Labour's GP commissioning policy bribe will sink before it begins

A new 'bribe' to encourage GPs to take up practice-based commissioning will doom the whole policy to failure, according to the leading pressure group for GP commissioning. The National Association for Primary Care said the new nationally set financial incentive will mean PBC will 'sink before it has even got going'.

Under new terms of the general medical services contract, PbC engagement will become a 'direct enhanced service' - like the obligation to see patients within 48 hours.

It means practices will receive 95p per head of population to reimburse them for 'clinical time' spent on planning commissioning for their patient lists. They will also receive a further 95p per head for demonstrating they have reduced the number of patients going into secondary care in locally agreed clinical areas.

The NAPC was very influential in persuading ministers to reconsider giving indicative budgets to practices after Labour ditched GP fundholding in 1997. But this week the organisation slammed the new incentive to encourage GPs to 'engage' with PBC, which is included in new terms for GMS contracts from next financial year, negotiated by NHS Employers and the British Medical Association.

The NAPC says the incentive will set up a 'national standard-based approach' that will undermine the entire aim of the policy. Chair Dr James Kingsland said health minister Lord Warner and his former colleague John Hutton had both promised that there should not be a national standard run through primary care trusts 'because the whole point of this was supposed to be creating drivers to get GPs to adopt an entrepreneurial outlook, encouraging different approaches around the country.'

He said the way the new incentive was being introduced would mean the 'failed' system of PCT-managed commissioning would prevail, and PBC would 'sink'.

He added that he supported a small incentive to practices to kick-start their understanding of the budget and how competitive behaviour can drive up quality, but said if it was used to set up a centrally controlled system, then the whole policy was 'doomed to failure'.

However, NHS Alliance chair Dr Michael Dixon said the £1.90 incentive - which his organisation had recommended - was a necessary sweetener to get some 'very disaffected' GPs on board.

Dr Dixon also welcomed the agreement not to raise the amount GPs can earn per quality and outcomes framework point in line with inflation. 'I think it is quite right to say that after the big pay increases for GPs last year, we will go for that extra pound of flesh. It's perfectly reasonable for the NHS to expect general practice to work for higher standards without extra cash in the QOF this year,' he said.

NHS Employers lead GMS negotiator and Bradford South and West PCT chief executive Barbara Hakin said PCTs should be £300m better off on their GMS budgets in 2006-07 as a result of the QOF freeze.

She said PCTs should be able to save at least £1m each in the next financial year after the two sides agreed to maintain current prices attached to the QOF framework, which financially rewards GPs for achieving defined standards of care and services.

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