"The NHS will last as long as there are folk left with the faith to fight for it"
Aneurin Bevan

Friday, 8 January 2010

Conservative Draft Manifesto 2010: Dissection Part 5

An analysis of the Conservative Draft Manifesto 2010.

"we will give GPs the power to hold patients' budgets and commission care on their behalf"

The second part of this phrase "give GPs the power to … commission care on their behalf" is Labour party policy, it is called Practice Based Commissioning.

The "power to hold patient’s budgets" is a return of the GP fundholding scheme that the Conservatives introduced in 1991 and Labour abolished when it came into power in 1997. The problem with that fundholding scheme was that it encouraged GPs not to refer patients. The system was designed to allow GP practices to make a profit, and to keep any surplus from the money they were paid by the NHS. Consequently, there was a financial incentive for GPs not to refer a patient for more specialist care. Simply put, it was found that patients were better off if their GP was a non-fundholding practice.

The Conservative 2009 policy document calls this policy GP budget-holding and commissioning. The description lacks details about how the system will work, and only gives a vague description of what happens with surplus funds: "We will ensure … that [GPs] can hold and vary contracts with healthcare providers, and that they can reinvest any savings they make." It is unclear what the final clause means, but given the Conservative zeal for the profit motive, it is not unreasonable to interpret that clause to mean that the practice use a surplus to make a profit.

This is yet another old, failed Conservative policy that has been dusted down and handed to us as "new thinking".

"we will link GPs' pay to the quality of the results they deliver"

At the moment GPs are paid extra according to the amount of public health responsibilities (vaccinations, monitoring of patients' health, etc) that the GPs take on. This is the right thing to do because it pays GPs for the extra work that they do, and the extra work they do should be according to the need of the community.

The Conservative policy appears to suggest that GPs will be paid according to the outcomes of their care. Of course, the problem with this approach is that it very much depends on the patients, and what "results" are being measured.

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