BMA rejects Tory 'GP-led rationing'

As the BMA launches its general election manifesto, Richard Staines looks at the political battle lines being drawn.

Dr Meldrum: 'Patients must be involved in discussions about how to deliver care, rather then rationing through a sort if fundholding'

The BMA is on a collision course with the Conservatives over plans to hand GPs control of NHS commissioning.

The Conservatives, favourites to win the next general election, want to hand GPs real budgets and responsibility for all NHS commissioning.

But at last week's launch of the BMA's general election manifesto, doctors' leaders opposed the Tory policy, saying it would place GPs at the centre of an NHS rationing system.

Commissioning debate
The BMA is calling on all political parties to adopt its manifesto ahead of the general election, which must take place by 3 June 2010.

According to the Conservatives' NHS Improvement Plan, budget holding is a 'natural guarantee of efficiency, ensuring money follows the patient and it is spent on front-line care rather than on managers'.

'GPs - rather than remote managers - should be responsible for reconciling the available resources with clinical priorities and patient choice,' it says.

But launching the BMA manifesto, BMA chairman Dr Hamish Meldrum said: 'I am not convinced this is going to be appropriate for GPs. We would like a much more co-operative system. Patients must be involved in discussions about how to deliver care, rather than rationing through a sort of fundholding.

'We would want to see co-operative community primary care leadership involving patients, involving GPs, to build effective healthcare services.

'I am not sure GPs would want to take responsibility for rationing services.'

Other NHS organisations agree. The NHS Alliance opposes fundholding and argues for local commissioning councils governing populations of around 100,000 people.

Dr David Jenner, GMS lead at the NHS Alliance, says: 'The responsibility for commissioning should be outside the GP provider contract. But we do believe the GP provider contract should put more emphasis on demonstrating effective resource management.

'Each practice should demonstrate that it is reviewing everything from prescribing to referrals to ensure the best use of resources.'

Despite the opposition, the Conservatives say they will argue their case. A spokesman said: 'A lot of family doctors think that having more responsibility for their patients is a good thing. We are going to work with GPs to push this through.'

One set of GPs more likely to back the Tory stance is the National Association of Primary Care, whose own manifesto launched last month backed GP budget-holding and won support from the Conservatives.

Calls to action
The DoH says it remains committed to 'revitalising' its current policy of practice-based commissioning (PBC), with PCTs retaining control of budgets.

PBC was described in October as a 'corpse' by the government's national clinical director for primary care, Dr David Colin-Thome, although he later backtracked on the remarks.

But a study by the King's Fund in July showed 52 per cent of primary care professionals were not engaged in PBC by their PCTs and almost a third (29 per cent) of respondents reported delays of more than 25 weeks getting PBC business plans approved.

The BMA manifesto also reiterates calls for changes to the GMS contract to boost partnerships. 'Changes could make it more attractive to take on additional partners, particularly in areas of greater need,' says Dr Meldrum.

In addition, the manifesto warns against a 'slash-and-burn' approach to tackling the financial crisis. 'It would be disastrous to resort to measures such as cutting front-line services and clinical staff at a time when demand for healthcare will be increasing,' says Dr Meldrum.

The BMA also reiterates its call for action to combat alcohol-related harm, tobacco use and obesity.

Measures proposed include above-inflation tax rises on alcohol, minimum pricing, an end to 'happy hours' and a total ban on alcohol advertising.

The association wants to see a tobacco-free society by 2035, and the manifesto urges the DoH to tackle obesity by introducing consistent traffic-light food information systems and banning on junk food advertising.

Action must be taken to cut climate change and its effects on health, the document adds.

It also reignites the debate on organ donation, backing the 'presumed consent' model the DoH has rejected.

BMA manifesto at a glance
  • Increased alcohol duty and a ban on alcohol advertising.
  • Increased tax on tobacco and censorship of films glamourising smoking.
  • National traffic-light food information to cut obesity and ban on advertising for unhealthy foods.
  • A public debate on an opt-out system for organ donation.
  • Political parties should combat climate change and its negative health effects.
  • GPs should be engaged with practice-based commissioning, but not fundholding.

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