Confusion and apathy reign as GP commissioning nears
pharmafile | March 15, 2005 | News story | |Â Â Â
Practice based commissioning, the latest radical reform which will re-shape the way the NHS treats patients is just days away from its official launch but remains shrouded in confusion and GP discontent.
The scheme comes into existence on 1 April and will give GPs and primary care professionals the power to commission services, and is intended to motivate them to create improved, patient-centred services.
As such, the initiative should be one of the most popular reforms introduced in recent years, but GPs and their leaders are protesting about what they say is inadequate Department of Health planning and worst still, politically-inspired manipulation.
A recent survey found just one in five practices plan to join the scheme in its first year and the majority – 55% – do not plan to take part at all.
Despite this, Dr Michael Dixon, chairman of the NHS Alliance, said practice based commissioning is likely to spell good news for pharmaceutical companies, as it will grant GPs the option of freeing up funds for pharmaceuticals.
"It means we have the means of releasing money into the system for pharmaceutical products. If for example GPs are able to reduce the use of diagnostic care then it will free up funds for pharmaceutical products, which is a mechanism we have not had in the past," he said.
GPs will also be more involved in the decision about what sort of drugs are prescribed in hospitals and Dr Dixon predicted this could mean more money in the system to pay for drug treatment.
But Dixon is concerned that a number of concurrent reforms will hamper the introduction of PBC.
In particular, he says the new Payment by Results system may not see cash flow from secondary to primary care to support the new commissioning centres.
"Our concern is how we loosen the system to allow PBC to innovate and change," adding that current financial restrictions could be an obstacle.
"If we rely on practices just to have a budget for one or two items, I think we are missing a trick and this would be a minimalist interpretation of PBC."
Meanwhile, Choose and Book, the electronic system allowing patients to choose between four or five providers to carry out their operation is also a cause for concern.
Patients will be able to choose between local NHS hospitals and privately run treatment centres, and the initiative is a centrepiece in the government's vision of patient choice supported by a competition-based mix of private and NHS providers.
Determined to ensure fast uptake of the Choose and Book scheme, the government has made it a mandatory component of PBC – a move which has angered doctors' leaders, who already had serious reservations about the new choice system.
A report by the independent watchdog the National Audit Office has confirmed doctors' fears that the system faces technical and organisational obstacles when its first phase is introduced in June this year.
Dr Dixon is scathing about the government's approach, saying: "Concerns about the Choose and Book system cannot be dismissed as a mere matter of engaging GPs, as if doctors are nothing more than travel agents who have to be told more about the latest fashionable destination."
He said that the scheme would generate a huge new workload for GPs, who would now be faced with either following Department of Health instructions or looking after the needs of patients.
"Patients want to make informed choices about treatment, understand the possible side-effects, consider alternatives to surgery or drugs, think about the impact on their personal lifestyle and much more.
"Choice of provider is just one of a group of issues. It is more relevant to the fit, young or middle-aged patient with a short-term acute illness than for the elderly and those with long-term conditions who make up the majority of patients that GPs see in their surgeries."
He concluded: "If GPs are to be convinced it is in the patients' interests to operate the Choose and Book system, these are the issues that must be addressed."
Even without the complicating factor of Choose and Book, the NHS Alliance and BMA said plans for practice based commissioning were riddled with errors and unanswered questions, particularly in relation to finance.
Hamish Meldrum, chairman of the BMA GP committee (GPC) commented: "GP practices interested in taking on practice based commissioning will need to know how these local budgetary decisions will be made, how to work out 'reasonable' management costs and how you can be sure that data for monitoring practice based commissioning will be accurate."
There are many other vital areas where GPs have been left in the dark.The new system will be introduced just one year on from the most fundamental overhaul of GP practices in years, the new GMS contract, and the administrative burden of yet more reform is another reason for its unpopularity.
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