Editorial: Reform puts GPs in the driving seat of the NHS

It has been a busy time for the DoH as it embarks on one of the biggest restructures of the NHS in England in its 62-year history.

However, the health White Paper raises far more questions than it answers, and it is already clear that many GPs are nervous or downright unhappy at the prospect of being 'forced' to undertake commissioning.

These are bold plans that have not been tested, so concerns are understandable. But there is no denying that the proposals will put GPs well and truly in the driving seat of the NHS and, as such, the profession cannot reject the White Paper out of hand.

Despite the fact that all practices will have to be part of a consortium by next April, in all likelihood GPs will have options about how involved they become with commissioning.

If the experience of Nene Commissioning is anything to go by, only those GPs who want to be active within their consortium will actually undertake commissioning, the rest will continue to work in their practice as normal.

But the plans do rely on a significant number of GPs putting themselves forward for this commissioning role. Many will feel there is not enough information for them to know what they are signing up to.

GPs need to know what is in the small print. They will want more detail on a vast number of issues, not least financial accountability, the sanctions GPs will face if their consortium runs out of money, how commissioning out-of-hours will be remunerated and, perhaps most importantly, what all this will mean for the existing GP contract.

Health secretary Andrew Lansley has said that individual GPs won't be financially liable if their consortium fails. This suggests practice funding will remain separate from commissioning budgets, but GPs (and the GPC) will want cast iron guarantees on this point before embracing any new role.

However, if the government can offer a commitment on this and, providing any changes to the contract are acceptable to the profession (both, admittedly, very big 'ifs'), the White Paper could liberate GPs to really make a difference and improve patient care.

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