GP revealed exclusively on Friday the contents of a draft NCB document, titled Securing excellence in commissioning primary care which explains how the NCB will buy £12.6bn of primary care. It reads: ‘The following, carried out by some PCTs, will not transfer to the NCB but will be the responsibility of providers themselves:
- provision of locums and other temporary or support staff
- block purchasing of equipment and services other than the disposal of clinical waste.’
An NCB statement explained that: ‘The NCB will continue to be responsible for payments to practices in line with the Statement of Financial Entitlements (SFE) and there is nothing in this document that proposes any changes to existing funding support.’
However Laurence Slavin, a partner at specialist medical accountants Ramsay Brown and Partners, pointed out the discretionary nature of the SFE. It reads: ‘Even if the PCT is not directed in this SFE to pay for such cover it may do so as matter of discretion.’
Mr Slavin said: ‘Payments for locums covering maternity and sickness are all based on PCTs’ discretion. Some PCTs have used this, others haven’t. What this change does is make life uncertain for GPs. It will make them more cautious about taking people on long term.
‘If you go back 10 years, every practice would have received an amount for locum fees for maternity and sickness. Gradually this has become discretionary.
‘I don’t think this will be the final nail in the coffin for some practices because its effect will be limited but it’s another pretty brutal kick.’
Mr Slavin’s interpretation fits with the austere nature of other changes. Speaking exclusively to GP, NCB managing director for commissioning development Dame Barbara Hakin said other PCT support which would no longer be available would include for procurement, training and education for staff.
Dr Richard Fieldhouse, chief executive officer for the National Association of Sessional GPs, said: 'I guess for locum GPs, it's going to reduce a regular source of organised income, and instead leave them to be independent locums again with all the hassle that entails.
'For the practices much the same - instead of having a relatively well organised bank of accredited locums organised by their PCT, if they haven't got a locum chambers near them, or a well organised locums group, it's going to mean more work for practices to organise their locum cover.
'As for overall expense, I guess at the end of the day this sort of purchasing decision/responsibility will be handed on to clinical commissioning groups where it may well be done a lot better.'
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