Government urged to slow pace of NHS reforms
pharmafile | April 4, 2011 | News story | Sales and Marketing | GP consortia, Liberating the NHS, NHS reform
The Government should slow down its health reform programme to allow GPs to grow into their new role, the think tank Policy Exchange says.
Its new report, ‘Implementing GP Commissioning’, published today, suggests that plans to abolish every Primary Care Trust by 2013 could lead to the new structure replicating the existing system in all but name. The report says that by slowing reform, would create ‘enormous’ potential to produce real and lasting transformation in the NHS.
The research is based on interviews with the GP leaders or managers of 16 ‘pathfinder’ consortia and with other experts. It looks at different ways in which consortia could work, and the factors which they and the Government will need to focus to make the policy a success. The study finds that the Government has lost many potential supporters inside and outside the NHS. The report concludes that this is because they have pressed ahead with handing more responsibility to GPs without gaining their support for the policy.
The study also stressed the need to ensure GPs have the right skills to run such highly-complex operations before the transition to GP commissioning takes places.
Eve Norridge, lead author of the report, said: “In recent years, GP commissioning has in principle received widespread support from politicians of all parties and across the NHS. There are many GPs who have the potential to become highly successful commissioners. It would be a loss to everyone, especially patients, if the policy were discredited due to overly hasty implementation.”
She added that ministers need to address GPs’ concerns before burdening them with responsibility for the health service.
“The danger is that GPs take part so reluctantly in the new scheme that it ends up replicating the existing model rather than becoming the new and innovative system the Government desires.”
The evidence gathered from the interviews and case studies in the report has highlighted key areas which the government and GPs will need to focus on if new GP consortia are to achieve their full potential:
1. Not abolishing Primary Care Trusts too quickly. PCTs are struggling to deal with the transition because good staff are increasingly leaving, knowing their organisations are set to be abolished in two years time. The subsequent loss of expertise is creating a vacuum that is deterring many GPs from trying new and innovative ideas under the new system.
2. An end to micromanagement. Many GPs are worried about the size of the new Commissioning Board and whether a culture of bureaucracy is really ending. The rapid pace of change and the lack of enthusiasm from the NHS also means that many consortia are not being given the space to develop as they want to. The research found that some had been pushed into large groups against their will. Others are facing pressure to employ ex-PCT staff, regardless of whether they are the best people for the job.
3. Bringing commissioning decisions much closer to patients. This is one of the key aims of the policy but it is under threat. GP consortia need to be much smaller than existing PCTs. Current projections for the size of GP consortia mean that commissioning could be no closer to patients than it was in 2002.
4. Establishing quickly how private firms and the NHS will work together. The report says the Government has provided little clarification about the framework and terms under which private providers might operate. It warns that if the Department of Health does not engage with private suppliers soon, companies might leave the UK market. One provider, Humana, has already ruled itself out, saying it envisaged no opportunities arising from the reforms. One danger is that if providers of specialist support services for conditions like cancer are not assisted to work in the new system then their skills and help could be lost.
5. Trust in the new system. It is crucial that patients have absolute trust in GPs if the new system is going to work. Consortia and their GPs should have to declare any hospitality or gifts they receive from providers of NHS care. The regulator will need to ensure that information is widely available to mitigate against the conflict of interests between GPs’ roles as providers and commissioners of services.
The need to take time to get GP commissioning right is supported by evidence from Cumbria where, since 2006, a similar system has been slowly established under Labour’s Practice-Based Commissioning Programme. It is also backed up by the experience of promising GP ‘pathfinder’ consortia. Kingston Consortium member, Dr Charles Alessi, believes taking time to ensure all local doctors backed the plans was crucial for his group.
Dr Alessi said, “There are GP consortia – like ours in Kingston – which are enthusiastically pushing ahead with this policy to transform patient care. If we work hard, I believe we can create a system that is new, innovative and improves the care our patients receive.”
“We have made winning the support of local GPs our first priority. This has been time-consuming and labour intensive but we think it is a fundamental foundation for the consortium’s success. Emerging consortia are all at different stages of development. While some will be ready to take on commissioning responsibilities by 2013, others may need more time to get the groundwork right. The pace of change needs to suit the local circumstances. ”
“We must make the best of this opportunity to transform the care of our patients and deliver the care we all aspire to. The biggest danger of implementing a ‘one size fits all’ approach is we end up with the same system just with different leaders. The future is in distributed leadership where all clinicians have a part to play”.
Report: ‘Implementing GP Commissioning’
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