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PBC must give GPs real power and control

The King's Fund has highlighted the failure of practice-based commissioning to deliver better services and cost savings despite a £100m investment.

This is a shame as when the idea was introduced I detected a flush of enthusiasm from GPs. Yet again a good idea has floundered.

Each time this happens GPs will be less willing to engage. PCTs seem to be bound by risk avoidance and bureaucracy, which has stifled innovation. We don't have world-class commissioning. We don't even have economy class.

It is time GPs were given real budgets, at least in specific clinical areas, and genuine incentives to redesign services. The NHS must be freed of centralised political control. Financial risks will have to be taken and a fair but less bureaucratic method of tendering for services must be found. Otherwise we will be stuck where we are.

Dr Paul Charlson, Brough, East Yorkshire, Chair, Conservative Medical Society

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