04 February 2005
GPs will refuse to take up practice-led commissioning because the payment by results system is riddled with errors and there is no means of rectifying mistakes, primary care representatives are warning.
The NHS Alliance, which speaks for primary care trusts and providers, said these fundamental reforms to the health service were under threat because they were badly designed.
Its chair, Dr Michael Dixon, told Public Finance that research by the alliance into the early operation of PBR and GP commissioning found substantial problems.
Dixon said: 'At the moment we just don't think the system is fit for purpose, partly because the treatment categories are too broad and partly because foundations are putting in bills and they are going through on the nod.'
The alliance is demanding that payment is in future linked to patient discharge letters, which are frequently sent late or not at all. According to Dixon, this failure has been 'a running sore' between NHS trusts and GPs.
The alliance wants the letters, which are meant to detail tests and treatments given to patients and future care requirements, to act as an invoice. Trusts would not be able to demand payments from GPs until they had been sent.
The alliance published a study, Caveat emptor – Buyer beware, on February 3. Its findings suggest that the reforms, still in their infancy but central to the government's NHS modernisation plans, are already failing.
The three-month study monitored all the payments going to an anonymous foundation trust from one GP surgery.
It found that the coding system being used for PBR, which so far has been implemented only by foundation trusts, is not detailed enough to reflect accurately the costs of patients' treatments.
PBR groups procedures and diagnoses into broad categories, which each have a tariff attached. The alliance found that conditions requiring routine treatment could cost more than complex conditions because they fall in a category with a higher tariff.
At the same time, the alliance said there was no straightforward way for GPs to question charges or verify that patients have received the treatment listed on bills.
'GPs are unlikely to enter or remain in a system that is unable to reflect the costs relating to individual patient care, and where payments cannot be effectively challenged,' Dixon said.
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