By Nick Triggle BBC News health reporter

Langbaurgh is a mix of rural and urban areas

But in one area of northern England they are set to take centre stage by taking control of their own budgets, allowing them to shape the way health services are run.

Langbaurgh Primary Care Trust (PCT), which covers a mixed urban and rural area in east Cleveland encompassing 100,000 residents, is one of the few places in the country to have the majority of their GPs signed up to the government's practice-based commissioning scheme.

Ministers believe that by allowing GPs to take responsibility for their own budgets from PCT managers, the NHS will become more responsive to patient need.

In theory, GPs will, where possible, commission the services locally to stop patients clogging up hospital outpatient waiting lists.

And Langbaurgh GP practices - 15 out of 16 of which are signed up - certainly believe that will happen.

Approach

Dr Steven Kane-ToddHall, who works in a Redcar practice with four other GPs, said: "It will allow us to alter the whole way we deal with patients.

"We refer a huge number of patients to James Cook University Hospital in Middlesbrough - it is a long way away and parking is a real problem.

"Patients tell me they would prefer to be treated within the community, so that is what we will try to do."

Quick guide to practice-based commissioning GPs will be given their own budgets to commission services, taking control from PCTs Practices will be allowed to keep the savings they make to invest in new services, equipment or facilities Ministers believe it will make the NHS more responsive to patients' needs and reduce unnecessary hospital admissions Only a quarter of GPs are expected to take control of budgets from April, although the government wants to see them all on board by 2008

Under the system, GPs can keep the savings they make each year, and Dr Kane-ToddHall said he would like to see this money spent on specialists services.

At the moment Langbaurgh does not have a district general hospital, but it does have specialist GP-led clinics to treat diabetes, substance misuse and muscle and bone problems.

It also has a number of outreach clinics, where consultants from nearby hospitals come to the community to treat patients.

In total, 15% of referrals go to these clinics, but the PCT is hoping that within four years that number will have doubled.

Dr Kane-ToddHall said: "I think we will be looking to develop more specialist and outreach clinics to treat people for specific problems locally. We have a heart failure one on the way, but I would like to see more work being done on obesity and smoking.

"Another area we could invest in is counselling. There is a five-month wait at the moment, but patients say they would rather do that than take drugs so if we make enough savings we could look at this."

Dr Richard Rigby, who works at a practice in Loftus, a rural area in east Cleveland, and helps run the specialist diabetes clinic, agreed there could be an expansion in specialist services.

Savings

But with practices only expected to make a 2% saving in the first year - between �50,000 and �100,000 depending on the size of the surgery - Dr Rigby said the initial developments may be more modest.

"These clinics can take a few years to set up, so, in the short-term, we may see GPs spending money on extra nurses, waiting rooms, maintenance. Things such as these can make a big difference too."

Despite the enthusiasm of Langbaurgh, the scheme has still been dogged by claims practice-based commissioning is a return to GP fund-holding.

Dr Kane-ToddHall wants to see more specialist local services

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

Dr Rigby believes the fears are unfounded, pointing out that none of the area's GPs took part in the fund-holding scheme during the 1990s.

"Fund-holding was seen as leading to inequity. But the NHS is totally different these days, we are much more closely supervised by PCTs."

Another criticism is that the new system encourages GPs not to refer patients to hospital as then the cost of treating them would come out of the practice's budget, even though it may be in the best interests of the patient to see a hospital specialist.

Referrals

John Doherty, the GP who has been the driving force behind getting the area's practices to sign up, does not believe this will happen.

"We will pick up on it if it does. But GPs are not going to do this.

"Already there are huge variations in referral patterns, but I believe this is because doctors are not using local services when they could be.

"The incentive is not not to refer, but to think about what is best for patients."

We have to look at more innovative ways of providing patients with a choice of healthcare providers Jon Chadwick, PCT chief executive

One of the reasons Langbaurgh GPs have been able to make such progress - when nationally only about a quarter of GPs will be on board when the scheme starts in April - is the backing they have received from the PCT.

Despite some PCTs being reluctant to hand over control of budgets, officers at Langbaurgh positively welcomed it.

Strategy director Mark Gibbin said he did not see it as handing over the purse strings.

"It is about partnership working. The PCTs and GPs want the same thing for patients - better, faster treatment."

And PCT chief executive Jon Chadwick also believes it will help Langbaurgh meet other government targets.

"Ministers say we must give patients choice. Well in London that is simple, on one bus route you can pass many of the country's top hospitals.

"That is not possible here. It is quite a rural area and we do not have that sort of provision so we have to look at more innovative ways of providing patients with a choice of healthcare providers.

"This will allow us to offer choices through services such as GP-led specialist clinics."