‘Practice-Based Commissioning (PBC): practical implementation’, published this week, says it is ‘imperative that practices are allowed to use a minimum of 70 per cent of any freed-up resources to reinvest in patient care’.
Variation from this should only happen by agreement between practices and PCTs, it says.
But it adds that in exceptional circumstances SHAs can ask for DoH permission to ‘modify locally the PBC guidance relating to indicative budget setting and the use of freed-up resources’.
The guidance also bans clinicians from taking part in any commissioning decisions on services they have an interest in or association with.
In addition, practices that fail to take on PBC will be ‘challenged’ by their PCTs, health secretary Patricia Hewitt warned at the NHS Alliance conference in Bournemouth last week.
However, in return she pledged to set a time limit for PCTs to set practice budgets.
She said PCTs should support and enable practices that are commissioning, but ‘challenge those who don’t get involved’.
A DoH spokesman subsequently elaborated on Ms Hewitt’s statement on ‘challenging’ practices saying that ‘PCTs would encourage practices — rather than challenge — through dialogue, to get involved more by looking at the benefits to the practice, staff and patients’.
He said: ‘For example, this can be achieved by outlining information about finance and activity; outlining an indicative budget that shows their patients’ share of the PCT budget; and how, through case studies, that could be maximised if patients were engaged more.’
Ms Hewitt’s statement came on the same day that PBC uptake figures slipped behind the DoH’s expectations with only a third of the projected number of practices signing up to the scheme in October 2006 (see graph). The DoH had expected a rise from 82 per cent to 92 per cent practice involvement, but the reality was a rise from 82 per cent to just 85 per cent.
However, a breakdown of the figures shows that practice uptake of PBC incentive payments still varies from zero to 100 per cent in different PCTs. It is the government’s intention that every practice should be involved by the end of this month.
Ms Hewitt also pledged to reform the Payment by Results tariff system for paying hospitals.
East London GP Dr Clare Highton, from Hackney, told the minister hospitals were driving up admissions, while commissioners were trying to control it.
Ms Hewitt said: ‘There are some perverse incentives in Payment by Results. ‘It was seen as a way of driving up secondary care activity when that was a key need.’