Patients 'must be priority if GPs take over NHS'

Spending time with patients must remain a "top priority", doctors' leaders said last night as proposals emerged to make GPs responsible for most of the NHS budget.

The Government plans for GPs to take control of commissioning services for patients which could see around 80bn – 80 per cent of the NHS budget – handed to family doctors.

Dr Richard Vautrey, deputy chair of the BMA's GP committee, said the proposals had the potential to be "radical", although he insisted doctors would need adequate resources.

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His comments came as a report said evidence suggesting GPs will be more effective than health trusts at commissioning NHS services "is weak".

Think-tank Civitas said the "only possible justification" for restructuring could be that "GPs will be universally and significantly better" at it than primary care trusts (PCTs) who currently hold the purse strings and warned the Government's plans would lead to a "one year dip" in performance in the NHS in absolute terms.

The role of strategic health authorities and PCTs will be dramatically scaled back in the plans which Health Secretary Andrew Lansley will flesh out in a White Paper next week.

At the moment, PCTs control most of the budget, commissioning services in their areas.

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But Mr Lansley believes GPs are best placed to understand patient needs and to decide where money should be spent.

He has also said GPs must be involved in commissioning out-of-hours care, which has come under fire since PCTs took control.

The plans involve setting up groups of practices which would work together as consortia responsible for billions of pounds spent on mental health, hospital and community services.

Such plans could force GPs to become commissioners but a previous similar plan under the Tories, called GP fundholding, saw only around half of doctors get involved.

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Dr Vautrey said: "We do live in tough economic times, but we must make sure that doctors, working together in groups, are given the necessary resources to implement any reforms properly. It is also vital that spending time with patients remains the top priority for all GPs."

The acting chief executive of the NHS Confederation, Nigel Edwards, said: "In transition to this new system there are some quite significant risks.

"Obviously it is going to take time to implement this and the PCTs at the moment are the people who keep the lid on the performance and financial management of the system."

Mr Edwards said the reform would move the NHS from a market in which a number of large organisations place big contracts to one more like the gas or telecoms market in which demand is shaped by many individual purchasing decisions.

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"I think the concept here is lots of individual decisions by GPs – when they make referrals and send people to hospital – will be added up and we will have a greater market dynamic," he said.

"GPs will also help plan services and direct strategy for hospitals by telling hospitals what they need for the longer term."

Mr Edwards said he expected many GPs to recruit former staff from PCTs in order to help them cope with the additional workload, which will involve "quite a big step up from what they've been doing before".

Others may contract the work out to insurance companies or other private firms with relevant expertise.

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Shadow Health Secretary Andy Burnham said: "More than anything else, the NHS needs stability right now.

"Instead, we have an 80bn political experiment. It exposes deeply flawed thinking."

Yesterday in Leeds, Mr Lansley confirmed a review of funding for end-of-life services.