Intended for healthcare professionals


What will the white paper mean for GPs?

BMJ 2010; 341 doi: (Published 23 July 2010) Cite this as: BMJ 2010;341:c3985
  1. Martin Roland, general practitioner1, professor of health services research2
  1. 1Nuffield Road Medical Centre, Cambridge CB4 1GL
  2. 2University of Cambridge, Cambridge CB2 1TN
  1. mr108{at}

    The NHS needs GP leaders who are driven more by patient centred values than by government targets

    The history of primary care led commissioning in the NHS is not encouraging. GPs took slowly to the introduction of fundholding in 1991. A few enthusiasts improved care for their patients, but overall, the effect was modest.1 Inequalities in care increased2 3 and GPs were not strategic in their purchasing decisions. The limited initial scope of fundholding was extended in 1995 under a scheme called “total purchasing”, but that model didn’t really get going before it was abolished by the incoming Labour government in 1998.4 Primary care trusts proved to be risk averse, bureaucratic, and ineffective commissioners, which led the government to revert to giving GPs notional budgets under “practice based commissioning” in 2004.5 The effects were again patchy, with GPs slow to get involved and with mixed levels of enthusiasm. By 2009, substantial numbers were engaged and starting to show some success in improving services.6 Despite that, practice based commissioning was described by the government’s own primary care tsar as “a corpse not fit for resuscitation”.7

    And yet the idea persists that GPs hold the key to effective purchasing of high quality care. Now the incoming government …

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