Editorial: Risks of PBC must not outweigh the benefits

What will practice-based commissioning (PBC) look like under the new Conservative-Liberal Democrat coalition government?

It's an interesting question and one nowhere near answered by the 36-page programme for government published last week. It says only: 'We will strengthen the power of GPs as patients' expert guides through the health system by enabling them to commission care on their behalf.'

The King's Fund asked last week whether this meant the Conservatives' commitment to giving 'hard' budgets to GPs had been ditched.

This week, GP reports on the contents of next month's LMCs agenda. Delegates will vote on whether PBC has been 'an abject failure', has the 'potential to improve healthcare efficiency' or even 'lead to concerns over conflict of interest on which the GPC should consider and report'.

So the LMCs' jury is out and the debate will be fascinating.

Motions for GPs holding more than indicative commissioning budgets are less enthusiastic, with options ranging from 'this should always be voluntary' to 'deplores any connection to a GP's income'.

This week, GP reports on a plan by NHS Cambridgeshire (remember new health secretary Andrew Lansley is MP for South Cambridgeshire) to give GPs 'real' commissioning budgets. GPs can pocket 10 per cent of their savings but should balance this by considering placing a deposit or bond with the PCT to cover overspends.

Last week, a member of the Tory party clinical advisory committee told GP that commissioning responsibility would initially be voluntary. This is welcome.

Given the financial problems the NHS will face, PBC is surely a potential source of 'efficiency savings' that the government so desperately craves. At a time of pay freezes, it is also an incentive for the entrepreneurial GP to improve services and increase income.

'Hard' budgets could also shock PBC into life and PCTs must ensure that the financial risk to GPs, practices and the clusters in which they work do not outweigh the benefits.

What the NHS will be like in the new Con-Dem nation The prospects for increased pay over the next five-year parliament may be bleak but you could just be granted a little more autonomy to get on and do the job you were trained for.

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