Best GPs will outperform PCTs, says PCT leader
pharmafile | July 15, 2010 | News story | Sales and Marketing | NHS, commissioning
The leader of the PCT managers’ organisation David Stout and Mark Britnell, the architect of the former Labour government’s commissioning strategy, have both declared their support for the new radical health service reforms.
New health secretary Andrew Lansley recently unveiled plans to scrap England’s PCT and SHA management structure. In their place, consortia of GP practices will take control of 80% of NHS budgets and will be responsible for commissioning and improving services for patients.
The plans are far more radical than expected, and have been severely criticised from some quarters – critics saying the service can ill afford another major reorganisation. But many leaders in the field are accepting the new reality, and are urging others to seize the initiative.
David Stout, director of the NHS Confederation’s PCT Network said he welcomed Lansley’s plans – perhaps surprising as PCT managers who make up the network’s membership are now facing redundancy once PCTs are abolished by April 2013.
Speaking at the Westminster Health Forum on World Class Commissioning in London, Stout took a pragmatic approach. Asked whether he believed the plans would succeed he replied:
“Will it work? Well I am an optimist, but we will have to make it work, whether you think it will or not, whether you are a manager or a supporter of the NHS.”
Stout did defend the achievements of PCTs. Invoking a comparison with the recent World Cup final between the Netherlands and the eventual winners Spain, Stout said: “PCTs should not be seen as the Dutch and GPs as the Spanish – it’s not as simple as that,” saying progress made by PCTs should not be lost in the change over.
Nevertheless, Stout indicated that he agreed with the widely held belief that PCTs had not improved services fast enough, and said leading primary care doctors could achieve more.
“The best GPs will be better than the best PCTs,” he said. However he expressed doubts that excellence could be achieved consistently.
“The question is how you move everybody up that [quality] ladder,” he added.
Stout warned that the track record of GP practices working across larger networks was ‘not particularly strong’ and said a huge collaborative effort would be needed.
500 mini-PCTs would be ‘a disaster’
Among the other speakers was Mark Britnell, partner and head of the UK and Europe health division of management consultants KPMG.
A former leading NHS reformer, Britnell was the architect of the existing NHS ‘World Class Commissioning’ (WCC) strategy which he created at the Department of Health between 2007 and 2009.
Britnell declared his wholehearted support for the plans and ‘clinical commissioning’ and said his own WCC model had only stopped short of giving GPs financial control because of political concerns.
Characterising the plans as “a very important piece of disruptive innovation,” he said the new environment provided a chance for existing commissioning experts to provide answers.
Addressing existing PCT and health service managers he said: “Take the opportunity to re-invent what you do.”
He added the people who had been characterised as ‘bureaucrats’ would now have to fight for their role in the new health service.
“I do think the entrepreneurs in the NHS should start thinking more hopefully about their future, and seize that future before [options] are closed down.”
The government has refused to predict how many GP consortia will be formed across England, but many observers are predicting as many as 500 will be created.
Britnell warned that this anticipated number and relatively small scale of GP consortia meant they could not – and should not – consider mimicking existing PCTs.
“Two years ago I concluded that not every one of the 152 PCTs could be world class in their commissioning – so it’s certainly not going to be possible for 500 GP consortia.”
He warned: “500 mini-me’s trying to commission would be a disaster.”
Instead Britnell envisages GP consortia outsourcing much of the detailed commissioning work to third parties – be it NHS bodies, the private sector, social enterprise or (preferably) partnerships between these groups.
He advocated the setting up of Integrated Care Organisations, to co-ordinate health and social care together in local areas.
Are GPs willing to take on the challenge?
Dr Paul Charlson, a GP and member of the steering committee of Doctors for Reform also welcomed the reforms, but warned of the challenges ahead. He said not all GPs were alike, with some eager to get involved in commissioning and innovation, while others were absolutely not motivated to participate.
He said most of those GPs willing to lead were already engaged through the existing Practice Based Commissioning (PBC) and other initiatives.
Many GPs were underused, he said, still treating a huge casebook of relatively minor ailments which could be dealt with by other healthcare professionals.
Dr Charlson said he believed the reforms were about freeing up GPs to take on the more challenging clinical cases, reducing unnecessary referrals to secondary care while leaving the most complex cases to consultants.
He also warned that the demographic of GPs had changed immensely since the days of GP fundholding, a similar system introduced by a previous Conservative government in the 1990s. At that time, most GPs were independent contractors to the NHS, but today a growing proportion are salaried GPs “who simply aren’t going to be interested in commissioning”, he said.
He dismissed as ‘farcical’ the notion that GPs could not simultaneously provide and commission services, but agreed that safeguards against potential conflicts of interest needed to be addressed. Concerns about conflict of interest was one of the main reasons behind the Labour government abolishing fundholding in 1998.
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