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Payment by results must be reformed

Amid the rhetoric from all sides about GP commissioning, there is one major issue that receives scant comment, but that needs to be aired – the imposition of the payment by results tariff.

I have a strong sense that many PCTs have been inept in managing the cost of referrals while secondary care has been very skillful at maximising income through the tariff.

GPs are very competent at designing pathways and assessing what needs to be commissioned, but they also need to check patients are receiving appropriate treatment and that the GP-held budget is not being overcharged.

Payment by results is hugely complex and while there are multiple pieces of software that purport to be user-friendly in allowing practices to check secondary care treatment and billing, anyone who has tried to master them in a GP setting may well disagree.

Until such time as the tariff is simplified and some method of joining up GPs' knowledge of patient needs with what actually happened to them after referral is achieved, there will be a significant risk that the reforms will just be a case of doing what we have always been doing and therefore getting what we have always been getting.

Payment by results was a disaster for the NHS budget and it is time for it to be changed, and for a more user-friendly IT system for monitoring payments, but that depends on political will.

From Alan Moore
Group practice manager, Cheshire