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Pin PCTs down over commissioning money

By Helen Crump

GPs must get their PCT to sign binding legal agreements detailing their obligations before they agree to take on practice-based commissioning, a leading lawyer has advised.

Speaking to GPs at Pulse's commissioning seminar, Andrew Lockhart-Mirams, partner at Lockharts, warned the agreements were needed to ensure trusts did not go back on promises.

The agreements needed to cover payment of directed enhanced services money, the right to keep freed-up resources and indicative budgets, he said.

Otherwise PCTs might baulk at parting with any savings GPs had made or may argue about the proportion of savings they released to practices. PCTs may also attempt to stall a move from basing budgets on historic spend to a fair shares basis.

Mr Lockhart-Mirams said. 'It's no good just holding your hand out in year two or year three,' he added.

GPs also had to ensure PCTs retained ultimate liability for commissioning decisions, Mr Lockhart-Mirams said.

Commissioning consortia should be a loose association of GPs that would act as 'think-tanks' for the trust, directing it on ways to redesign services.

He urged: 'If you're a consortium you must not under any circumstances have a relationship with the PCT where you are liable for the operation of their contracts.'

The advice was disputed by Dr James Kingsland, chair of the National Association of Primary Care and a GP in Wallasey, Wirral, who also addressed the seminar.

He urged GPs to adopt a more collaborative approach with PCTs.

Dr Kingsland said: 'The last thing we need is legally binding documents. With so little trust between practices and PCTs, to go to a lawyer to write a legally binding document would be a terrible start.'

Mr Lockhart-Mirams also urged GPs to separate the commissioning and provider functions of their organisation.

Commissioning consortia existed to hold an employment contract and buy equipment, he said, but providers would be trading for profit. GPs trying to commission and provide would have to excuse themselves from meetings where contracts for their specialty were being discussed in order to avoid conflicts of interest.

Mr Lockhart-Mirams said: 'The danger is you just get in a huddle and all make nice friendly decisions, because that's not going to be seen to be OK.'

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