GPs’ “major concerns” about Lansley’s reforms

It has been described as the Coalition’s Charge of the Light Brigade – but now it seems the cavalry are having second thoughts.

Andrew Lansley’s plans for GP commissioning involve giving £80 billion of public funding for NHS care, and decisions on how these are deployed, to GP consortia, to which all GPs will have to belong. This received a major setback this week when their professional body, the Royal College of GPs, voiced serious doubts in a report on consultation with its members over the summer.

Left Foot Forward has previously highlighted Lansley’s plans for GP budgets as “counter-cultural”, given the profession’s lack of interest in voluntary involvement in NHS commissioning under Labour.

The RCGP consultation response highlights growing concerns about many elements of the Coalition’s GP budgeting plans. These includes the speed of change, diversion of time and money away from clinical care, fear of growing inequality of provision, the lack of GPs’ skills to manage commissioning budgets, and the risk of privatisation of NHS service provision and resulting fragmentation of services.

The cornerstone of general practice is patient relationships and trust, and there is fear that this could be weakened by Lansley’s plans:

“Some members are also concerned that GPs will be held responsible for shortcomings in services, and that this will disrupt public trust in the crucial doctor-patient relationship which underpins effective uptake of services and clinical interventions.”

The report does attempt to be even handed, reflecting in positive terms some features of the plans. However, it states openly that there were “significant numbers of concerns about the effect of these reforms on the NHS in England” from GP respondents.

The report also fires a warning shot on health inequalities, highlighting

“the need for the government to provide clearer details on how these reforms will reduce rather than exacerbate health inequalities, as the existing evidence base on commissioning suggest there is little impact on inequalities, and increased local variability can lead to disadvantaged populations being further marginalised.”

Lansley’s 4 months as Secretary of State have been characterised by strength of vision but political mistakes, such as his gaffes over Jamie Oliver’s school dinners campaign, and the closure of NHS Direct. This is the most serious yet, however, as it suggests he failed to use his six years as Shadow Health Secretary to warm up the key professional group required to make his reforms function.