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Watchdog delivers wake-up call over PBC shortcomings

A public spending watchdog has sent the Government a wake-up call over its plans for

practice-based commissioning, highlighting inadequate incentives, poor value for money and conflicts of interest.

The Audit Commission says the Government's flagship scheme risks 'exacerbating financial pressures', 'widening inequalities' and wasting money.

'Even in the most successful areas, there are still differences in understanding about what practice-based commissioning means in practice,' it says.

The criticisms, drawn from an investigation of four PCTs selected for being 'relatively successful' implementers of the scheme, will undermine ministerial efforts to talk up the scheme.

The study, a precursor to a wider report to ministers next year, says additional incentives over and above the directed enhanced service must be an 'ongoing priority'.

It says deficit-stricken PCTs face a particular challenge balancing Government guidance to let practices keep 70 per cent of savings against their statutory duty to break even.

GPs in Craven, Harrogate and Rural District PCT, one of the four exemplar sites, are threatening to boycott the scheme over budget cuts.

However, the commission concludes that PBC must proceed on a 'learning-by-doing basis' despite attacking the quality of data used for service redesign and the way budgets based on historical activity penalise some low referrers.

Andy McKeon, managing director of health at the commission, rejected the notion the scheme should be piloted, saying the concept had been tested under Total Purchasing pilots.

He said: 'Looking at what early implementers are doing, how they are addressing some of the risks, is an important part of the process.'

But GPs in three of the

four PCT areas highlighted

by the commission voiced concern over their trust's ability to act as an example to the rest of the country.

Dr Paul Roblin, chief executive of Thames Valley LMCs, said West Berkshire PCT, another

exemplar, 'was not regarded as trailblazing locally'.

GPs in the South-West said South Hams and West Devon PCT was not sufficiently advanced in its implementation of the scheme.

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