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Health bill will force GPs to work in federations

By Ian Quinn

Exclusive: The Government is to make it mandatory for GP practices to join federations in a new health bill being finalised by ministers.

The radical overhaul of commissioning will hand GPs control of over 95% of PCT commissioning budgets, putting them at the centre of plans to make huge efficiency savings.

Whitehall sources also confirmed plans, revealed by Pulse earlier this month, for the new NHS Board to hold contracts

directly with GPs, replacing the existing role of PCTs. The NHS Board is set to have a contract with each federation, which in turn will have a contract with each member practice.

Health secretary Andrew Lansley is due to present the bill next month and insiders made clear all GPs would be expected to sign up to joint commissioning arrangements, with practices expected to share back-

office functions and human resources, and work to an agreed commissioning budget.

‘Practices will have to work on a federated basis,’ the source said.

The Government’s plans are being widely compared to a return to the days of GP fundholding – but with the crucial difference that this time the strategy will be mandatory.

With the health secretary having ordered a huge cull of PCT management in the operating framework, it is anticipated

federations will employ many as business managers.

But the source said: ‘GPs will be in the driving seat.’

The news comes as a report by the Nuffield Trust, the National Association of Primary Care, the NHS Alliance, the NHS Confederation’s PCT Network, the RCGP and The King’s Fund welcomed Government plans to put GPs ‘centre stage’ – but warned the Government faced ‘significant challenges in engaging more than an enthusiastic minority’.

The report called for incentives for GPs, suggesting commissioning groups could retain 100% of savings in return for them being re-invested in local services. It called for guarantees on management support and clarity over the possible risks to GPs. RCGP chair Professor Steve Field called the commissioning plans a ‘new dawn’.

Professor Steve Field