It is one of a number of issues that will be answered in PBC guidance expected next month.
The guidance will also clarify that PCTs will not necessarily have to put services out to tender and will review incentives to encourage more practices and private providers to get involved.
The prospect of acute service tariffs being applied to PBC services had raised fears that GPs would lose a loophole that allows them to make savings by undercutting the hospital tariff on services (GP, 14 October 2005).
But last week the DoH began ‘unbundling’ tariffs to allow pri-mary care services to charge less than secondary providers by paying only the relevant parts of a broken down tariff.
Bob Ricketts, DoH reform director, said it would be totally impractical to apply the same tariffs to GPs as secondary care.
‘There has been some confusion over whether there will be like-for-like tariffs in primary care,’ he said. ‘You would only ever pay the secondary care tariff in exceptional circumstances — we will lay that out in the guidance due in December.’
He said the guidance would cover incentives for new providers, including bonus payments, tariff supplements and guarantees on income and length of contracts. It would also ‘revisit the saving incentives’.
His assurances, given at the National Association of Primary Care (NAPC) annual conference in Harrogate last week, were echoed by health minister Lord Warner, who said he did not ‘see much point in having an average acute trust tariff applied willy-nilly to a non-acute trust’.
Lord Warner said PBC clusters should look at other ways of negotiating contracts by cost and volume rather than individual tariff.
He pointed to the most recent DoH guidance on indicative ‘un-bundled’ tariffs for rehabilitation and diagnostics, under which local negotiators can decide their own price for primary care provision of these services using the unbundled tariff as an indicator but not a set price.
NAPC president Dr Peter Smith welcomed his words ‘encouraging us to start fiddling with tariffs locally’ and urged GPs to look at volume-based contracts.
Both Lord Warner and Mr Ricketts emphasised the importance that the DoH would place on PBC in the coming year.