What a difference a week makes – GPs views on the Health Bill

Dr Shane GordonDr Shane Gordon, GP in Colchester and chief executive of the North East Essex GP Commissioning Group, on the views of GPs on the Health and Social Care Bill.

What a difference a week makes. Or does it?

Just back from a week-n-a-bit’s holiday to see copious smoke arising from the media & Westminster about the health bill.   It will be interesting to see how much this changes what we are already doing.

Several issues appear to be conflated in the general discussion:

  • GP commissioning.  There seems to be general agreement that more involvement of GPs in the commissioning process is important.  I think that the getting ordinary GPs to think about the resource utilisation of the whole population is the “golden nugget” in the reforms.  The question for me is how to get this?  Just pushing the reset button on PCTs seems doomed to repeat history.  The challenge should not be to get managers to involve GPs more in commissioning (which has failed in many PCTs) but to make GPs, as accountable commissioners, see the value of excellent managers.
  • Specialists in Commissioning:   This is clearly hugely important and it would be wholly unacceptable for GPs to redesign pathways about specific diseases without the inclusion of their specialist colleagues. I know that most consortia are already doing this as well as engaging a range of other clinical colleagues.
  • Competition.  This is a touchstone for much of the dissent. Some potential softening has already been indicated in the hard line market-driven approach initially proposed.  I wonder how necessary further pressure is, given that NHS expenditure through independent sector providers is rising exponentially already.  According to Ernst & Young analysis of DH figures, it has risen from £50m in 2006 to over £400m in 2009-10.
  • Integration of services.  With even Mark Britnell, KMPG champion of the market, agreeing with NHS Confed’s Nigel Edwards on Newsnight that there is strong evidence in favour of integration of health services, perhaps the time is now right to discuss how integration of service provision could be allowed in the new NHS?  I know many GP consortia leads who would be keen explore this option.

Whatever the outcome of this period of reflection, we must not let go of the golden opportunity to get GPs properly engaged in population health.  And we need to keep the momentum going.  Delay equates to doubt in the minds of those who have to make the change work, both clinical and managerial; lack of strong, shared purpose is surely our deadliest enemy in these challenging times.

In Pathfinder Learning Network, Shane Gordon | Tagged , , , , ,

5 Responses to What a difference a week makes – GPs views on the Health Bill

  1. Richard Blogger says:

    ISTCs “According to Ernst & Young analysis of DH figures, it has risen from £50m in 2006 to over £400m in 2009-10.”

    Are these real term figures? Even so, are they significant? According to the House of Commons note SN/SG/724 the cash figures for NHS funding (England) in 2005/06 was £74.4bn and in 2009/10 it was £100.2bn, so you are talking about 0.06% (05/06) rising to 0.4% (09/10). To put these figures in perspective, the Audit Commission reckon that if PCTs reduce their expenditure on low clinical value treatments (tattoo removals, homeopathy etc) they could save £441m. The ISTC spend does not sound much if we are already spending more than that on treatments with no clinical value.

    Without any figures between the two years you mention I cannot determine whether the change is linear or exponential. If it is exponential then after 4 years (13/14) the figure would be £3.2bn (assuming a true exponential growth). Is this what you mean, or were you using hyperbole when presenting these figures?

    • Shane Gordon says:

      Thanks Richard

      The graph shows approximate doubling of independent sector NHS spend each year. This is significant in terms of rate of growth rather than absolute value currently, but if maintained would rapidly become significant in absolute value. Personally, I think £400m is a lot of money anyway!

      BTW – it is independent sector not ISTC spend.



  2. Eric Blaxe says:

    “GP’s as accountable commissioners” Not a good track record to date I would say.

    My experience of GP’s is that they operate as small businesses exploiting a geographic monopoly. They appear to be organised for their own self interest and convenience. The only body to whom they are really accountable are the PCTs who are being abolished – this is truly bizarre!

    The public may, in time, develop some faith in these proposals if GP’s are shown to be more accountable and transparent. I would hope that this is done before, not after, they are handed £80bn of funds to distribute.

    • Shane Gordon says:

      Thanks Eric

      I will not seek to justify the behaviour of all GPs as providers. There is great variability, I agree.

      As GP commissioners we will be accountable both to the NHS Commissioning Board and the local population. We will have to demonstrate good governance and transparent processes to be authorised.



  3. Douglas Smallwood says:

    Great blog Shane – you’re my hero!

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