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Reality of ‘slash and burn’ cuts ahead dawns on PBC

Practice-based commissioners could find their services easy prey for PCTs who go for last-minute ‘slash and burn’ cuts after 2010, experts have warned.

Practice-based commissioners could find their services easy prey for PCTs who go for last-minute ‘slash and burn' cuts after 2010, experts have warned.

In his recent annual report, NHS chief executive David Nicholson warned there were harder times ahead with the Department of Health looking to make efficiency savings of up to £20bn between 2011 and 2014.

Dr Donal Hynes, joint vice-chair of the NHS Alliance and a GP in Bridgwater, Somerset, said the GMS contract and PbR tariff meant it would be difficult to target cuts in GP and acute hospital services. And so PCTs, faced with having to make unprecedented cuts, would turn to interface community-based services that were easier to disassemble.

He said: ‘Very often these are sites of the most radical developments. I think the reality of the enormity of the task ahead is starting to dawn on PCTs.

‘A wise PCT board would realise such PBC cuts are bad for the long-term future, as it is more cost-effective to have these services outside hospital and such decisions would be hugely unpopular because people will see services that have developed disappear.

‘A wise finance director would call in the practice-based commissioners because having clinicians leading on cost-efficiency will be much more efficient for the local population.'

NAPC chair Dr Johnny Marshall said: ‘The efficiency savings ahead mean we must get clinicians engaged in the radical redesign of services now. We can't afford to wait until it hits. If we do, we will be fiddling while Rome burns.'

Dr Shane Gordon, national co-lead for the NHS Alliance PBC Federation, said practice-based commissioners and PCTs would need to discuss how the efficiency savings will be made.

He said: ‘There are two ways PBC could go – either it gets completely marginalised as PCTs slash and burn services or it becomes completely enshrined as clinicians are recognised for their value and quality and PBC is brought into the middle of the process. Our PCT seems to be going for the latter.'

In his annual report, Mr Nicholson said: ‘We have a unique opportunity and a serious responsibility now to invest the growth of the next two years in plans that will benefit patients over the next five to 10 years.'

Dr Hynes said it would be a ‘tragedy' to see PBC services decommissioned as clinicians would become disengaged.

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