GP practices are to become actively involved in the commissioning of patient care and the control of budgets under new government plans.

The proposals for practice-based commissioning have been seen by commentators as a return to the last Conservative government’s policy of GP fundholding. This was scrapped in 1997 by Labour (who disapproved of competition within the NHS).

The new proposals could lead to many hospital outpatient visits being handled by primary care, meaning that more patients would be able to be treated locally, without being referred to a hospital. From next April, practices will receive an indicative budget from their PCTs to improve the delivery of services — PCTs will remain legally responsible for the contracting process.

GPs would then be allowed to keep up to 50 per cent of any savings they make by managing referrals more efficiently (ie, sending fewer patients for hospital care).

Health minister John Hutton denied that the new plans would create a two-tier healthcare system, as GPs would not get any more money than those not taking part in the new plans. In announcing the proposals, Mr Hutton said:

‘This will enable GP practices and other groups to play a bigger role in commissioning services for their patients and local populations. It will mean greater flexibility for GPs to deliver services tailored to their patients’ needs.

‘PCTs and practices should see practice-led commissioning as an opportunity to change the NHS from the bottom-up. Money freed through practice-led commissioning will be ploughed back into the delivery of patient services, therefore increasing investment in primary care.’

Some GP practices are already involved in practice-led commissioning. North Bradford PCT began such a project four years ago, whereby all secondary care is included in the scheme. Dr Ian Rutter, a GP in Bradford, said:

‘Our experience of offering practice-led commissioning has been immensely positive. It has achieved greater involvement of clinicians and practices with their patients in decisions about care. We have been able to deliver improved quality and better use of resources by empowering primary care to manage secondary care budgets.’

The NHS Alliance is particularly keen on the new arrangements. Dr Michael Dixon, alliance chairman commented:

‘Practice-led commissioning has the potential to re-ignite the enthusiasm of frontline GPs and practices who want to have a greater say in improving the range and quality of services available to their patients. It will support and strengthen PCT commissioning by making it more sensitive to individual patients and the decisions they make with their frontline clinicians.’

However, Dr Dixon warned that ‘practices and PCTs must have the freedom to develop the scheme in the way that suits each locality best, rather than being hide-bound by over-zealous performance management or national targets.’

The next stage is for tests to be undertaken (‘over the next few weeks’) to judge the effectiveness of the proposals. If workable, practice-based commissioning will be available to any GP practice. It will also be open to groups of professionals, such as community-based nursing teams.

The Scottish Health Minister Malcolm Chisholm, has left the Health Department to become Communities Minister for Scotland. He is replaced by Andy Kerr, the ex-Finance and Public Services Minister. Born in 1962, Mr Kerr was educated at Claremont High School in East Kilbride and obtained BA Social Sciences at Glasgow College. Since entering the Scottish Parliament as MSP for East Kilbride in 1999, he has acted as convener of the Scottish Parliament's transport and environment committee and served on the Confederation of British Industry (CBI) working group and on the cross-party group on ageing and the elderly.

Mr Chisholm’s deputy, Tom McCabe has also left the Health Department to be appointed Minister for Finance and Public Service Reform. Rhona Brankin (who has served in the ministries for culture and sport and environmental and rural development) takes over.

GPs and PCTs have come together to identify best practice and explore new ways of working together in a new publication.

PCTs and LMCs* working together is a 41-page document published by the national primary and care trust development programme (NatPaCT).

It states that a good working relationship is vital if the benefits of the new primary care contracts are to be realised. Much of what it identifies is already happening on a daily basis across the country, but where this is not the case, working examples are given.

*General practitioners make decisions collectively concerning their working relationship with the NHS through the local medical committee (LMC).

This year’s campaign to promote flu jabs is targeting people with chronic health conditions. Traditionally, the emphasis is on covering the over-65 population, of which 70 per cent was immunised last year.

Sir Liam Donaldson, chief medical officer said:

‘If you suffer from a chronic illness like asthma or diabetes, or are 65 years or older, you are particularly at risk from flu. This means that if you do catch flu, it is more likely to lead on to a more serious illness. The flu jab is the most effective protection from the flu. That’s why our message for this year’s campaign is “If you knew about flu, you’d get the jab.”’

Anyone who falls into one of the above categories can contact their GP for the flu jab, which is free of charge. Manchester United footballer, Paul Scholes is helping by fronting the campaign. As an asthma sufferer he says that he will be getting the flu jab later this year.

Between 10 and 15 per cent of the population are believed to develop flu each year.

The national programme for IT has delivered a new software system to reward doctors for good patient care.

The web-based tool, quality management and analysis system (QMAS), will give feedback on quality of care to 9,000 GP practices across 303 PCTs.

QMAS is needed because under the new general medical services contract (nGMS), which was introduced in April, GP practices are paid more for delivering high quality care.

A drop in Welsh prescription charges has made many fear a stampede of 'health tourists' coming across the border from England.

NHS Wales has taken another step towards free prescription medicine in 2007. Prescriptions in the principality, which are already free to the under-25s, now cost just £5. The charge has been frozen at £6 since 2001.

In England, however, patients must pay £6.40 to pick up their medicines. It is feared that people eager to save £1.40 will come across the border, as there are no measures yet to stop a prescription written in England from being picked up from a Welsh pharmacist.

However, Health Minister Jane Hutt said that by 2007, arrangements will be in place to stop this: 'Those people who will benefit from free prescriptions are those whose medicines are prescribed by a prescriber contracted to a Welsh local health board, on a Welsh prescription form and dispensed by a Welsh pharmacist.'

Dr Andrew Dearden, chairman of the Welsh GP Committee, told Pharmaceutical Marketing magazine of his fears that patients would seek prescriptions for over the counter medicines. 'If people are coming to their GPs for a prescription for paracetamol, instead of buying it themselves, the consultation rate will rocket.'

Jane Hutt responded saying: 'It is the GP's responsibility to ensure they are prescribing appropriately and the population of Wales will have to be sensible about how they can benefit from the prescription charge reduction.'

The pledge to abolish prescription charges was made in Improving health in Wales — the Welsh NHS Plan.