LMCs say there is a risk that the 'tipping point' for the success of PBC might not be reached. Primary care czar Dr David Colin-Thome has said that 30 per cent of practices must take part for it to be a success.
GP leaders are urging practices not to reject PBC because they fear this could give private providers opportunities to fill the breach, putting general practice at risk.
Heavy top-slicing of budgets for contingency funds and to plug deficits will leave some practices with only 80 per cent of funds they should receive, making savings almost impossible, say LMCs.
Few practices have received indicative budgets to date. Many GPs fear they will have to wait until after PCT reconfiguration.
GPs also believe that there is little prospect of them having any real control over how savings are used because spending has to fit with PCT development plans. Some PCTs have threatened to keep savings to combat deficits.
LMCs warn that revisions to the quality framework, which take effect from April, may have convinced practices they will be too busy to take part.
In addition, the directed enhanced service (DES) for PBC might have made the situation worse. LMCs say PCTs are expecting too much work for the DES payments, which is also deterring practices.
Avon LMCs chief executive Steve Mercer said budgets should be based on historic levels of activity multiplied by the Payment by Results tariff.
But only 80 per cent of this could remain after DoH and PCT cuts.
He pointed to the 2.5 per cent national 'efficiency slice' the DoH was taking from PCT budgets, a 5 per cent local contingency fund for high-risk operations, cuts under PCT recovery plans, and a top slice worth up to £20 million across Avon to bail out failing trusts, all of which will hit indicative budgets.
'How do you make a surplus when 20 per cent of the budget is already gone?' Mr Mercer said.
Andrew Bradshaw, deputy chief executive of Essex LMCs said the DES had had a negative effect: 'PCTs that were talking about resourcing PBC properly are now hiding behind the DES.
'They are expecting practices to work on service redesign and new care pathways, but this involves time and needs resources over and above the DES.'
GPC deputy chairman Dr Laurence Buckman said: 'I would like to say "do it because it's a money-spinner", but it's not. The reason we are encouraging practices to do it is political - it is important for practices to stay in control of what is going on in primary care.'
A DoH spokesman said that PCTs should have arrangements in place for universal coverage of PBC by December. He added that the DoH believed there was an appetite for PBC among GPs.
Why GPs might not take up PBC:
- Top-slicing of budgets.
- Lack of control over spending.
- PCT reconfiguration.
- Confusion over the DES.