GPs forecast major savings through PBC

Tens of thousands of pounds are available for 'easily imitable' schemes under practice-based commissioning (PBC) in England, some GPs are claiming.

Early results of a GP commissioning survey reveal pockets of practice where early adopters of the scheme estimate savings from £20,000-£50,000 for specific schemes.

Dr Tim Morton, a GP in Beccles, Suffolk, expects to save over £30,000 next year performing vasectomies, while a commissioning group in Sidmouth, Devon, hopes to save similar amounts through community nursing initiatives.

Under commissioning rules, at least 70 per cent of that money can then be reinvested into practice services and premises.

Fifteen practices have joined a commissioning group with Dr Morton in Suffolk, and he hopes that through his vasectomy work alone it will save 'a conservative £20,000 but a realistic £30,000 plus'.

'The tariff price of a vasectomy at the hospital is £350, but they also charge for pre- and post-op care, so the total bill can be as much as £700,' he explained. 'We are still negotiating but we are looking at around £250 for an all-in price.'

GPs are able to undercut hospital tariffs because the Payment by Results system used in secondary care does not apply to work done in primary care.

Dr Morton said that vasectomies were a particularly suitable area of care for GPs to offer under PBC because they could do them in their own premises. Once a GP had been trained and bought the equipment, they were quick, easy and cheap to do.

'It's easily imitable and particularly lends itself to those in primary care who like to have a fiddle around with minor injuries,' he added.

Devon GP Dr Ross Dell said that his Sidmouth practice was looking at a 'top 10' list of people most at risk of hospital admissions then applying a traffic-light-style system to them.

Those 'red light' patients most at risk would then receive more visits from community nurses.

'It's some effort to set up and convince the PCT of its worth,' he said but he hoped practices would see some return.

Dr David Jenner, commissioning lead for the NHS Alliance, believes practices could make up to £250,000 in savings a year through schemes (GP, 14 October 2005). He said that central to this was undercutting the hospital tariff, as Dr Morton plans.

'Many GPs don't realise that you can beat the tariff. Being both commissioners and providers must be an advantage,' said Dr Jenner.

GPC deputy chairman Dr Laurence Buckman said that the GPC was beginning to hear of a number of schemes around the country where GPs were estimating similar savings.

'We know of very good schemes in Middlesbrough, Essex, Birmingham and all over,' he said. 'It's not universal but they're definitely out there.'

However, the GP survey results also show wide discrepancies across the country, with a number of GPs unwilling or unable to take part in practice-based commissioning at all.

- Full results in GP next week.

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