Front-line support 'vital' for new GP consortia

Dr Richard Vautrey, deputy chairman of the GP committee of the British Medical Association, backed the Government's radical shake-up of the health system that will see primary care trusts (PCTs) and strategic health authorities (SHAs) abolished and replaced by hundreds of GP groups which will take control of the spending.

The Leeds GP was confident a clear divide could be established between front-line patient services and financial decisions.

"We hope that GPs are given the necessary support to lead the organisation – it will only work if we are given the right support and the time to make it work.

"The financial climate is very difficult for all concerned and one of the fears for GPs is that they will be the ones making the cuts. It is going to be hard for them to avoid making some tough decisions and those on the front line will need to ensure that they have their confidence.

"However, the groups that GPs will be working on will be quite large and few of the front-line GPs will be involved directly in making those decisions.

"I believe they can ensure that there is separation between the patient sat in front of the GP, and the GP making financial decisions."

Health Secretary Andrew Lansley yesterday unveiled measures to "free an NHS stifled by a culture of top-down bureaucracy".

Targets set by the previous Government have been abolished and Mr Lansley criticised a system he claimed "blocked the innovation of staff".

He told MPs both SHAs and PCTs would be phased out in the drive for greater efficiency and said back-office functions would be axed to free 20bn in savings to reinvest in patient care.

GP working groups will be in charge of hospital, mental health and community services although certain specialist services and dentistry will not fall under their control.

Under the new system, an independent board will sit above as many as 500 consortia of GPs to set standards and hold the groups to account.

The changes will result in job losses and Dr Vautrey warned it was important the expertise and skills of some management staff were retained.

"The job losses are likely to be mostly within the PCTs and the SHAs. Some of the key people will find roles in the newly emerging GP groups – it is important we do not lose those skills and expertise.

"The level of bureaucracy will depend on what the Department of Health require – the reason for the explosion in bureaucracy was the Department of Health asked for it, now it will be up to them to show a lighter touch."

Unveiling a White Paper on "liberating" the NHS, Mr Lansley said clinicians should be in the "driving seat" on decisions about services.

He said NHS staff had to contend with 100 targets and more than 260,000 separate data returns to the Health Department annual and the aim was to bring resources and decision-making as near to patients as possible.

Mr Lansley pledged: "We need to liberate the NHS from the old command and control regime. So all NHS trusts will become foundation trusts, freed from the constraints of top-down control with power increasingly placed in the hands of their employees."

The Health Secretary said he recognised the scale of the reforms was "challenging" but added: "With this White Paper we are shifting power decisively towards patients and clinicians.

"We will re-balance the NHS, reducing management costs by 45 per cent over the next four years, abolishing quangos that do not need to exist and we will shift more than 1bn from back office to the front line."

But Shadow Health Secretary Andy Burnham accused him of a "U-turn of epic proportions" by "ripping-up" the coalition agreement to stop top-down reorganisations of the NHS.

"This reorganisation is the last thing the NHS needs just now. It needs stability not upheaval," he insisted. "It is a huge gamble with an NHS that is working well for patients."

Mr Burnham said there had never been an NHS reorganisation that had not cost money and diverted resources in the short term, and Mr Lansley's plans were "tantamount to the privatisation" of commissioning.

"Will there be any restrictions at all on the use of the private sector by GPs?" he asked. "Isn't this the green light to let market forces rip right through the system with no checks or balances?"

Mr Burnham also asked how more than 500 GP consortia could be less bureaucratic than 152 primary care trusts, and demanded to know how accountability would be ensured.