Intended for healthcare professionals


Tories will put GPs in charge of commissioning services for patients

BMJ 2010; 340 doi: (Published 11 March 2010) Cite this as: BMJ 2010;340:c1428
  1. Deborah Cohen
  1. 1BMJ

    GPs will hold the personal budgets of patients and commission services on their behalf under Conservative health plans in their draft election manifesto.

    Speaking at the King’s Fund shadow health minister, Stephen O’Brien, said that GPs will be given the power to hold real cash budgets with which to commission care and their pay will be linked to the quality of the results they deliver. They will need to be trained to commission services when that responsibility is passed to them, he said.

    The proposal is part of Tory plans to make the NHS more “locally driven” and “patient centred” giving people more responsibility over their health. Part of this move would mean that clinical need would determine funding flows.

    “Politically motivated” process targets would be scrapped in favour of health outcomes that measure the whole care pathway, although Mr O’Brien did not specify exactly which targets would be removed or whether the party will continue to monitor waiting times.

    Under Tory plans public health spending would be “ring fenced,” and it would be given increased priority in the newly named “Department of Public Health.”

    “Rather than focus funding for authorities on deprivation indices, public health directors would be able to bid for money based on burdens of disease,” said Mr O’Brien.

    Research funding too would be commensurate with demographic projections, so if a disease affected a large population that area would attract greater funding. NICE would also have a statutory requirement to take into account the wider societal cost of an intervention.

    Mr O’Brien also said that he wanted to persuade the Royal Colleges that doctors should be able to spend six months after qualification in a developing country where they “would do nothing but public health.” But, he conceded that there may be problems for re-entry into the NHS.

    Jonathan Nicholls, research director of Health and NHS of pollsters MORI, said that the NHS has dropped down the public’s list of concerns partly because satisfaction with the NHS is at an all time high—although there are concerns about public health. “People think that money should be invested in preventative care,” Mr Nicholls said. “People are becoming increasingly intolerant of funding people’s bad habits.”

    Unlike the Liberal Democrats, the impact of the financial crisis did not play a part in Tory health plans. Mr Nicholls also said that over 80% of those polled want to protect the NHS from cuts—more than any other service.

    Mr O’Brien said the Tories would “protect” health spending in real terms beyond 2011 and provide an NHS that was free at the point of use and not based on the ability to pay.

    However, despite recent campaigns to keep the market out of the NHS and the government’s switch to making the NHS the preferred provider, he said that the Tories “will use any willing provider as long as they provide NHS quality at tariff prices.”

    Sue Slipman, director of the Foundation Trust Network, said that the reform process must continue and politicians should not turn back.

    Although Mr O’Brien pledged to take out some of the “administrative back office” Ms Slipman said it was an “easy assumption” that cutting bureaucracy and management would save money in the long run.

    She also urged “politicians to create the political space” to enable reconfiguration of services in the face of public protests. However, Mr O’Brien recognised that reorganisation carried a risk of demotivation. “It’s also morale sapping for clinical staff and managers and creates uncertainty about jobs,” he said.

    Mr O’Brien conceded that decisions should not be centrally imposed and services should change if there was a local need.


    Cite this as: BMJ 2010;340:c1428

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