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Plan raises spectre of GP fundholding

GPs are demanding safeguards to ensure Government plans for practices to be offered financial incentives to commission care will not signal a return to fundholding.

The warning comes after sources close to the Department of Health revealed ministers want GPs to be able to keep any savings they make as a result of the practice-led commissioning initiative.

Under the scheme, GPs or consortia of practices will be given cash by PCTs to buy care from the NHS or private sector for groups of patients.

Dr Paul Zollinger-Read, joint-chief executive of Witham, Braintree and Halstead care trust and former Department of Health adviser, said the scheme would link into the Government's payment by results plan.

He said: 'The idea is that under payment by results, GPs could retain any savings they make on commissioning care.'

But GPs argued the plan could lead to the same two-tierism and inequity as fundholding.

GPC member Dr Chaand Nagpaul said the department needed to introduce the 'right safeguards' to stop inequalities developing.

He said: 'We would not want to see a simple rehash of fundholding. It needs to be within a local framework of ensuring equity.'

Dr Ian Trimble, a Government adviser and GP in Nottingham, said he feared linking the scheme to payment by results would 'introduce perverse incentives'.

A King's Fund report released last week, although backing the principle of

practice-led commissioning, warned lack of Government guidance could lead to fragmentation of services.

East Devon PCT, one of a handful of trusts piloting the initiative, has allowed GPs to keep 50 per cent of underspends but has issued a list of things practices cannot spend the money on.

Dr Phil Taylor, a GP in Axminster, said: 'When the savings are made the practices have to get the PCT to approve the plans to spend it.'

Dr Michael Dixon, NHS Alliance chair, said extra PCT control was one reason the problems of fundholding would not recur.

He said: 'This is not fundholding revisited. Any savings will go into services and not pockets.'

A spokesman for the department said it planned to

issue guidance.

By Nerys Hairon and Alisdair Stirling

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