Huge challenge ahead for GP groups to take charge of budgets for patient care

12 July 2010

Commenting in response to today’s publication of the Coalition Government’s health White Paper, Equity and Excellence: Liberating the NHS, Nuffield Trust Director Dr Jennifer Dixon said:

‘Handing GPs real budgets for commissioning care on behalf of their local communities has real potential to help shift care out of hospitals and reverse the upward trend in avoidable hospital admissions. But the scale of the challenge is huge. Previous similar reforms have not motivated enough GPs to manage budgets – to date GPs have been far more interested in providing primary care than buying hospital care.

‘At present we don’t know how general practitioners manage their finances or provide value for money. It is risky to hand over £70 billion of taxpayers’ money to around 8,000 general practices. GP commissioning consortia will need huge investments in their management if they are to transform themselves from convenience stores into the Tescos of the health service – delivering and commissioning, at scale, high quality care for patients and challenging large hospitals. The details of how GP commissioning consortia will be held to account for the use of those budgets, and how their performance as commissioners will be assessed and managed are still to be developed.’

Dr Dixon added: ‘The White Paper signals a shift in emphasis in the NHS away from central grip, and relies instead on patient choice, competition and commissioning to improve performance for patients. The broad aims – to cut bureaucracy and give more space to hospitals and general practitioners to innovate – are the right ones. But it is risky now to reduce central grip given the urgent need to make efficiencies in today’s economic climate.

‘It is particularly risky to rely on competition and choice which are so under-developed, and to scrap the main means of enforcing waiting times targets. Waiting is an iconic issue in the NHS – it is not simply a ‘process measure’ but represents avoidable ill health for each individual waiting. Every effort should be made to minimise it.’

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