Practice-based commissioning faces trials, amid PCT concern

Guidance for practice-based commissioning is to be 'road-tested' by primary care trusts and practices to ensure that it does not push change too far too fast.

The guidance, issued on Tuesday and revealed by HSJ last week (news, page 3, 30 September), has been officially downgraded by the Department of Health to 'latest thinking' following expressions of concern by some in primary care. Views will be sought from the service over the next few weeks.

But the guidance will give all GP practices the right to insist on holding their own indicative budgets from April next year, and the right to keep half of any savings they make.

Some PCTs had expressed concern that while practices stood to gain financially from the system, the risk rested with the PCT, which would have to meet any overspends. However, a safety net for PCTs included in the guidance will remove a practice's automatic right to hold its own indicative budget if it fails to balance its budget over a three-year period.

Reaction from PCT chief executives to the guidance varied wildly.

One PCT chief executive described it as 'insane', arguing that none of its practices had expressed any interest in holding their own budgets, and pointing out that many smaller or singlehanded practices would lack the sophistication to do so.

Other chief executives argued that while PCTs would have to manage the shift closely, to avoid the danger of the quality of care fluctuating by practice, front-line commissioning would improve effectiveness.