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Trusts to be allowed to deny GPs PBC savings

By Steve Nowottny

Angry GPC advises GPs to get assurances on commissioning savings

The Department of Health has given PCTs carte blanche to withhold savings from GPs under practice-based commissioning, after admitting it would not compel trusts to comply with guidance.

A new Pulse survey reveals at least one in seven PCTs is failing to allow GPs the recommended 70 per cent of savings, but the department made clear it would not hold them to the deal.

A spokesperson did insist it was 'imperative' practices received 70 per cent of savings, but admitted: 'In some areas a locally agreed adjustment to the percentage of freed-up resources may have been made. We expect SHAs to assure themselves that guidance is being followed in 2007/8.'

The GPC is now recommending that practices do not participate in practice-based commissioning unless they have a signed agreement that they will be able to keep at least 70 per cent of savings.

Dr Hamish Meldrum, GPC chair, said: 'Securing absolute clarity from the Department of Health on the rights of practices to, at least, 70 per cent of any savings made via PBC has been like drawing blood from a stone.'

'At a time when PCTs are desperate for resources, we feel that watertight arrangements have to be put in place in advance to help ensure benefits for patients are delivered.'

Pulse surveyed all PCTs this week and five of the 37 that replied said they were not allowing practices to keep at least 70 per cent of savings as recommended. Some PCTs are keeping all savings until deficits are cleared while others are handing over 50 per cent.

Already Hillingdon PCT has said it will not commit to handing over any savings to practices this year. A spokesman said: 'The PCT has a recovery plan of £15m for 07/08. The PCT has agreed with the PBC consortium that the PCT must achieve financial balance in 07/08 before any savings are kept by practices.'

Dr Tony Grewal, vice-chair of Hillingdon LMC, said: 'Every patient pathway means extra work for us – the old principle of no extra work without extra money seems to be disappearing very rapidly down the pan through no fault of ours. If the pump-primer gets taken away, you can't really blame GPs for only giving token enthusiasm rather than their whole heart to it.'

He added: 'Hell hath no fury like a GP who's had the finance rug pulled from under him.'

Practices in Liverpool, Bolton, Kensington and Chelsea and Bexley will also not receive the full 70 per cent savings until deficits have cleared. However, Kensington and Chelsea PCT has plans to offer GPs 100 per cent of savings in three years' time.

PCTs not offering 70% of savings

Hillingdon PCT
GPs will not get savings until PCT is in financial balance

Kensington and Chelsea PCT
Split 50:50 for three years, then practices will get 100 per cent

Bolton PCT
Savings to fund successful practice schemes and pay back pump-priming fund, then split 50:50

Bexley Care Trust
Savings capped to maximum of value of second instalment of PBC DES

Liverpool PCT
Would not confirm GPs would keep 70 per cent of savings, saying no savings were expected

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