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There seems to be a growing tide of criticism of plans to transfer commissioning budgets into the hands of GPs at the moment, with the BMA on Friday announcing that the pace of change and nature of the reforms could affect the service’s “stability and future”. There could also be financial problems: The HSJ ran an article in August after collating budget and spending details from 190 practice based commissioning consortia, which comprised 2000 PCTs, and there was a collective overspend of 2.5%. Not a bad performance considering they are doctors, not accountants, but 2.5% applied to the 80B commissioning budget is a 2B overspend when the NHS is supposed to be finding 15-20B of savings. Pulse also ran some research a couple of weeks ago to research what levels of PCT debt GP consortia will inherit, of 40PCTs surveyed, at least half were predicting deficits at the end of the this financial year. Giving GPs responsibility for commissioning is quite a task considering GPs are not financial managers, but putting many on the back foot by also giving them a PCT debt could be a recipe for disaster. No wonder then, in a recent survey conducted by Practical Commissioning, 46% of 325 surveyed GPs said they did not feel ready for the impending changes. That’s a lot of apathy about a lot of responsibility.
I personally think the idea of GPs taking responsibility for commissioning budgets is solid in principle, a common cause of PCT overspends is over referrals from GPs of patients to acute, if doctors have direct responsibility for budgets they should be more inclined to better manage referrals and care pathways? The key will be how well GPs take up the mantle and how effectively they buy-in the right management support to ensure they both commission effectively without compromising their ability and capacity to provide patient care. Your thoughts as ever are appreciated.
Steve Melber is Senior Consultant, Health at Interim Partners.
October 8th, 2010 at 7:10 am
I think your numbers may be a little off. There are approximately 150 PCTs, not “190 practice based commissioning consortia, which comprised 2000 PCTs”. I assume you mean …which comprised approximately 2000 GPs….
The sentiment is of course correct. The question PCT GP commissioning leads are asking is why the typical PCT budget has increased by over 40 percent in the past three years. Allowing for NHS inflation at its very highest, this accounts for at most 20 percent, so where has the rest gone? What services or products are now being provided which were not available three years ago? The belief is that we should be able to wind back to a 2006/7 or 2007/08 budget without too much trouble or pain. Many to whom I have spoken see this all as a storm in the making when there is a realistaion that billions have been frittered with no benefit.
October 8th, 2010 at 8:32 am
Steve, in principle the fact that commissioning budgets should be transferred to GP’s is one thing as you have alluded already in the 1st para above 3 key things will affect the delivery: Resources available, time and the abilitity to influence changes in existing practise and manage/monitor the long term aspects.
Do GP’s actually have the time to take on this extra burden on? - As you may be aware it’s difficult to even have an hour to spare for a meeting with practicing GP’s and most consortia tend to meet at lunch times as this is the only time they have.
They might inherit the PCT debt along wth the personnel, but will they be given a choice under TUPE regulations?
It’s all in the making at this stage I would say.
October 8th, 2010 at 8:33 am
We already have many GP commissioning groups. Have any of these been successful? Not many is the answer. But have PCTs been any better - perhaps not. GPs already know how much things cost - drugs, referrals, staffing costs. Meetings between PCT bosses and practices constantly highlight their spends, but it seldom changes behaviour. GPs are business men (and women) - their business is about seeing and treating people. More and more they are taking a cautious line by referring, prescribing and treating people who don’t need it - they are becoming risk adverse. We have some who are unduly influenced by marketing, or pressures from local hospitals about “missed cases” etc. Society makes undue pressures, demanding the quick fix, be that for cancer, obesity or feeling good. Is it right that we detract from their time and use them for something that others are better equipped to do? I do not think so. Good commissioning managers are able to bring the right people together to establish a network and pathway for necessary referrals, educating those making unnecessary referrals, and encouraging others to use the system where appropriate through training and education. GPs in the commissioning role will fight their own corners, building their own empires and won’t save money. A salaried GP earns £70-80kpa. So why pay these others for seeing fewer patients double and triple that amount?
October 8th, 2010 at 8:54 am
The French system is far better. Their health care is better and far more of the money spent goes on healthcare. But then they don’t try to run a ”national” health service.
(No one can run a state service spending £110bn with 1.3m employees and 62m clients) .
The French state sticks to providing universal uinsurance and leaves the medics to provide health care. Result- more doctors(paid a lot less) more competition, cleaner hospitals, no waiting lists and far better food too. it doesn’t cost less - but it works far better.
It also renders the army of non medics redundant-perhaps not so good for interims.
October 8th, 2010 at 9:19 am
I was diagnosed with two herniated discs in my spine October 2008. My PCT refused to sanction the operation to correct my problem until finally after lobbying with my local MP I was allowed the operation in March 2010. Between diagnosis and operation I lived in excruciating pain despite being tranquillized on Tramadol and Pregabalin. The pain made it impossible for me to even think about work and as I am a self employed contractor I had non of the employed benefits, sick pay etc. My doctor put down the PCT refusal as a lack of funds. I know that I am not the only person to suffer in this way, in fact my orthopedic consultant told me that it is now virtually impossible to obtain PCT authorization for operations.
With my own experience it is very apparent that the whole system needs overhauling not only for financial but equally moral and humanistic reason. The current system absolutely does not work and therefore is not even an option! We are all too aware of the waste within the NHS especially when they spend millions of pounds on new IT systems which fail to work and employ so many admin and managerial staff any budget would be burdened.
October 10th, 2010 at 1:07 pm
Clinical accountability will reduce total costs and improve healthcare, but it’s important not to set GPs against specialists and to find incentives for FT acutes to manage demand. How GPs will find time to manage entire system and their patients needs further thought. What will happen when budgets are missed has not been spelled out.