DH must 'allow GPs freedom for reforms to work'

The government must relinquish control of local decision making for the NHS reforms to succeed and to keep GPs engaged, a clinical commissioning group (CCG) chairman and former MP has warned.

Dr Howard Stoate: GPs need freedom to make reforms work
Dr Howard Stoate: GPs need freedom to make reforms work

Chair of Bexley CCG and former Labour MP Dr Howard Stoate said GPs’ hearts sink when he explains the bureaucracy his CCG has to undergo to be authorised by the NHS Commissioning Board (NHSCB).

Speaking at an all-party parliamentary group on primary care and public health meeting on the health reforms yesterday, Dr Stoate said that if the government insists on a ‘heavy touch’ it risks killing the reforms.

He said: ‘The government has got an issue it has to resolve, which is that the initial intention was localism. The idea was that if you were to devolve power down to local groups they would make local decisions for local people and local clinicians will be in the driving seat working with their local communities, patients and with the local authority at a local level. However the command structure for the DH has actually pretty much made that a much more difficult task. It can’t quite relinquish central control.

‘On the one hand, localism is the watchword, and on the other hand command and control and centralism is very much the way it is being driven. It does make the job of people like me and my colleagues across the country rather more difficult.’

Dr Stoate said there was more bureaucracy than anticipated and that authorisation is ‘proving quite technically difficult’.

He said: ‘We had a year of trying to engage with GPs. In Bexley we are very engaged with our practices but you could see their faces fall when you explained the latest round of bureaucracy you had to go through - a constitution, setting up a CCG, explaining the legal hoops to go through to get there, the governing body, probity, all the governance issues - huge amounts of it.

'You could see their hearts sinking because they were saying: "What about the clinical stuff?". I think we have now turned a corner. In Bexley we have got GPs working on service redesign. When you get GPs back involved in service redesign, they are engaged.

'If we can get through authorisation smoothly, without too many conditions, and we get authorised, and get on with the job, I think we can get back to the optimistic stage. It depends on how the government want to play it. If the government want a light touch, it can work, if they insist on a heavy touch, they will kill it.’

NHSCB regional director of Midlands and the East, Dr Paul Watson, told the meeting: ‘The issue of bureaucracy, I agree we have to keep it to a minimum, but at the end of the day these are public bodies, they are statutory bodies, they work for you and me, they use our money. In the Midlands and East, we will be putting through about £20bn of public money through 61 CCGs and there has to be some proper governance around that.’

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