Editorial: Detail is needed on Tory commissioning plans

We are at last starting to see some difference in health policy from the two main political parties. Commissioning (and in particular GPs' role in this) is one area where Labour and the Tories hold different views.

The Conservatives plan to give GPs in England responsibility for commissioning, devolving real budgets to practices. Labour, meanwhile, remains committed to practice-based commissioning in its current form.

This week, GP reports that NHS experts have labelled the Tory plans 'problematic' and expressed concern about whether GPs have the skills to commission.

The proposals certainly raise more questions than they answer. Not all GPs want to commission, so how can the policy work? Will practices be responsible for commissioning all secondary care? If so, will they have to be part of a larger consortia to achieve this?

However, it is fair to say that the current system is simply not working in many areas. Tory shadow health minister Mark Simmonds describes PCT commissioning as 'patchy'. Meanwhile, early findings from GP's 'Rate Your PCT' scorecard show the vast majority of GPs believe their PCT's performance on commissioning is 'poor'.

Improvements must be made, and involving GPs and other clinicians is the key to this. This does not necessarily mean GPs should do all commissioning, but they must be consulted about it.

GPs are uniquely placed. They have ongoing relationships with patients so they understand their needs and frustrations and can see problems in existing pathways. Managers do not have such insights.

But do the Conservatives' plans go too far? Without more detail it is impossible to tell.

This is a key plank of Tory health policy so the party must now explain how it will work in practice. What happens if GPs do not want to commission? Will there be safeguards to protect practices from financial risk if unexpected costs materialise in the process of redesigning services (a reason why Labour argues against giving practices real budgets)?

Without this information it is impossible for GPs to decide if they support the plans.

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