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Pension plans leave me confused and powerless

The Government is making practice-based commissioning 'unworkable' for GPs because of its insistence on using more private providers in the NHS.

Supporters of the scheme say GPs who take on commissioning in April will be 'straitjacketed' by having to spend up to 15 per cent of their budget in the private sector.

GPs would be constrained because ministers have told PCTs they must spend between 8 and 15 per cent on private providers.

Dr Mike Dixon, chair of the NHS Alliance, said strategic health authorities were 'bulldozing' PCTs into striking more contracts with private firms in order to meet the target. GPs would then have to take the contracts on.

He said: 'GPs will find they have around 15 per cent of the budget already accounted for. They will feel they have been straitjacketed in.' Dr Dixon, who practises in east Devon, one of the two areas piloting practice-based commissioning, said health authorities were being 'too heavy-handed'.

A former Government adviser has also warned GPs that a Department of Health decision to delay inclusion of

non-elective treatments in the Payment by Results tariff system has made practice-based commissioning less attractive to GPs.

The department was forced into the embarrassing U-turn after it found that foundation hospitals were gaming Payment by Results by admitting more patients through A&E.

Professor Chris Ham, former head of the department's strategy unit, said the omission of non-elective care 'reduced the incentive' for practices to take on commissioning in April.

He said: 'I think it is likely to have less interest than if it was introduced in 15 months.'

Steve Mercer, chief executive of Avon LMC, said the restrictions would cause GPs to pull back from the scheme.

He described the planned April start date as 'crackers'.

He said: 'What if we don't want to commission from private providers and can get a better deal elsewhere, perhaps from within the public sector? And where does it stop? Will it be 25 per cent next year?'

By Joe Lepper

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