Exclusive - 'Let GPs control purse strings for social care'

GPs should be able to commission health and social care from a single budget, according to a joint DoH and GP task force.

The government 'bottled out' of a greater merger between health and social care in the recent White Paper, 'Our Health, Our Care, Our Say', according to Chris Town, chairman of the Working in Partnership Programme (WiPP) advisory group.

He said he would like to see a single budget across health and social care, with services commissioned through practice-based commissioning, and believes that is the 'direction we are heading in'.

The WiPP is heading a number of initiatives to help implement the White Paper. Under its original brief of supporting the introduction of new GMS, it set up a number of pilots which are now being adopted to help implement the White Paper changes.

Among these are four pilots on self-care, which aim to help closer links between health and social care.

Mr Town said: 'We should be pooling our resources, not arguing whether something is a social care or a healthcare pathway.'

He said that practice-based commissioning was the ideal conduit to make this happen.

However he said that a single merged health and social care budget would not necessarily mean GPs commissioning 100 per cent of social care.

'For complex mental health needs, for example, that may not be appropriate, but it requires a lot of integration' he said.

WiPP advisory group member and GP Dr Ian Trimble, said that practice-based commissioning could give 'the big push' that is required to integrate health and social care.

However, GPC chairman Dr Hamish Meldrum described the single budget as a 'holy grail' that might not ever be achievable.

'The fundamental issue is that healthcare is free for all at the point of use, while social care is means tested,' he said. 'You can move some way, but you will run into problems eventually.'

However, he said that this would not prevent some level of greater integration, possibly through practice-based commissioning.

The White Paper says that the DoH will 'streamline budgets and planning cycles between PCTs and local authorities', but does not talk about merging budgets.

Single budgets for health and social care, even including housing budgets, were also touted by the NHS Confederation in its election manifesto last year (GP, 18 March 2005).

Confederation policy manager Jo Webber said: 'Practice-based commissioning can deal with part of the equation. Sometimes it is social care that can keep a person living at home for longer, as can appropriate housing. You need to put the budgets together.'

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