GP commissioning is hard to do well, says US academic

GP commissioning will not succeed unless there is adequate investment in management and leadership, a leading US health academic has said.

Talking at a Nuffield Trust event, Professor Lawrence Casalino, chief of the division of outcomes and effectiveness research at Weill Cornell Medical College, New York, warned that GP commissioning is ‘hard to do well’.

He said the policy would need to be handled ‘very well’ to avoid there being a large number of failures.

Professor Casalino cited the experience of Independent Practice Associations - the US equivalent of GP consortia - as evidence of this.

He said there is ‘no question’ that the vast majority of IPAs ‘failed badly’ by going bankrupt or by not improving patient care. ‘Of the 2000 IPAs that were set up, less than 200 groups were successful,’ he said.

Professor Casalino also set out the capabilities that successful consortia will need, including the need for adequate investment in management. ‘Don’t skimp on management funds,’ he said. ‘These organisations will not work without good leadership and management.’

He also called for the government to make things ‘better for GPs’ as a means of gaining support ‘rank and file’ from GPs. He said GPs must believe that the changes will significantly improve some or all of the following: quality of care for patients, the quality of their workday, respect from peers and income.

He said: ‘When there is one change after another it is very easy for physicians to be cynical. The government needs to look at how to make things better for GPs.’

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