Row over ‘tariff' for primary care

GPs and district nurses are set for a row over whether a Payment by Results-style tariff should be introduced to primary care in 2008.

GPs oppose the DoH plan because it would close the loophole that allows practices to make savings of up to £250,000 a year under practice-based commissioning (PBC) by undercutting the hospital tariff on services (GP, 15 September).  

However, district nurses are keen because individual prices on areas such as health visitor or district nurse visits would be helpful for nurses setting up social enterprise schemes.  

But they are concerned that it would help independent or private companies benchmark costs.  

GPs feel a primary care tariff would introduce unwelcome complexity to their work.  

GPC chairman Dr Hamish Meldrum said: ‘We were not aware that a group had been set up to look at this. If that is the case, we would expect to be involved.’  

GPs point out that introducing a tariff would actually mean increasing the cost of some treatments, which was ‘absurd’ and ‘incomprehensible’.  

They share district nurses’ fears that a tariff would encourage private involvement by introducing a level playing field.   

Lynn Young, primary care adviser to the Royal College of Nursing (RCN), confirmed that work had started on the tariff, although admittedly in an ‘embryonic’ form.  

‘There is a group of people who have met a couple of times to work out how this can be done. It is a devilish business, though. It is extremely complex and we need to have it absolutely right,’ she said.  

She said the RCN’s intention was to complete the work by 2008.  

Ms Young said Payment by Results was now the economic policy of the NHS, but it was difficult while the whole area of community services was, as yet, uncosted.  

Lucy Botting, chairwoman of the RCN’s district nurse forum, said the move was welcome but that more clarity was needed as some PCTs had already started trying to do work themselves.  

‘We know the DoH is working on unbundling tariffs, such as those around post-operative care,’ she said. ‘We know that some PCTs have already started attempting to cost community services themselves. It would be nice to know exactly what the DoH is going to produce on this.’  

A tariff for primary care?

FOR: District nurses - It would enable nurses to set up social enterprises.  

AGAINST: GPs -  It would stop GPs undercutting hospitals via PBC. 

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