The radical changes set out in the NHS White Paper are likely to
undermine the NHS and also lead to a worsening of public health. In
particular, GP consortia commissioning looks like a recipe for disaster
for both patients and GPs.
All general practices will be compulsorily involved in
commissioning(1) but most general practitioners lack the appropriate
management skills, training or experience.(2) It is also questionable
whether it is appropriate and cost-effective to use limited clinician time
this way. Some argue that GPs are well-placed to lead commissioning based
on anecdotal experience with fund-holding and practice-based commissioning
recently. However, the scale of commissioning involved is considerably
greater than what fund-holding entailed and practice-based commissioning
has tended to be arduous and cumbersome due to factionalism and competing
self-interests.(2) Whether GP consortia can operate as effective corporate
organisations is unknown. Furthermore, governance structures and
accountability mechanisms have not been worked out.
More worryingly, relatively inexperienced, ill-equipped and less well
-organized consortia of GPs will be pitched against foundation trusts that
have played the game for longer. It is misleading to assume that “not-for-
profit” foundation trusts are beneficent organisations in public health
terms. The negotiating clout of these often large oligopolies of hospital
providers is substantial. All will strive for financial viability, and
increased hospital activity, irrespective of appropriateness, would
guarantee this. A market-led health system tends to be driven by financial
priorities, not health needs. The financial risks for GP consortia are
also considerable as the government’s has vowed not to bail out failing
consortia.(1) It is conceivable that some GP consortia will run into
financial trouble and end up being taken over by private health companies.
The stage seems set for private organisations to enter more forcefully and
substantially into the health system.
This appears to be a thinly veiled cost-shifting exercise with the
work and costs of commissioning transferring from Primary Care Trusts on
to GP budgets. Some GPs will undoubtedly be champing at the bit to finally
take on fully the commissioning responsibilities. However, health service
management metaphorically is similar to football management: there will be
many who think they can do the job and do it better than the current
incumbent. However, reality is considerably more complex and difficult. In
this case, GPs will not be inheriting asset-rich Chelsea FC, but rather
debt-laden Portsmouth FC. GPs will be expected to do much more, with less,
and the success (and failure) of the scheme will be placed squarely at
their feet.
References
1. Department of Health (2010). Equity and excellence: Liberating the NHS.
London: Department of Health.
2. Curry N, Goodwin N, Naylor C, Robertson R. Practice-based
commissioning: Reinvigorate, replace or abandon. London: The King’s Fund
(2008).
Rapid Response:
The perils of GP Consortia commissioning
Dear Editor
The radical changes set out in the NHS White Paper are likely to
undermine the NHS and also lead to a worsening of public health. In
particular, GP consortia commissioning looks like a recipe for disaster
for both patients and GPs.
All general practices will be compulsorily involved in
commissioning(1) but most general practitioners lack the appropriate
management skills, training or experience.(2) It is also questionable
whether it is appropriate and cost-effective to use limited clinician time
this way. Some argue that GPs are well-placed to lead commissioning based
on anecdotal experience with fund-holding and practice-based commissioning
recently. However, the scale of commissioning involved is considerably
greater than what fund-holding entailed and practice-based commissioning
has tended to be arduous and cumbersome due to factionalism and competing
self-interests.(2) Whether GP consortia can operate as effective corporate
organisations is unknown. Furthermore, governance structures and
accountability mechanisms have not been worked out.
More worryingly, relatively inexperienced, ill-equipped and less well
-organized consortia of GPs will be pitched against foundation trusts that
have played the game for longer. It is misleading to assume that “not-for-
profit” foundation trusts are beneficent organisations in public health
terms. The negotiating clout of these often large oligopolies of hospital
providers is substantial. All will strive for financial viability, and
increased hospital activity, irrespective of appropriateness, would
guarantee this. A market-led health system tends to be driven by financial
priorities, not health needs. The financial risks for GP consortia are
also considerable as the government’s has vowed not to bail out failing
consortia.(1) It is conceivable that some GP consortia will run into
financial trouble and end up being taken over by private health companies.
The stage seems set for private organisations to enter more forcefully and
substantially into the health system.
This appears to be a thinly veiled cost-shifting exercise with the
work and costs of commissioning transferring from Primary Care Trusts on
to GP budgets. Some GPs will undoubtedly be champing at the bit to finally
take on fully the commissioning responsibilities. However, health service
management metaphorically is similar to football management: there will be
many who think they can do the job and do it better than the current
incumbent. However, reality is considerably more complex and difficult. In
this case, GPs will not be inheriting asset-rich Chelsea FC, but rather
debt-laden Portsmouth FC. GPs will be expected to do much more, with less,
and the success (and failure) of the scheme will be placed squarely at
their feet.
References
1. Department of Health (2010). Equity and excellence: Liberating the NHS.
London: Department of Health.
2. Curry N, Goodwin N, Naylor C, Robertson R. Practice-based
commissioning: Reinvigorate, replace or abandon. London: The King’s Fund
(2008).
Competing interests:
None declared
Competing interests: No competing interests