GP Commissioning

The excellent Roy Lilley from nhsmanagers.net makes the following point in his email newsletter.

In 1998 the New Labour government created Primary Care Groups with the intention to: improve health and address health inequalities in their communities; develop primary and community services; advise on and commissioning, directly, services that met the needs of their patients; develop the highest quality provision and provide value for money within available resources.

These are all the aims of the current Conservative government which they hope to achieve through GP commissioning. But Lilley says that like PCGs GP Commissioning will fail. He says:

"They failed because there were too many of them, too small, too poorly run, cost a fortune in running costs and duplication and were beset with bickering GPs. ... On the face of it, they were a good idea, the PCGs reflected coterminous boundaries and natural communities but they duplicated functions and cost stupid amounts of money. As a result, the planned 'option' for PCGs to mature and work towards a more independent Primary Care Trust status was turned into a 'requirement'. All the 'Groups' were rammed into 'Trusts'.


Trusts were given real budgets, real money and all of the responsibility. They were not ready, not trained and key players, such as GPs, were trying to do 'PCT stuff' whilst they were doing 'doctoring stuff'. As a result, standards and the brand quality were diluted but more importantly, they never really caught their breath. They were unprepared. The natural consequence happened; small, badly run organisations, merged to became bigger, badly run organisations. The rest, as they say, is history."

 In effect, Lilley says that the aspects that are meant to be the most attractive about GP Commissioning (teh "localism" of many small consortia run by GPs) will be the reason why they will fail. This "localism" is something that cannot be afforded at a time of reducing budgets and over time the GP consortia will merge into 150 consortia with very much the same aspects of today's PCT.

The problem, of course, is the matter of the £2bn to £3bn that it is estimated that this experiment will cost.