GP representatives are advising GPs not to take part in practice based commissioning if they feel that funding for the preparatory management costs such as GP time and data validation are inadequate.
National guidance on management support for practices from the Department of Health was due out last month but has been delayed and GPs are facing a mixture picture on funding from primary care trusts.
The British Medical Association’s General Practitioner Committee has also recommended that practices who do sign practice based commissioning agreements with their PCTs should ensure that a clause is inserted which requires that any agreements on costs will be superceded by the national deal if a better rate is negotiated.
Dr Stewart Drage, one of the GPC’s negotiators and joint chief executive of Londonwide LMCs, said difficulties over management costs were deterring practices from taking part.
He told EHI Primary Care: “The current guidance requires PCTs to make available management resources and its down to potential practice based commissioning projects to agree this allowance. Those bids need to be realistic and PCTs need to be prepared to fund realistic bids.”
Dr Drage said some PCTs were failing to engage GPs in practice based commissioning at all, others wanted to help with management costs but were finding it difficult to find any funding and a third group were providing some funding but not enough.
“If there is under-investment by PCTs practice based commissioning won’t take place in the way it should,” he added.
Dr Drage said data collection and validation were a key part of the management costs involved in practice based commissioning and that no GP would be prepared to fund the NHS out of their own pockets. He said there was also no specific pot of IM&T funding targeted at practice based commissioning.
“We need to be clear about how its being funded and what processes there are.”
Dr Drage said the problem over lack of resources for management costs together with the prospect that practices who take part in practice based commissioning could find themselves burdened with a PCT’s historic debt are keeping practices out of PBC.
The delayed national guidance is due out this month or in December although Dr Drage cast doubts on the timescale.
But he added: “When any guidance is produced it has to address these issues if the government is serious about practice based commissioning.”
The government announced this summer that it wants to see all practices involved in practice-based commissioning by December 2006.