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Tough targets hit PBC

By Helen Crump

Strict financial targets on PCTs are hampering GPs' efforts to make meaningful practice-based commissioning decisions.

GPs say Government demands for PCTs and practice-based commissioners to break even each year are stopping them redesigning services and investing to make longer-term savings.

The Department of Health originally said commissioners must at least break even over a three-year cycle, but recent guidance insisted they achieve financial balance each year.

Dr Chaand Nagpaul, chair of the GPC's commissioning and service development subcommittee, said the restrictions were 'gravely impeding the successful development of PBC'.

He said: 'Many of the investments will take more than one year to achieve financial efficiency gains and the current system prohibits that.

'As a result, we're finding that many practice-based commissioners and consortia are not able to redesign services because investment will not translate into savings until the next financial year.'

Dr Nagpaul, a GP in Stanmore, Middlesex, also warned GPs that getting the go-ahead to invest mid-year would be impossible because savings could never be realised in the same year.

He called on the department to return to the three-year timescale. 'We need to step up the pressure. Government needs to realise this is a false economy,' he said.

Dr John Crompton, a GP in Boroughbridge, North Yorkshire, said GPs were being forced to 'tinker at the edges' rather than propose far-reaching changes to services.

He said: 'If everybody is being dragged down by having to make each end of year balance it's going to make it much harder to make changes.'

Dr Ethie Kong, a GP in Willesden, London, said balancing the books was important but practices had to be trusted to make decisions.

She said: 'It makes it very disheartening for enthusiasts like me who really believe in the principle of practice-based commissioning.'

A department spokesman said it was considering the recommendations of a review into NHS accounting systems and would be responding in due course.

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