UK: GPs to gain commissioning powers

GP practices are set to be handed responsibility for most health services under ministerial plans for a radical shake-up of the National Health Service in England.

Local trusts and strategic health authorities will be sharply scaled back to make way for their new role, BBC News Online reports.

Health Secretary Andrew Lansley believes GPs are best placed to understand patients’ needs and to decide where money should be spent. But there are concerns GPs may not have the skills or will to take on the role. Others have questioned how they would be held accountable.

The NHS budget currently stands at £100bn a year. About 80% of this is given to local health managers working for 152 primary care trusts, which in turn commission services for their areas. The plans involve setting up groups of practices which would work together in consortia, then buy in management skills, possibly from people doing the same job for existing primary care trusts.

The consortia would take charge of billions of pounds of funds for mental health, hospital and community services.

The White Paper, Equity and excellence: Liberating the NHS, sets these proposals out under the heading ‘Autonomy, accountability and democratic legitimacy’:

The Government’s reforms will empower professionals and providers, giving them more autonomy and, in return, making them more accountable for the results they achieve, accountable to patients through choice and accountable to the public at local level:

-- The forthcoming Health Bill will give the NHS greater freedoms and help prevent political micromanagement.
-- The Government will devolve power and responsibility for commissioning services to the healthcare professionals closest to patients: GPs and their practice teams working in consortia.
-- To strengthen democratic legitimacy at local level, local authorities will promote the joining up of local NHS services, social care and health improvement.
-- We will establish an independent and accountable NHS Commissioning Board. The Board will lead on the achievement of health outcomes, allocate and account for NHS resources, lead on quality improvement and promoting patient involvement and choice. The Board will have an explicit duty to promote equality and tackle inequalities in access to healthcare. We will limit the powers of Ministers over day-to-day NHS decisions.
-- We aim to create the largest social enterprise sector in the world by increasing the freedoms of foundation trusts and giving NHS staff the opportunity to have a greater say in the future of their organisations, including as employee-led social enterprises. All NHS trusts will become or be part of a foundation trust.
-- Monitor will become an economic regulator, to promote effective and efficient providers of health and care, to promote competition, regulate prices and safeguard the continuity of services.
-- We will strengthen the role of the Care Quality Commission as an effective quality inspectorate across both health and social care.
-- We will ring-fence the public health budget, allocated to reflect relative population health outcomes, with a new health premium to promote action to reduce health inequalities.

The NHS budget has been protected by the coalition government, and is not subject to the severe cuts of other Whitehall departments, BBC News Online reports. But the health service has been told to save up to £20bn by 2014 to help it cope with the ageing population, rising drug prices and lifestyle changes such as obesity.

The move to having GP consortia controlling spending has long been championed by Mr Lansley - and in recent months the British Medical Association has indicated it is open to working with the government on the idea.

Dr Laurence Buckman, chairman of the BMA’s GPs committee, said: ‘We will have to see the details, but there is certainly a willingness to look at this.’ However, he also warned that the process should not be rushed, as this would risk a loss of focus.

Professor Steve Field, chairman of the Royal College of General Practitioners, said: ‘From what we can glean, the direction of travel is the right one.’

There have been other reports of opposition to the plans amongst GPs, with the website Healthcare Republic reporting: GPs and practice managers split on health White Paper.

NHS shake-up ‘hands funding powers to GPs’ BBC News Online 9 July 2010

Equity and excellence: Liberating the NHS. Department of Health, July 2010.

NHS White Paper 2010 - news and analysis. Healthcare Republic, July 2010.

Q&A: The NHS shake-up. BBC News Online, 15 July 2010