GPs are to get their own budgets from April 2005

The voluntary scheme, set to be introduced in April 2005, will mean family doctors get more of a say on the treatment their patients receive.

Ministers envisage practice-based commissioning will lead to many of the 45m hospital out-patient visits a year being handled by primary care.

But they denied it was a return to the much-criticised GP fund-holding system.

The initiative was abolished in 1998 after accusations the NHS was operating a two-tier system because the patients of GP fund-holders were often able to get treatment more quickly than patients of non fund-holders.

But the government said under the practice-based commissioning scheme, GPs would not get any more money than those not taking part.

Practices will be given an "indicative budget" by their primary care trusts - which control 75% of the NHS budget - to commission services for patients.

Action

Family doctors can use the money to provide the services themselves, commission treatments not provided by their PCT, by either using other trusts or local hospitals, or buy in services from the private sector.

Dr David Colin-Thome, national director of primary care, said an example of this might be a patient with back pain who needed an MRI scan to see if they had slipped a disc.

With increased access to MRI scanners in primary care, the patient could be diagnosed without having to be referred to hospital and the GP could decide what action to take from there.

Like any complex change, it would benefit from more discussion with those responsible for implementation Nigel Edwards, NHS Confederation

Dr Colin-Thome said at the moment patients were often made to attend hospital out-patient appointments which were unnecessary.

Health Minister John Hutton claimed the new system could lead to savings, meaning extra money was left for expanding and providing services for patients.

"There are 45 million out-patient appointments a year, with two-thirds of these follow-up appointments.

"These are much more likely to be done in primary care.

"A lot of follow up appointments don't need to be done by specialists in hospital."

'Re-ignite'

The system has already been used by several PCTs with great success, according to the Department of Health.

NHS Alliance chairman Dr Michael Dixon said the plan had the potential to "re-ignite the enthusiasm of front-line GPs".

He added: "It will support and strengthen PCT commissioning by making it more sensitive to individual patients and the decisions they make with their frontline clinicians."

Dr Hamish Meldrum, chairman of the British Medical Association's GPs committee, said the scheme had potential.

But he said he was concerned by the lack of "clear national guidelines".

"If it is to be successful, this scheme must ensure both equity of access and quality of service for all patients and fair rewards for the practices that will take responsibility for managing these complex processes."

But Nigel Edwards, director of policy at the NHS Confederation, which represents health service managers, said: "Like any complex change, it would benefit from more discussion with those responsible for implementation.

"In particular, we need to incorporate the lessons of previous experiments in practice-led commissioning, which have proved to be all incentive and no sanction - practices that under-spend can keep the surplus, whereas those who over-spend are allowed to rely on PCTs to pick up the tab. "

And Dr Maureen Baker, honorary treasurer of the Royal College of GPs, said: "This is something that will allow GP practices to provide better care for patients and that is something that must be welcomed.

"Obviously, though, such initiatives need to be adequately resourced."

Political reaction

Shadow Health Secretary Andrew Lansley said: "This is yet another example of the Conservatives leading the debate in healthcare.

"We have consistently argued that GPs should have greater responsibility for their budgets."

Paul Burstow, for the Liberal Democrats, said nureses, therapists and pharmacists should be involved in commissioning.

He said: "If this initiative is to succeed it must go beyond the GP and involve the whole primary care team so that the expertise of nurses, therapists and pharmacists are also harnessed."

"This initiative has the potential to put patients in the driving seat, but it is essential that this does not mean the patients of some GPs get a better deal than others."