Spending power: GPs’ mixed response

Published: 15 July, 2010
by TOM FOOT

DOCTORS in Camden have given a cautious welcome to radical health reforms that will put them in charge of NHS budgets – but have warned they must not become bogged down in bureaucracy.

Under the reforms, GPs will become the new paymasters of most health services while the borough’s Primary Care Trust will be abolished by 2013.

Practices will club together and decide which health services to “buy” from which providers.

Conservative Health Secretary Andrew Lansley, unveiling the Government white paper on Monday, said he believes doctors are better placed than managers to make decisions for patients.

For the first time, family doctors will have direct control over finance for mental health, hospitals and social care services.

Dr Marek Koperski, a partner at the James Wigg Practice in Kentish Town, said: “What we have here is the possibility of great opportunity for patients, to make the NHS more efficient and patient responsive – it’s something we’ve wanted for years. 

“But the devil is in the detail and the trouble is we haven’t seen any of the detail. It really depends on how many resources are devoted to this.”

Dr Paddy Glackin, secretary of Camden and Islington’s Local Medical Committees (LMC), representing around 6,000 doctors, added: “It could work as long as we are not forced to be too detached from the day job and we get the management and support we require. It will also depend on whether we get to reduce the endless, mindless bureaucracy imposed on us.”

GPs, who typically earn around £80,000 a year, will be given substantial financial incentives to take on the extra workload. 

Critics say it is unclear whether the majority of family doctors have the skills, time or resources to manage big budgets.

And campaigners from the Keep Our NHS Public (KONP) group fear many will inevitably turn to private companies to do the work for them.

The government has already created a list of accredited companies – including UnitedHealth UK and Care UK – it wants GPs to consult with and contract from.

Dr Robert MacGibbon, a former partner at the Regent’s Park Practice, said: “The NHS is being divided up into a public health service, which has collective responsibility for everyone’s health, and a medical service that is being set up in a way that all the private companies will be coming in and cherry picking what they want. 

“What will happen to the medical care, as opposed to the public health service, is that there will be a loss of continuity and collective responsibility for everyone’s health.”

He added: “There is a disparity of incomes among GPs. There are GPs that are business-orientated, who are running their practices efficiently but not comprehensively. If you have any organisation with increasing disparity of income, it leads to ill health.”

Mr Lansley’s White Paper also paves the way for all hospitals to become independently run Foundation Trusts – like University College London Hospital.

It means hundreds of public institutions will become designated as not-for-profit private companies, with a similar status as universities and housing associations. 

An independent health board will monitor the funding decisions, while local councils and patients will have increased power in informing decisions. The changes are being touted as a solution to the widely reported problem of NHS funds being routinely wasted on consultancy and red tape.

An NHS Camden insider told the New Journal that the PCT had recently spent £60,000 on hiring a consultant to boost the trust’s ratings and had paid £10,000 for a powerpoint presentation. 

But union leaders have warned that abolishing the PCT – known as NHS Camden – will bring wide-scale redundancies of clinical advisers and administrative staff.

NHS Camden serves around 220,000 people and, in 2009, had a budget of £448million to spend on local healthcare.

The NHS Alliance, representing NHS managers and clinical advisers, warned doctors will fail by making decisions that “make them unpopular with patients”.

Dr Sunil Gupta, chairman of the Alliance’s PEC network, said: “The clinical leaders at the PCT level are ideally suited to help provide this ‘tough love’ to the NHS for the best long-term interests of the people of this country.”

A report from North Central London NCL sector chief executive Rachel Tyndall, the body currently overseeing cuts to five primary care trusts across north London, said she was facing a “significant financial challenge in 2011/12”. 

The report said they had to find around £85m of savings.