EXCLUSIVE: NHS reform red tape could hinder commissioning benefits, NAPC warns

GP commissioning groups could 'really fly' and improve the NHS, but there is a risk that too much red tape could stop them achieving this, the National Association of Primary Care (NAPC) chairman has warned.

Dr Marshall: avoiding a 'two-tier system' in GP commissioning
Dr Marshall: avoiding a 'two-tier system' in GP commissioning

Talking exclusively to GPonline.com, Dr Johnny Marshall said the NHS reform changes introduced following the government’s listening exercise must be handled carefully to ensure clinical commissioning groups, formerly GP consortia, do not just ‘recreate PCTs’.

He warned that the plans to require GPs to consult with a number of professionals, including clinical senates, could slow commissioning decisions.  

The softening of the commissioning timetable and the suggestion that not all GPs have to be involved in commissioning could also mean momentum is lost and result in a two-tier system, he added.

He said: ‘We are very close to a system that could see clinical commissioning groups absolutely fly. We just need to make sure that we don’t over-clip the wings of GPs and bog the groups down with bureaucracy and red tape.’

Dr Marshall said while the NAPC believed that including other health professionals will result in ‘better services and outcomes’, the plans must be handled carefully.

Requiring clinical commissioning groups to consult health professionals, the public, patients, local authorities as well as clinical networks and senates could make the decision making process ‘more complex’, he said.

‘How will they be able to make a quick decision if they have to deal with all these relationships?’ he said.

‘The negatives are that we might find it takes a long time to reach decisions. It might mean we end up doing a lot of talking but not much changing.’

Dr Marshall suggested that while GPs should engage and consult others in their decisions, GPs should have the final say on plans.

Dr Marshall also warned that clinical senates could enforce too much central control over clinical commissioning groups.

He said the proposal to house clinical senates within the NHS Commissioning Board would make them feel ‘remote’ and clinical commissioning groups could feel that they must follow their advice.

He said: ‘If these clinical senates were generated from the bottom up they could provide rich clinical support. If they are top-down they may not feel like that at all.’

He said it would be a good idea to move the clinical senates from the NHS Commissioning Board over time so they eventually become independent bodies.

Dr Marshall, meanwhile, said the ‘softening’ of the GP commissioning timetable will mean momentum is lost and the benefits of GP commissioning not realised.

He said: ‘This does require a foot on the pedal. We don’t want to see a shift away from that sense of urgency. That doesn’t mean we should be rushing in to this, but it does mean we need to make sure GPs are properly supported in this process.’

He also said the government’s suggestion that not all GPs have to be involved in commissioning would mean that commissioning is separated from provision, resulting in the ‘re-creation of PCTs’.  

He said while every GP does not need to take on a leadership role within clinical commissioning groups, they do need to be ‘on board’ with decision making process.

He said: ‘If this thing becomes optional it will be more difficult to get everyone on board. We need everybody to share the responsibility.’

Dr Marshall said the risks involved in the plans could be avoided if GPs grasp the agenda now.

He said: ‘The overall message for guys doing it on ground is don’t let uncertainty deviate you from the task of improving care for patients because there is still a way to go with this.

‘If GPs take hold of the agenda now and demonstrate that they understand this, it will give people more confidence in us, which will result in more autonomy for clinical commissioning groups.’

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