's supposed to be practice-led but so far it seems to be PCT-led commissioning.

'PCTs are using off-the-shelf agreements rather than allowing local entrepreneurialism to shape them.'

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