How GPs fit into Tory NHS vision

Shadow health minister Mark Simmonds explains his party's plans to put GPs at the heart of NHS commissioning.

MP Mark Simmonds: 'Only GPs understand their patients' needs'
MP Mark Simmonds: 'Only GPs understand their patients' needs'

The Conservative Party has pledged to make primary care more patientand outcome-focused, and believes the best way to do this is to put GPs back at the heart of the system, building on the all-important GP-patient relationship.

The tragic case of David Gray is a reminder that the out-of-hours system is not fit for purpose. The inquest into his death revealed that Dr Daniel Ubani had flown in from Germany, had limited sleep and was unfamiliar with the use of diamorphine.

Sadly, the case is not unique. Statistics show complaints against GPs have risen 25 per cent since 1997. I have no doubt that this is in part due to changes which absolve GPs of responsibility for out-of-hours care.

The Conservative Party believes this change was a serious error. We believe that only GPs really understand their patients' needs and requirements, and are therefore best placed to commission services for their care.

Out-of-hours care
We are not advocating a return to a Dr Finlay-style system where GPs provide around-the-clock care; however we do believe GPs should be collectively responsible for commissioning out-of-hours care for their patients.

Giving GPs responsibility for leading commissioning is at the heart of Conservative proposals for primary care, and is a clear dividing line between the two main parties.

GPs are highly trained professionals; Labour has undermined and demoralised them, burdening them with increasing bureaucracy and endless targets.

Under Labour, practice-based commissioning and world class commissioning have completely stalled, undermining taxpayers' investment and GPs' goodwill and hard work.

Trust in the skills
It is this trust in the skills and detailed knowledge of healthcare professionals that is behind our policy of giving GPs - working in consortia - responsibility for commissioning a range of services for their patient groups.

We recognise there are some specialist patient groups whose care must continue to be commissioned at a regional, or even a national level, and this would be retained; however GPs would be responsible for commissioning the majority of services.

The Conservative Party also envisages GPs working with other professionals to inform commissioning strategies and decisions. Putting commissioning back in the hands of those who know their patients best will result in new service provision models developing.

We envisage a system where GP commissioners look beyond the traditional service providers, and draw upon the skills of pharmacists and the voluntary and not-for-profit sectors to provide services which would offer the best possible outcomes for their patients, at a location and in a manner that best meets the patients' needs.

This is not a return to GP fundholding for many reasons. Firstly, there would be much tougher rules on GPs commissioning services from themselves.

There would be an open tendering process, and any service provided 'in-house' would have to demonstrate that it offers the very best service to patients, as well as, of course, good value for money.

GP consortia
Secondly, unlike fundholding, we would like to see all patients benefit and would expect GPs to form consortia.

If they prefer, the GP consortia could bring in external commissioning expertise - from another consortium, the PCT, a voluntary or not-for-profit organisation or the independent sector.

These consortia would hold real budgets which, combined with our determination to give QOF a stronger clinical focus, would give them a real incentive to commission the best possible services for their patient cohort.

These hard budgets will be used to commission local health services, and will be kept separate from practice income.

Therefore, should a GP have a deficit on their budget, it would not come out of their practice's income. GPs who consistently fail to balance their books could risk losing their contracts.

We believe that budget holding is a natural guarantee of efficiency, and ensures the money follows the patient.

It would also encourage practices to develop services that are in the best interests of their patients. Consortia would be rewarded for good patient outcomes, and would be expected to reinvest in services a proportion of any savings or profits made.

The Conservatives recognise that GPs have the skills and desire to achieve the best outcomes for their patients, and they can only do this if they are given the freedom and responsibility to invest and innovate on behalf of their patients through real budgets and responsibility for commissioning services.

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