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Revealed: How GP commissioning is already creating a two-tier NHS

Exclusive: GPs are already operating in a two-tier NHS with different consortia moving at vastly varying speeds towards the Government's relaxed deadline for taking on commissioning, a Pulse investigation reveals.

Seven GP consortia – now to be rebranded clinical commissioning groups (CCGs) – are already the de facto commissioning organisations in their areas, having taken on 95% or more of their PCTs' budgets.

But 57% of consortia have taken on no budgetary responsibility from their PCTs at all, with warnings they have almost no chance of being ready to take on commissioning by the original April 2013 deadline.

The Government last week revealed only CCGs that were ‘ready and willing' would be authorised to take on full budgetary responsibility from April 2013, as part of a package of concessions on the health bill.

But its claims that most GPs would be on schedule to take over commissioning by 2013 are undermined by our findings, which suggest only those areas that were already active with practice-based commissioning are likely to be ready in time. Of 90 PCTs responding to Freedom of Information Act requests, 38 have devolved at least some portion of their budget to local consortia. Some 14 of these, including NHS Suffolk, NHS Heywood, Middleton and Rochdale, and NHS Peterborough, have devolved budgets for prescribing and acute care.

NHS Isle of Wight has handed GPs budgets for first outpatient appointments and follow-ups, prescribing, continuing care, and direct-access diagnostics and imaging. NHS Nottingham City is one of four PCTs to have delegated mental health budgets along with a host of others, including maternity care, elective hospital care, urgent and emergency care, and ambulance and out-of-hours services.

Seven GP consortia now control almost the entire budget, including those in Cumbria, Cambridgeshire and Northamptonshire, all of which were active in PBC. But 52 areas, including NHS Medway, NHS Leicester City and NHS Plymouth, are yet to devolve any budgets.

Dr Peter Weaving, a GP in Brampton and commissioning locality lead for NHS Cumbria, said: ‘As of April 2011, we have 97% of the budget. It's taken us three or four years – two to three was optimistic in the extreme. We're making good progress but it would be disingenuous to say we've got it all sorted.'

Dr Nigel Watson, chair of the GPC's commissioning and service development sub-committee and a GP in the New Forest in Hampshire – where the PCT has yet to pass any budgets to GPs – urged the Government to set an end date for full handover: ‘Quite a lot of consortia will not be ready by April 2013. But there has to be an end point and that's not been clarified.'

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