Head to head on GP commissioning
Posted: 23 June, 2010 by Andrew Craig
As a regular contributor to Roy Lilly’s NHSmanagers.net site, I did a not-overly-serious head to head this week about GP commissioning with Lynn Young, a long time mate who is the RCN’s Primary Healthcare Adviser. You can follow the rough and tumble here and tell us what you think on this issue that will not go away. 
http://www.nhsmanagers.net/sitebuildercontent/sitebuilderfiles/youngandcraigongpconsortia.pdf
A new briefing from the Nuffield Trust today on Giving GPs Budgets for Commissioning: what needs to be done? acknowledges that public involvement and engagement is likely to be a big problem for GP commissioning consortia. If PCTs, who themselves are pretty variable in their PPI record, aren’t around to assist with this, accountability will not be complete as the report admits. Read it here
http://www.nuffieldtrust.org.uk/members/download.aspx?f=/ecomm/files/Giving_GPs_budgets_for_commissioning.pdf
The sign up to this briefing from six leading trade organisations is interesting in itself.
A knockback from the Treasury for Mr Lansley’s plans to hand about £80bn of public money to GPs for commissioning? Seems someone at HM Treasury just realised that GPs are – with a few exceptions – small businesses who only contract services to the NHS but aren’t employed by it. That’s not news as it was the 1948 settlement. However, according to a report in the Guardian http://www.guardian.co.uk/society/2010/jun/25/nhs-review-treasury-stonewalls, there has to be much more accountability before the funds are handed over. Can’t argue with that, but accountability to whom and for what is the real question? Will the possibly now delayed White Paper clear up the accountability muddle? Watch this space.
Media reports that the revised publication date for the Health White Paper of 12th July may not hold because agreement cannot be reached between the coalition partners, some of whom are worried by the scale of the organisational change which pushing £80+bn of commission money down to GP consortia entails.
And the Nuffield Trust warns that the NHS faces an “unsustainable” and therefore “unaffordable” rise in emergency admissions. http://www.nuffieldtrust.org.uk/publications/detail.aspx?id=145&PRid=714 It’s a murky area, but most of these are for very short periods, often less than one day. This can’t mean people are just sicker suddenly. It must have something to do with GP behaviour making many more emergency referrals compounded by the failures in community and social care to prevent breakdowns of elderly frail people and those with long term conditions.
If these are now 49 per cent of all emergency admissions, accordingly to the Nuffield analysis, then Mr Lansley’s reforms look doomed unless something can be done to turn this around without delay.