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Slow down health reforms, think tank warns

Caroline White

Monday, 4 April 2011

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The Government should put the brakes on the pace of its health reforms to give time for GPs to get used to their new role, says think tank Policy Exchange in a report published today.

The report’s publication comes as the reforms are set to come under fresh attack by Labour leader Ed Milliband, amid growing speculation that the government is getting cold feet on some aspects of the legislation currently working its way through parliament.

Implementing GP Commissioning suggests that the Health and Social Care Bill’s proposals to abolish every Primary Care Trust (PCT) by 2013 could lead to the new structure replicating the existing system in all but name.

But by slowing down the proposed reforms, the potential to deliver real and lasting transformation in the NHS is enormous, says the report.

The research is based on interviews with GP leaders or managers in 16 pathfinder consortia and other experts.

It looks at different ways in which consortia could work and the factors which they and the government will need to focus on if the policy is to be a success.

It concludes that the government has lost many potential supporters inside and outside the NHS. This is because they have pressed ahead with handing more responsibility to GPs without winning backing for the policy from them first.

It also emphasises the need to ensure GPs have the necessary skills to run such highly complex operations before the transition to GP commissioning takes places.

Eve Norridge, lead author of the report, said: “In recent years, GP commissioning has in principle received widespread support from politicians of all parties and across the NHS.

There are many GPs who have the potential to become highly successful commissioners. It would be a loss to everyone, especially patients, if the policy were discredited due to overly hasty implementation.”

“Ministers need to address GPs’ concerns before loading such huge new responsibilities on their shoulders,” he adds, warning if GPs are reluctant to embrace the reforms, the new system could end up replicating the existing model rather than transforming services as the government intends.

The evidence gathered from the interviews and case studies, shows that PCTs are struggling to deal with the transition because of the exodus of good staff and subsequent loss of expertise.

Many GPs are worried about the size of the new Commissioning Board and whether a culture of bureaucracy is really coming to an end, it says, with many consortia are not being given the space to develop as they want to.

Current projections for the size of GP consortia mean that commissioning could be no closer to patients than it was in 2002, yet this is one of the primary aims of the reforms, says the report.

The need to take time to get GP commissioning right is supported by evidence from Cumbria where, since 2006, a similar system has been slowly established under Labour’s Practice-Based Commissioning Programme.

Kingston Consortium member, Dr Charles Alessi, commented: “We have made winning the support of local GPs our first priority. This has been time-consuming and labour intensive but we think it is a fundamental foundation for the consortium's success.

Emerging consortia are all at different stages of development. While some will be ready to take on commissioning responsibilities by 2013, others may need more time to get the groundwork right. The pace of change needs to suit the local circumstances. ”

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