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Tories in advanced talks with GPC over contractual commissioning responsibility

By Gareth Iacobucci

The Conservatives say talks with GP leaders over plans to write commissioning responsibility into GP contracts are at an advanced stage.

Shadow health minister Andrew Lansley said last week his party had reached ‘consensus' with the GPC over the proposals which would see GPs take on responsibility for real budgets and free to use any savings they make through PBC. But they will also be held financially accountable for any losses incurred.

He also revealed that the plans hinged on a move to ‘migrate from the MPIG', towards a system that pays GPs on the basis of ‘real contemporary data about disease prevalence', rather than historic data.

Mr Lansley said: ‘We've had considerable discussions with the GPC about this - we need a new contract to get these commissioning responsibilities just as we need new legislation for practices to make themselves real budget holders.'

‘The discussion with the GPC quite clearly demonstrates that there's a consensus that when we start to move towards real budgets have to do it alongside a move towards budgets that are calculated on much better evidence of the prevalence of disease.'

Mr Lansley said the Conservatives planned to ensure that practice budgets and commissioning budgets were kept separate, so that ‘it doesn't come out of their (GP's) money'.

The plans could lead to a huge growth in schemes like in Bexley, south London, where GPs made £4m worth of savings after being given real budgets for prescribing, but also took on responsibility for 54% of any overspend, which could have cost them tens or hundreds of thousands.

GPC Chair Dr Laurence Buckman, said it was premature to speak of a ‘consensus' and warned that any move away from MPIG would be dependent on GPs receiving a pay uplift in future years – something the Tories have already ruled out for 2011/12.

‘No, there's no consensus, that's his view,' he said. ‘We have always made it clear that we are wary of hard budgets, but we're not opposed to it. We just think its something that's quite difficult to work.'

Dr Buckman said separating patient and practice budgets would reduce some of the GPC's fears about real budgets, but warned it wouldn't solve the problem of what happens when the patient budget runs out.

Dr Johnny Marshall, NAPC chair and a GP in Wendover, Bucks, said he supported the plans for GPs to hold budgets provided there was a proportional degree of ‘risk and reward'.

‘There should be a positive incentive to support change. If key performance measures aren't achieved, there should a little bit of risk to drive you on to improve.'

PBC: What they say

Shadow health secretary Andrew Lansley - ‘Commissioning should be in the hands of the primary care practice. PBC is supposed to do that. But it's bust. It hasn't happened in anything like the way that it should have done.'

GPC chair Dr Laurence Buckman - ‘We're keen that PBC should continue. We have always made it clear that we are wary of hard budgets, but we're not opposed to it.'

Primary care czar Dr David Colin-Thome - ‘Of course I don't think the darn thing's dead... [but] I'm certainly disappointed with the impact PBC is having.'

Shadow health secretary Andrew Lansley Shadow health secretary Andrew Lansley

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