Prescription for chaos as GPs left out of £6bn NHS shake-up

Dr Richard Vautrey
Dr Richard Vautrey
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MAJOR disparities have emerged over how family doctors plan to operate when they take charge of NHS spending worth more than £6bn in Yorkshire under highly-controversial Government reforms.

Analysis by the Yorkshire Post has uncovered huge variations in the numbers of GPs closely involved in the region’s 23 new clinical commissioning groups which will over from next April.

Some GP board members will devote just two days a month to their new roles, while only a minority of groups have so far involved hospital doctors, patients or local councils in their work, raising questions about how representative they are of the NHS or the wider public.

The findings will fuel concerns about the patchwork development of the groups which could have significant knock-on impacts for patients when key decisions over major service changes are taken as the NHS faces growing financial turmoil.

Four new groups in North Yorkshire are likely to face the biggest struggle after it emerged NHS services in the county will be at least £19m in debt by March.

All groups face stringent authorisation tests from the new NHS Commissioning Board.

A Yorkshire Post survey found some GPs on commissioning groups working four days a week, while most GPs board members in Sheffield, with the biggest budget in the region of £700m, plan only two days a month.

In Doncaster and Calderdale, 10 family doctors have been appointed to GP commissioning boards, but in Rotherham, Leeds North, and the Airedale, Wharfedale and Craven group there are only four.

Pay varies for GPs involved in commissioning work from around £50 an hour in Doncaster to £80-£90 elsewhere.

Only a handful of boards have appointed hospital doctors. In Hull, two patient ambassadors have places on the board. In the East Riding, a representative of the local medical committee, which negotiates on behalf of GPs, sits on the board.

Few boards have council representatives even though Health Secretary Andrew Lansley wants improved links between the NHS and social services.

A dispute between GPs in Barnsley means no appointments have been made to its commissioning group and it is doubtful it will be handed full authorisation to take charge of budgets in April.

Leeds GP Richard Vautrey, deputy chairman of the British Medical Association’s GP committee, warned groups faced a huge task as financial problems worsened. He said GPs needed to involve NHS staff, local authorities, politicians and patients as a priority.

“Cost savings and efficiencies in relatively easy areas have already been found. The very difficult decisions about service changes everyone knows are needed still have to be made,” he said.

Mike Simpkin, of campaign group Sheffield Save Our NHS, said there was uncertainty about how the groups would work.

“GPs will find their positions more and more uncomfortable and possibly untenable.”

Boroughbridge GP John Crompton, chairman of North Yorkshire’s local medical committee, said the new groups would be asked to deliver a radical restructuring of NHS services to move care out of hospitals and into the community to deal with the financial shortfall.

“There is real concern over the inherited financial position. How do we change and develop services when we are already overspent.”

Former Bradford GP Dame Barbara Hakin, managing director of commissioning development at the NHS Commissioning Board, said she was “optimistic” the vast majority of the country’s 212 commissioning groups would be authorised from April. “The authorisation process will be absolutely key,” she said. “We want them to be the best they can be.

“Even across Yorkshire there are very significant differences in the population, demographics and provision of services so it’s important that the clinical commissioning groups do shape themselves appropriately to reflect that.”