No money for extra primary care work

The DoH will offer no new money to encourage the shift of work from secondary to primary care in areas such as post-operative checks, GPSI clinics and surgery.

DoH primary care czar Dr David Colin-Thomé said that service changes could be achieved through practice-based commissioning (PBC) schemes and by avoiding existing duplication in areas like post-operative checks, rather than contractual changes or cash injections.

He said that there had already been sufficient DoH investment in premises and added that peer pressure could be ‘one hell of a driver’ as patients played practice services off against each other.

For example, he said that GPs could work shift patterns to open later without spending more.

His comments came as he launched a report outlining proposals for which services could be brought into primary care. He also revisited the idea of a practice accreditation scheme, proposed by the RCGP, so patients can make informed decisions about GPs (GP, 29 September 2006).

The report, ‘Keeping it Personal’, says: ‘We do not wish to have a star ratings system but to find a mechanism that will further reassure patients that their practice is operating within the highest clinical and managerial standards.’

The report includes the concept of GPs doing some post-operative checks (GP, 12 January).

Other recommendations suggest more consultants working in community hospitals and primary care settings, GPs, nurses and consultants coming together to form ‘day surgery companies’, more GPs working from ‘one-stop health centres’ and GPs taking greater responsibility for patients’ social care.

Dr Colin-Thomé’s words on using peer pressure rather than cash to drive change were echoed by health secretary Patricia Hewitt. She said that 10 per cent of patients changed their GP each year and they would switch if they thought they could get better service elsewhere.

Ms Hewitt said that tools such as patient access questionnaires would give PCTs increasing amounts of information about patient satisfaction and practice performance, which patients could use to make educated choices about which GP to visit.

GPC chairman Dr Hamish Meldrum agreed that primary care could take on more work but not without more resources.

‘This can only happen if GPs are given resources to do the job,’ he said. ‘They need to expand their premises and employ more staff to deliver the government’s agenda of care closer to home where clinically appropriate.’

The DoH announced a 30 per cent increase in annual PCT funding for buildings and equipment this week, to £382 million, but stressed that how it was spent would be up to PCTs.

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