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GPs holding real budgets will be allowed to take financial reward

By Gareth Iacobucci

The new Government will be ‘relaxed' about GPs taking financial rewards from real budgets, insiders say.

Dr James Kingsland, the Department of Health's national PBC clinical network lead, and a GP in Wallasey, Merseyside, predicted that the new Government would be happy to see GPs being financially rewarded if they demonstrated their ability to drive change quickly, but warned of a disinvestment for those who refused to engage.

‘I think the Government will be very relaxed about any system that delivers the productivity challenge,' he said. ‘So the idea of risk and reward is the only way forward'.

He added: ‘There's got to be an investment in those who can and will, and a disinvestment in those can't or won't.'

The forecast came as a report by the Health Services Management Centre in Birmingham concluded that the full benefits of the Government's plans to give GPs control of real budgets may not be realised unless GPs that deliver savings are allowed to retain some of the profits.

Professor Chris Ham, author of the report and now chief executive of the King's Fund, questioned whether the current incentives are strong enough to realise the ‘full potential' of the policy.

He said: 'Concerns about knavish behaviour on the part of some GPs may blunt the willingness of policy makers to offer GPs hard budgets with the prospect of personal financial gain from any savings made. If this is the case, then the full potential of budget holding may not be realised in practice.'

The report says there is ‘major uncertainty' over GPs enthusiasm to hold real budgets, and said an alternative could be for budget holding to be offered as a prize for GPs if they demonstrate preparedness to take on a significant role in commissioning, rather than expecting all practices to be involved from the start.

It says key caveats for the policy to be successful include ensuring that ‘any reductions in management costs are implemented to ensure that enough resources are available to GP budget holders'.

It also calls for the size and scope of GP budget holding to be flexible, for budgets to be adjusted according to the risks of populations served, and for the quality of care to be regularly monitored to ensure that financial incentives do not lead to ‘under diagnosis and under treatment of patients'.

Dr James Kingsland, NAPC chair Dr James Kingsland, NAPC chair