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CAMHS won't see you now

Victory on incapacity checks

When the contract went live, Pulse asked four PCTs if they were ready. Three months on, Cato Pedder finds out how implementation is going

'Struggling with GPs over closing lists'

Central Liverpool PCT is facing a struggle with GPs over the issue of when practices should be allowed to close their lists.

The PCT is working with the strategic health authority and other trusts to try to resolve the issues but admitted it continued to have 'concerns about the open/closed/full lists scenario'.

The PCT got off to a flying start on the new contract, with an unexpected half-a-million-pound windfall allowing it to commission 10 national and local enhanced services.

But Dr Rob Barnett, chair of Liverpool LMC, said that although the services had been commissioned, details of how they were going to work were yet to be hammered out.

Enhanced services commissioned include anti-coagulation monitoring, IUCD fitting, minor injuries and near-patient testing.

And the PCT has commissioned a nationally enhanced service for care of the homeless, confounding fears that lack of practice interest would see the homeless neglected.

The PCT is expecting an out-of-hours service, currently out to tender, to start in October. But Dr Barnett said it was progressing at a slow rate.

'The way things are going GPs will be retaining responsibility up until the stroke of midnight on December 31,' he said.

Substantial redevelopment of premises is expected in the city, thanks to the PCT's membership of a LIFT scheme.

One-star PCT Central Liverpool

Population 266,000

Number of GPs/practices 160/63

GPs opting out of out-of-hours 100%

Average practice Q&O target 900 points

Prescribing overspend 2003/4? No – £500,000

under budget

% of practices in PMS 44%

% of GMS practices needing MPIG 80%

'Fearing pressures on drugs budget'

Coventry PCT remains worried about expected increases in the cost of prescribing as a result of the new contract.

The PCT is grappling with a near £2 million overspend and believes the quality and outcomes framework will 'inevitably' put further pressure on the budget'.

Peter Hodder, the PCT's director of primary care, said the trust was looking at 'wastage and working with pharmacists and GPs' to cut the overspend.

He admitted to frustrations for both the PCT and GPs surrounding departmental guidance and changes to the global sum. But he said comments by GPC chair Dr John Chisholm that PCOs were demonstrating a 'predictable' failure of vision were unfair.

Mr Hodder warned that some changes, such as the transfer of services from secondary to primary care, could take time, but that the contract provided a platform to allow this to happen more easily.

'For example we are encouraging patients to go to their GP with minor injuries rather than to hospital,' he said.

The trust has not yet commissioned an enhanced service for intrapartum care – with discussions ongoing – but anticoagulation, homeless and IUCD fitting services are all in place.

And the PCT has confounded fears of out-of-hours chaos , with new services going live just two weeks after the new contract.

Mr Hodder said: 'Our out-of-hours service went live on April 17 and judging by complaints from patients and GPs we are doing well – as we are not getting any.'

Two-star PCT Coventry

Population 330,000

Number of GPs/practices 170/63

GPs opting out of out-of-hours 100%

Average practice Q&O target 800-1,000 points

Prescribing overspend 2003/4? Yes – £1.8 million

% of practices in PMS 50%

% of GMS practices needing MPIG 100%

'Enhanced services disputes rumble on'

Disputes over enhanced services are rumbling on in Central Manchester PCT despite its claims to have resolved outstanding problems.

The PCT has agreed deals for national enhanced services covering intrapartum care, IUCD fittings and drugs misuse.

Local enhanced services include near-patient testing and the response to disease outbreak.

But LMC representatives say they will advise GPs to opt out of providing post-surgical and interim care unless deals are struck soon.

PEC chair Dr Ivan Bennett, a GP in Manchester, said that the PCT was 'ahead of the game' on enhanced services and had now resolved the contentious issue of

near-patient testing.

But LMC member Dr Charles Simenoff, also a GP in the city, said an agreed waiting period on Zoladex injections, post-surgical care and interim care had now expired, and that the LMC would be meeting this week to discuss the issue.

Ian Mello-Baron, associate director of primary care at the zero-star trust, said an on-going strategic review would help decide what further locally enhanced services would be needed to improve services for patients.

Out-of-hours services in the city are currently out to tender but Dr Bennett said the new service would be adopted before December so the system could be 'up and running with a month to spare'.

Zero-star PCT Central Manchester

Population 185,000

Number of GPs/practices 105/41

GPs opting out of out-of-hours 80%

Average practice Q&O target 800-900 points

Prescribing overspend 2003/4? No – break even

% of practices in PMS 34%

% of GMS practices needing MPIG 70%

'No premises cash for expanding practices'

The new GMS contract has left one of the country's top PCTs struggling to find extra room for its fast-growing practices.

Rapid population growth in and around Cambridge has put pressure on many facilities in the area – but cuts to the premises growth allocation mean South Cambridgeshire PCT cannot afford to offer extra cash.

Ian Burns, director of primary care at the trust, said: 'We have great concerns because population growth means that a number of practices are outgrowing their facilities and we don't have the resources available to provide improvement grants.'

Another issue facing the PCT is the provision of out-of-hours services, with new arrangements not expected to come on line until next April.

The local out-of-hours

co-operative, which will continue to provide services until then, was struggling to fill shifts, said Mr Burns.

'But we haven't encountered any major problems yet,' he added. 'We are more concerned about when we hit the major bank holidays later this year.'

The PCT has commissioned enhanced services for near-patient testing, anticoagulant monitoring, IUCD fitting, minor injuries and nursing homes.

GPs with a special interest are now being commissioned as a locally enhanced service, covering areas such as dermatology, ophthalmology and orthopaedics.

'The biggest problem facing the PCT is managing the commissioning of resources in primary care to fit demand in secondary care,' he added.

The PCT was keen to use the opportunities offered by the new contract, he said, but was constrained by the lack of funding.

Three-star PCT S. Cambridgeshire

Population 103,000

Number of GPs/practices 64/17

GPs opting out of out-of-hours Anticipate 100%

Average practice Q&O target 850 points

Prescribing overspend 2003/4? Yes – £23,000

% of practices in PMS 41%

% of GMS practices needing MPIG 100%

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