Viewpoint: Dr Kailash Chand: Why I oppose the King's Fund's primary care plans

On Wednesday the King's Fund published a report calling for GPs to form larger organisations that could be contracted both for core GP services and as lead providers for wider out-of-hospital care, writes BMA deputy chairman Dr Kailash Chand.

Dr Chand: 'Moving care closer to home might sound appealing, but there is a complete lack of evidence.'
Dr Chand: 'Moving care closer to home might sound appealing, but there is a complete lack of evidence.'

I fear the King’s Fund proposal of a radical change to primary care is a recipe for another structural reorganisation resulting in a less effective and more expensive mishmash of ever-changing services and faces.

The NHS is already undergoing some significant and worrying changes. Is the King’s Fund telling government that the last reorganisation is not working and is not capable of delivering change?  And now we want another big structural reorganisation? I hope not!

Primary care does not need another reorganisation on the back of the incredibly time consuming and costly restructuring GPs have only just undergone. Instead we should be focusing on tackling the serious workload and financial challenges facing GP practices, and supporting them to evolve and develop rather than wasting resources rearranging the NHS’s already complicated bureaucracy. Further, such a model would be totally inappropriate and costly in rural areas.

The idea of moving care closer to home might sound appealing, but there is a complete lack of evidence for the alternative suggested. The King’s Fund alternative would see as Dr Chaand Nagpaul very rightly says, ‘GP services subsumed into wider commissioning budgets that would both make it more difficult to guarantee national standards and hinder the ability of local GPs to truly manage the services they deliver.’

How are we going to resolve the conflict of interest of GPs as commissioners and GPs as service providers?

I accept we need to be bold in addressing the problems facing general practice. But to implement needless, disruptive policies that focus more on structures than patient outcomes needs rejecting. In the last decade the creation of a marketised NHS and the corporate philosophy of treating health as a commodity and the patient as a target have resulted in a colossal waste of funds with little real benefit to the patient.

British GPs are not Luddites, and have adapted to the changes benefiting patients. The intensity and complexity of GP work has changed according to the needs of patients. It is now GPs, and not hospitals, who are organising the care of chronic illnesses such as heart disease, diabetes and the degenerative conditions that increasingly afflict an ageing population, often having to act as first port of call to most nursing and care homes and social needs.

The worrying bit for primary care to deliver desired outcomes is that the amount of money invested in primary care as a proportion of the NHS budget, has dwindled to all-time low (10.3% in 2005 to 8.3% in 2011). What is needed is adequate funding of the primary care with existing structures in order to improve patient care.