In an exclusive interview with GP, national clinical commissioning network lead for England Dr James Kingsland warned that the government's NHS reform plans would fail without a 'cultural shift' among GPs.
To save £5 billion a year, the NHS needs to save around 40p per patient every working day of the year, Dr Kingsland said.
'For a practice of 6,000 patients, that's about £2,500 per day you need to save by doing something remarkable in your prescribing, in urgent care, in long-term condition management,' he said.
GPs need to apply the management skills they use to run their own practice finances to their use of wider NHS resources, Dr Kingsland said.
'That's where it starts - within consultations, recognising that you align your clinical decision-making with the resources that are deployed.
'If we don't get that right in every consultation, in every general practice in England, the reforms can't work.
'Every GP needs to recognise that when you make a referral that is a commissioning act.'
|NHS savings: practice target|
Evidence from GP fundholding showed that if clinicians 'aligned clinical thinking with budgetary management' they made better decisions, used resources better and could prevent rationing of services, Dr Kingsland said.
'When NHS management controls budgets it can't change clinical practice. All it can do is change the resource flow, which sometimes means rationing,' he explained.
Dr Kingsland warned that practices could not join consortia and simply expect them to deliver efficiencies. Savings and better use of resources would come from aggregating 'small, remarkable actions' at practice level, he said.
GPC negotiator and commissioning lead Dr Chaand Nagpaul said levels of GP engagement with the NHS reforms would determine the ability of GP consortia to deliver efficiency savings.
Both he and Dr Kingsland agreed that a lack of engagement had doomed practice-based commissioning to failure.
Dr Nagpaul hit out at claims from health secretary Andrew Lansley that the roll-out of 141 GP pathfinder consortia across more than half of England showed GPs were behind the current plans.
'I think it is disingenuous for the health secretary to equate pathfinder applications with enthusiasm. They are a pragmatic response to PCT implosion and mergers,' he said.
Dr Kingsland warned that GP engagement could suffer if commissioning consortia were too large. GP reported this month the groups were 'frighteningly close' in size to PCT areas in 2006.
Watch more from Dr Kingsland on ideal consortia size and GP funding in an exclusive interview:
Editor's blog: Can every GP practice in England save £2,500 a day?