No guarantees over commissioning cash

GPs will be able to keep at least 70 per cent of any savings under practice-based commissioning, according to DoH guidance.

It is 'likely' that this will be in addition to the money they are entitled to under the recently negotiated directed enhanced service (DES), according to health minister Lord Warner.

But while the latest guidance makes the recommendation that this happens, it leaves a get-out clause enabling PCTs in financial trouble to swallow up savings and avoid DES pay.

Speaking to GP, Lord Warner said that he expected PCTs to offer at least 70 per cent of savings back to GPs but conceded that he would 'start from a position of trust until proved otherwise', with no plans on how to enforce the recommendation.

He added that only six PCTs were in serious financial difficulty, so he did not expect non-payment to be widespread.

GPC deputy chairman Dr Laurence Buckman said: 'I don't think many GPs trust their PCTs to hand over savings and I don't think any will come back.'

'It's understandable that PCT directors will want to keep the savings. We will ask Lord Warner to take a more prescriptive line.'

The guidance also gives a mixed message on the DES that will come into force from April, leaving it to the PCT's discretion.

It says: 'Local incentive schemes may already exist which focus on driving up clinical quality and value for money. The DES is not intended to override any such arrangements and PCTs will consider whether any supplementary resources are required.'

This statement follows confusion over whether GPs could have both DES income and keep savings (GP, 13 January).

Lord Warner said there was still no final agreement on the DES but it was likely that practices would get DES money as well as at least 70 per cent of savings. He said there were no plans as yet on whether the enhanced service would be renewed in 2007.

Dr Mitch Garsin, chairman of Hillingdon LMC, whose PCT faces a £26 million deficit, said he did not know 'how practice-based commissioning can influence NHS spending when there are such huge debts already'.

He added that patient choice meant they had little control over savings anyway.

However, he acknowledged that 'if we don't take up practice-based commissioning we are in even deeper financial trouble'.

The DoH expects all practices to be involved in practice-based commissioning by December. A tool kit to calculate budgets is included with the guidance.

- PCTs recommended to give 70 per cent of savings to practice but they
do not have to give anything back.
- DES resources are at PCT discretion.
- DoH says it is likely that PCTs will offer DES in addition to savings.

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