Labour's plan to 'scrap general practice'

News Focus - Tom Ireland looks at Labour's plans for the NHS for the next five years.

Mr Burnham wants more acute trusts to run GP services

Few wish to appear to be resistant to change in the face of the NHS's greatest ever financial challenge.  So it is no surprise that most health bodies in the UK have cautiously welcomed the DoH's latest policy document, NHS 2010-2015: From Good to Great.

The plans attempt to bring together all of the DoH's sprawling aspirations - high quality, preventative, personalised care, delivered closer to home, affordably and efficiently. The core policy change is a move towards hospital payments based on patient satisfaction, and there is a fresh commitment to shift patients away from urgent and emergency care and into GP and community services.

It also contains a set of 'rights' so both patients and staff are aware of what they can expect from the NHS over the next five years. It is made clear that all NHS ‘staff face sustained pay restraint.'

Some front-line staff, like nurses, will be offered job guarantees in return for modest or no pay awards. Beyond 2011, the quality framework will be 'significantly reformed' so that thresholds make practices work harder, and some indicators will be dropped to become standard practice.

GPs can expect to receive no more pay than any projected rise in expenses, and must find a 1% efficiency saving in 2010/11. More demanding efficiency savings will be considered in later years, the document says.

Launching the plans in London last week, health secretary Andy Burnham said he wanted more acute trusts to run GP services, and remove barriers preventing the private sector from entering the NHS.

But to GPC chairman Dr Laurence Buckman, the call for acute trusts to run GP services signals the health secretary's desire to ‘get rid of general practice completely'.

 ‘He wants to get rid of general practice, that's what he wants - anyone doing general practice except GPs. They want to make practices into bigger and bigger conglomerates and they want to get any willing provider in and get rid of small practices.'

Dr David Jenner, GMS lead at the NHS Alliance, says acute trusts should run GP services only where it is proven to be in the public interest.

‘It should be the exception, not the rule,' he says.  

A DoH spokesman said secondary care providers can already bid to run GP practices and there would be safeguards to prevent inappropriate referrals and gaming.

Dr Buckman was also concerned by the talk of ‘efficiency savings' having to be found in general practices. He thinks this just cannot be done - ‘efficiency savings' simply means less money, he says. 

‘This has been the mantra of the Treasury for the last 20 years. The government has to say this sort of thing - he's not going to call for more inefficiency is he?

‘We've reached a point where there are very limited opportunities to improve efficiency in general practice that don't involve losing our staff or closing.'

A DoH spokeswoman explained that ‘finding a 1% efficiency saving' really means that GPs should get a pay rise of 1% less than any projected rise in their expenses.

‘It basically means you have to find a 1% efficiency gain or effectively take a pay cut,' said the spokeswoman.  

Where does this leave the pay review bodies? At the launch of NHS: 2010-2015, one delegate told the health secretary that if the department were to make these statements on pay in five-year policy documents, the review bodies would effectively be redundant.

Mr Burnham committed to using ‘established systems' of setting pay awards, but the DoH's document is clear: GPs will get 1% less than their expenses at the most, nurses and other NHS staff face pay freezes in return for job security.

It's not just front-line staff feeling the pinch. All trusts will be expected to cut their management costs by 30% and consultants and very senior managers will receive no rise in 2010/11. The NHS's period of ‘sustained pay restraint' must ‘be led by our most senior managers and clinicians', according to NHS 2010-2015.  

Like the Royal College of Nursing (RCN), the King's Fund, and NHS Alliance, NHS Confederation officially ‘supports the vision'. But its chief executive Steve Barnett warns that the cuts to management costs would punish trusts which had already made savings, and hamper others in finding new ways to save cash.

Mr Barnett says that basing payments to hospitals on patient satisfaction, the heart of Mr Burnham's policy, was unpredictable and unproven.

‘Although an attractive concept, calculating payments to providers based on patient satisfaction is very challenging to put into practice,' said Mr Barnett.

For Dr Jenner, how a lot of the policies will be implemented ‘remains unclear'. He hopes the NHS Operating Framework, delayed and due in December, will add detail to some of the more vague ‘political gimmicks' in the document, such as scrapping practice boundaries.

In Mr Burnham's own words, NHS 2010-2015... is a ‘gritty and realistic' vision, while remaining optimistic and ambitious. But patients and NHS staff must remember: there's an election looming this summer, and Labour's vision for the next five years might not last five months.  

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