Election 2010: What does the coalition mean for GPs?

Tom Ireland reports on how Conservative and Liberal Democrat health policy fits together and its impact on GPs.

David Cameron and Nick Clegg: the leaders must work to conjoin their party's health policy (Photograph: Getty Images)
David Cameron and Nick Clegg: the leaders must work to conjoin their party's health policy (Photograph: Getty Images)

Andrew Lansley's first move as health secretary was to commit to a new GP contract and handing back out-of-hours responsibility to the profession.

Andrew Lansley: what the new health secretary has in store for the NHS

GPs expecting to be ignored as the coalition found its feet may have been taken aback at the early statement of intent, delivered through the pages of the Daily Mail.

But what other policies might the government have lined up for GPs, and will the Liberal Democrats have a say?

Both parties seem committed to changing the GP contract. Liberal Democrat leader Nick Clegg has said that he believes the 2004 contract 'has not delivered much for patients'. Mr Lansley has said it must incorporate commissioning responsibility and QOF must start to measure outcomes.

Despite this, GPC chairman Dr Laurence Buckman says he has been assured by Mr Lansley's team that the GMS contract will not be 'torn up'.

Slash administration costs
It's clear the coalition partners agree on the need to slash administration and management costs, an idea prominent in both parties' pre-election manifestos.

But the coalition has already agreed to ringfence the NHS budget, with real-terms increases in funding over the next five years, despite the Lib Dems arguing pre-election that this would have a negative impact on other departments.

Mr Lansley has appointed a Liberal Democrat health minister, Paul Burstow, but at the time of writing it was unclear if the party's health spokesman Norman Lamb would have a role in the DoH.

Mr Lansley may have some reservations about sharing a department with Mr Lamb, who dismissed the Conservatives' idea for an independent NHS board as 'crazy' during the election campaign, and mocked Mr Lansley over reports that he received funding from Care UK.

There are other areas where the parties' policies diverge.

The Conservatives want an end to 'politically motivated targets' while the Liberal Democrats, in their manifesto, wanted waiting times and other targets strengthened into a 'patient contract'.

Adult social care
Structurally, the Liberal Democrats want locally elected health boards, not a national one, and they wanted to scrap SHAs. The Tories also walked out of cross-party talks on how to fund adult social care.

But Dr Paul Charlson, a member of the Conservatives' clinical advisory committee, does not think health policy will be a big problem for a coalition with bigger differences in other departments.

Dr David Jenner, contract lead at the NHS Alliance, agrees that while the Liberal Democrats 'will have a say on health' their health policy 'was not as well developed' as the Tories'.

Besides, 'any tension in the DoH will be about money', says Dr Charlson.

The most controversial Tory policies, like handing commissioning responsibility to GPs and making practices stay open from 8am to 8pm, seven days a week, may get watered down says Dr Jenner. He believes the Conservatives started to 'row back' on their commissioning policy just before the election.

'We will see something, but it will not be full fund-holding at practice level. If you put it into the GP contract you have too small a budget. They might include clauses that make GPs pay attention to referrals and pathways and resource management,' he says.

Dr Charlson agrees there is likely to be a gradual hand-over of responsibility. 'I don't see that being a redrawing of the contract, not initially - it will be more of a voluntary thing. If you can't get anyone to do it in the local area then I suppose it goes back to the PCT,' he said.

As for the '8 til 8' policy, Dr Jenner says the meaning remains vague. 'The Tories say you should have a practice open 8am to 8pm near you. What does that mean? One in your village, one your town, or one in your PCT?'

Drastic efficiency savings
The pre-election debate about what the NHS will have to cut was also predictably vague, but Mr Lansley has continued to obfuscate over cuts.

In his first interview as health secretary, on Radio Four's Today programme, Mr Lansley warned that the NHS may need to make more drastic efficiency savings than Labour predicted. But he promised not to close any hospital or service against the wishes of clinicians and patients.

Health economist Professor Nick Bosanquet accused Mr Lansley of avoiding tough decisions. 'Now is a good opportunity, with a stable government, to have a realistic look at what is needed. I congratulate him on taking office but he needs to take a fresh look at these problems.'

Dr Jenner believes the coalition will make a lot of progress towards its shared goals. 'With this five-year fixed term, I think it intends to be radical.

'Yes, it will scrap boundaries, yes, it will renegotiate the GP contract, yes, realign and simplify QOF. It will be a tough year for the BMA,' he said.

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