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PCTs 'victimise' small practices

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NHS managers are preparing a devastating attack on the Department of Health's flagship scheme to give GPs the power to commission care.

An internal NHS Confederation document on plans for practice-based commissioning says it has 'never before received such a negative reaction about a policy' from PCTs.

The response argues trusts will be left facing huge deficits and shouldering all the financial risk under current proposals for GPs to take over commissioning.

Guidance released last month stated GPs could keep 50 per cent of savings made over three years but PCTs would have to cover overspends.

The savage attack from PCTs is almost certain to prompt ministers to make significant changes to the initiative, due to begin in April next year. Further guidance is expected later this month.

But amendments could mean practices signing up might be held responsible if they failed to save money.

The confederation said PCTs broadly supported the principles of practice-based commissioning ­ but argued ministers had underestimated the time and management capacity involved and warned practice managers could not cope.

It also predicted some practices could make 'significant windfalls' at the expense of others when a weighted capitation formula is introduced to calculate budgets in 2007.

GPs said the vehemence of the criticism could worsen relationships between practices and PCTs when the scheme begins. They also warned that altering the plans to increase GPs' financial exposure would put many practices off.

NHS Alliance new contract lead Dr David Jenner said GPs 'would not touch' practice-based commissioning if they had to take on more risk.

Dr James Kingsland, chair of the National Association of Primary Care and a GP in Liverpool, added that the confederation response was like saying: 'I love you, but I want to change everything about you.'

The NHS Confederation called for the April 2005 roll-out to be delayed, with the date becoming a deadline for PCTs and GPs to talk about how to implement the policy.

By Ian Cameron

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