Documents from PCTs that have finalised financial plans for beyond 2010/11 reveal trusts are looking to recover millions from PMS and GMS practices.

An SHA source also told GP newspaper that the DoH expects to save £42 million from primary care contracts if the DoH's proposals for GP pay are accepted by the Review Body in March.

PCTs have been told by health minister Mike O'Brien to use this year's 5.5 per cent growth to invest in efficient, innovative services and reduce hospital costs rather than 'slash and burn'.

But across the East Midlands SHA area, PCTs have calculated that up to £37 million can be saved this year by 'reducing the cost of primary care contracts'.

'Benchmarking' appears to be a common theme, with PCTs hoping to reduce spend on primary care contracts to match regional or national averages.

Board papers from NHS South Gloucester reveal an 'opportunity' to save £2.7 million by reducing GMS and PMS spend to match other areas.

By applying efficiency gains identified by management consultants McKinsey, the trust says it could save £5.26 million from GP practices and community services over the next three years. Bassetlaw PCT, in Nottinghamshire, is planning to recover £400,000 from 11 practices over the next three years.

Dr Chris Locke, chief execu-tive of Nottinghamshire LMC, said PCTs in his area 'didn't have a clue' how they would recover the money and GPs were anxious to find out what it would mean for them.

'They have no guidance from the centre on how to recover this money - they have been asked to come up with a figure before they've had time to think it through. They are all waiting to see if other trusts have come out and said how they will do it.'

PCTs have 'bottled out' of investing in services that would move services out of hospital and into primary care, Dr Locke added. 'Practice-based commissioning has stalled and there has not been any major shift in resources from secondary care to primary care.'

GPC deputy chairman Dr Richard Vautrey said: 'It is likely to be enhanced services that are cut - areas where PCTs have complete control. It could also be in the form of PMS reviews.'

He urged trusts to invest in primary care to resolve financial challenges elsewhere and said lowering practice funding to match a national or regional benchmark failed to recognise variation between practices.

'It is simplistic to assume everyone should be prescribing in the same way as the lowest prescriber,' he said.

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GP Funding Cuts

East Midlands SHA calculates £34-37 million savings by 'reducing cost of primary care contracts'.  Bassetlaw PCT plans to recover £400,000 from just 11 practices over the next three years.  NHS South Gloucester could save £2.7 million per year by reducing GMS and PMS spend.  NHS Walsall plans to recover £500,000 over five years from primary care and will restrict GP premises investment to existing projects.