GPs voice White Paper concerns

Commissioning is an inevitable part of the future for GPs. Nick Bostock reports on why the profession is worried.

Dr Dixon urges GPs to remain positive despite recogising their concerns
Dr Dixon urges GPs to remain positive despite recogising their concerns

The avalanche of policy and consultation papers emerging from the DoH in recent weeks paint a picture of GPs as the axis around which a radically reformed NHS will turn.

The trouble is that even as the profession's profile rises, prompting a gleeful return to GP-bashing headlines from the usual suspects in the national media, GPs still lack the information they need to judge the government's plans fully.

Against this backdrop, it is fairly unsurprising that a joint GP/Family Doctor Association (FDA) poll this month found that many GPs are terrified.

Widespread fears
More than half of respondents were worried and 22 per cent more 'scared witless' by the Liberating the NHS White Paper.

Funding is a key concern - 75 per cent want the GPC to block any plans to use existing pay to fund their commissioning role.

Some GPs worry that improving patient care may not be the only reason changes are being made. One respondent said: 'I suspect one motive for the reorganisation may be to transfer the blame for consequences of inadequate funding for services from the government to GPs.'

Another said: 'These changes are motivated by politics and have no evidence base. They will undermine the NHS.'

Whatever the politics behind the NHS overhaul, GPs fear the way they work and their status could be adversely affected.

Fifty-nine per cent of GPs said their roles would be affected by the plans. One said: 'I can see no way of undertaking this that will not reduce the time I have available to do the job I trained for, namely clinical medicine.'

How worried are GPs about changes proposed in the White Paper?

Bureaucracy concerns
More than four out of five - 82 per cent - of GPs polled were concerned about bureaucracy. GP consortia will have to link with member practices, sit on committees with local authorities, work with the NHS Commissioning Board and face regulation from Monitor and the Care Quality Commission.

GPs worry about their lack of commissioning skills. One said: 'PCTs struggle with this. What hope do untrained and inexperienced doctors have?'

The scale of change the White Paper envisages means the GP is not the only dog being forced to learn new tricks.

Consortia could have to sift through a reworked NHS tariff system as they deal with a new breed of hospital keen to maximise private income.

They are likely to have to buy services from providers recently converted into social enterprises, and weigh up offers of support from PCT managers who have morphed into consultancies and private firms keen to offer data gathering and analysis services.

Impact on morale
The impact on morale should not be underestimated. Several respondents were considering retiring early, or switching career.

One 50-year-old GP said that from a profession that had struggled through fundholding and countless other changes there was 'complete apathy towards this commissioning'.

'Colleagues are looking towards me and others who have previously embraced and done everything. I have now had enough, and I can't honestly see many young GPs who will be prepared to do it,' he warned.

The findings that 45 per cent of GPs feel they are being pushed too quickly into consortia, and that 55 per cent think their autonomy and independent contractor status are at risk, only deepen the gloom.

But on the upside, FDA chairman Dr Peter Swinyard spells out below his sense that the government is genuinely listening to input from GPs.

'Everything is still to play for, nothing is set in stone,' he says. Nothing, he admits, apart from the fact that one way or another, GP commissioning is coming. 'It's the only game in town.'

Since that is the case, it is a relief that a hard core of GPs remain willing to take on the latest challenge the DoH has thrown their way.

Many belong to organisations such as PBC groups that could develop into GP consortia.

Once-in-a-lifetime chance
One respondent sees the DoH plans as a once-in-a-lifetime chance GPs cannot afford to miss. 'This may be the only opportunity GPs have in the 62-year history of the NHS to make a positive contribution to reorganising and reforming a broken up NHS which has been destroyed by political interference and bureaucracy,' he says.

NHS Alliance chairman Dr Michael Dixon echoes this sentiment. He says GPs must seize this opportunity, and that consortia 'based on registered lists, predicated on GPs as entrepreneurs' could secure the future of GPs as independent contractors.

GPs in the poll were split on whether the DoH plans are an opportunity (27 per cent) or a threat (26 per cent) - but 47 per cent said it was too early to say.

Dr Dixon recognises the many concerns and unknowns, but urges GPs to be positive. If GPs do not step forward, he warns, they may find the DoH happy to turn to the private sector to grease the wheels of change instead.

Viewpoint: 'It is better to work with the government than go to war'

Family Doctor Association chairman Dr Peter Swinyard says GPs can influence the White Paper plans

Change. Threatening? Challenging? Promising? Dreadful? We at the Family Doctor Association were not sure, so ran a survey with GP. The results are fascinating.

Most GPs are a little worried about the future of the NHS while a quarter are 'scared witless'. This may reflect the lack of firm information about the final rules we will work to.

However, GPs are the doctors most used to coping with uncertainty in their everyday practice as well as being among the most versatile and entrepreneurial.

There is no certainty about how the new systems will work - largely because the DoH is consulting widely among the major medical organisations before writing the rules rather than just issuing diktats.

This change of emphasis must be welcomed and gives the leaders of the profession a chance to get themselves heard at the formative stage.

Although the survey reflects a mood for balloting on whether we want these changes, we have to accept this is a key government policy and it is better to work with it than to go to war. There would be no winners from such a fight.

There are clearly lines in the sand that our negotiating body will want to observe. The finding that GPs do not want a 'quality premium' to come from their existing funds is vital. This must come from savings from the abolition of SHAs and PCTs.

GPs fear the new system will be bureaucratic. It need not be - our practices are mostly free of unnecessary red tape and we have the ability to make decisions quickly and effectively. I have no doubt we can scale this up to consortium level. I am sure some consortia will engage private companies to do background work, but NHS GPs will remain in control of the organisations. This would prevent a takeover by big business of primary care.

GPs are also keen to keep some of the savings we make to reinvest in the local health economy. Improved services and facilities will motivate GPs to engage and ensure a good deal for both patients and practices.

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