More on GP Commissioning

It is clear that GPs are the lynch pin in Lansley's plans. If he cannot persuade GPs to carry out his plans then the de-nationalisation of the NHS will not occur. Lansley is bullish and arrogant, he believes that when he says "jump" everyone will jump. That is a very foolish attitude to take, since GPs have ruined the careers of better Health Secretaries than him.

So today we hear that Lansley has decided that GPs will be paid £9-10 per patient in management fees for performing commissioning. This will not go down well with GPs. I have heard many GPs saying that the red line is a figure of £12 per patient. Healthcare Republic says:

"A £9-10 fee per patient equates to roughly a third of the management budget PCTs currently receive."

Yet again, there is no supporting evidence that high quality (and safe!) commissioning can be performed for a third of what PCTs are paid. Yet again, Lansley has picked a figure out of the air and is making everything fit that figure.

Understandably GPs are not happy. If they are paid a third of what they need to do the work then they will have to find the rest of the money from somewhere else. And that means cutting into their profits.

Lansley is making the work of GPs far more difficult and this will ultimately result in a worse service for patients. Healthcare Republic reports that the changes in the White Paper are making many GPs think that now is the time to take early retirement:

Essex LMCs chairman Dr Brian Balmer predicted a 'bulge' in retirement as GP commissioning reforms in the White Paper take effect. Dr Balmer said: 'there will be a significant number of GPs who say this is not the kind of general practice they want to do and maybe think now is the right time to go.'

Brian Keeling, chairman of Lincolnshire Local Involvement Network, says 'We have a high number of GPs close to retirement and reforms giving a lot of extra responsibilities to them. It doesn’t take a genius to see that people will see it as a good time to move on' 

This is very concerning. Not only does it mean that the numbers of GPs will fall which will have effects on things like the availability of appointments, but it means that the immense wealth of experience will be lost.

And all of this is avoidable.

UPDATE: More on PCT debts

Pulse reports that it is very likely that GP consortia will have to take on some of the debts of the existing PCTs. This seems rather bizarre since you could argue that the debts have not been caused by the GP practices which are part of the consortia, and so why should they shoulder the financial cost.

The Department of Health said last week it could not guarantee a clean financial slate for consortia when power transfers, heightening fears that GPs could inherit hundreds of millions of pounds worth of debt from cash-strapped trusts. Dr Buckman acknowledged that GP consortia may have to accept responsibility for some modest debts, but warned the policy would ‘not get off the ground’ if they are forced to start from ‘a position of very serious debt’.

Perhaps as an indication of the pressure being applied to Dr Buckman by the Department of Health, he makes a statement that is not unlike Rumsfeld's "known unknowns" comment:

He said: ‘There are several kinds of debt. There’s the debt that inevitably occurs as a result of managing patients. We can argue whether it should or should not transfer to the new consortia. I think if it did transfer it's something we would have to manage and cope with. I don’t have a huge problem with that. Where I do have a problem is where for example the body of GPs opposed things and are now having them visited on us, like Darzi centres and PFI schemes, that the vast majority opposed. There is a whole series of things that were brought in by the previous Government that this Government is now reversing, and we’re going to be saddled with that debt too? I don’t think so.’

Well, I am sure that most GPs are saying: debt is debt, if I did not cause it, why should I be responsible for it? Dr Buckman does, however, point out that unless the Department of Health sorts out the issue GPs will refuse to participate. It is a pity that he's already started the negotiations by conceding so much already.