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PCTs offer stop-gap choice and access pay

PCTs across England are introducing stop-gap local enhanced service agreements, following the breakdown in negotiations over directed enhanced services for 2007/8.

GPs will be offered the payments in the hope it will stop them dropping Choose and Book or key access targets.A Pulse straw-poll of 18 PCTs found nearly half have already introduced a short-term LES in place of the choice and booking and access DESs, or will do so in the near future. Most of the remainder said they were actively considering the idea. Bristol PCT has set up one-year LES agreements for both Choose and Book and access for 2007/8. The Choose and Book LES has various pay bands, with GPs able to earn up to 58p per patient per year. The access LES will involve four separate payments, and could pay a maximum of £1.63 per registered patient per year. 'All practices have been given an outline notification of these LES arrangements and agreements are being sent out this week,' said a spokesperson for Bristol PCT.'We recognised that in the absence of a national DES it was important to continue to offer an incentive to practices that wish to continue to provide these services to their patients.'Other PCTs have set up temporary LES agreements in the expectation that the GPC and NHS Employers will thrash out a compromise on DESs by the summer. Devon PCT has implemented a one-month Choose and Book DES, while Eastern and Coastal Kent PCT said it was planning a three-month agreement. 'If a DES is not forthcoming we will continue with the LES, based on last year's DES but with local variations,' a spokes-person said.Dr Paul Cundy, chair of the GPC IT subcommittee, said Choose and Book 'is not a useful tool', and a LES would not persuade GPs to persevere with the system unless PCTs committed significant funding.'LESs are a temporary fudge,' he said. 'I think the Government need to decide whether they want it as a DES or not.'Dr Hamish Meldrum, chair of the GPC, said he did not know when negotiations with NHS Employers on national DESs would resume. But temporary LES agreements lasting only one or two months were unlikely to be sufficient, he added.'There will be plenty of notice if negotiations on DESs are coming along,' he said.Dr Paul Roblin, medical secretary of the Berkshire, Buckinghamshire and Oxfordshire LMCs, said the non-renewal of the national DESs had taken many PCTs by surprise.'They were all caught on the hop,' he said. 'I've made it clear that in the absence of any funding for access, GPs have no obligation to comply with the quarterly PCAS surveys. They also have no obligation to use Choose and Book.'

Local enhanced services

Setting up choose and book LESBassetlaw, Bolton, Bristol, Calderdale, Eastern and Coastal Kent, Haringey, South GloucestershireConsidering choose and book LESBath and Northeast Somerset, Berkshire West, Ealing, East Riding of Yorkshire, Kirklees, TraffordSetting up Access LESBolton, Bristol, CalderdaleHaringeyConsidering Access LESBarnsley, Berkshire West, Derby City, Ealing, East Riding of Yorkshire, Kirklees, South Gloucestershire, Trafford

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