White Paper support builds slowly

GP survey shows tentative support for the White Paper is building as GPs wait for more detail. Tom Ireland reports.

It appears support for health secretary Andew Lansley's NHS White Paper is growing among GPs

GP's latest survey of the profession - carried out in association with the NHS Alliance - suggests support for the White Paper is slowly growing.

Shortly after the White Paper was published in July, 38 per cent of respondents to a GP survey backed GP-led commissioning, but two-thirds opposed making it compulsory to join a consortium.

This month, 54 per cent of respondents report some degree of support for the White Paper. More than 10 per cent are 'enthusiastic' and 44 per cent back the plans but want more detail.

More than half (51 per cent) of GPs are now either in a GP consortium or a practice-based commissioning (PBC) group that intends to become a consortium. Just 30 per cent are yet to take any action at all.

Genuine enthusiasm?
Does this latest survey show genuine enthusiasm, or is it reluctant acceptance?

NHS Alliance chairman Dr Michael Dixon says he now sees 'two types' of GP offering support to the White Paper.

'We've seen more people signing up to the idea and getting interested over the course of the discussion,' he says.

'There is a second lot that are beginning to realise that this is actually happening and don't want to get left behind.'

Whether GPs support the reforms or not, it is easy to see why they want more detail. It remains unclear how much funding consortia will receive, what functions they will have, whether they will inherit PCT debts and what happens if they overspend.

One response from a partner in Evesham, Worcestershire, proves even enthusiasts need more information. 'I'm a GP commissioning consortium lead - and still largely in the dark,' he writes.

Another partner from Battersea, south London, said: 'There is not enough detail and I think it is rather fanciful that this new role can be absorbed into the GP's job as it stands.'

The DoH is due to publish an NHS operating framework in December, which promises crucial details on the management allowance and functions of consortia.

It is unlikely there will be any further guidance for GPs on the structure or size of consortia.

However, 52 per cent of respondents to the GP/NHS Alliance survey want the DoH to set a minimum size for the new organisations. Just 27 per cent disagree, while the rest were unsure.

Views were more divided on whether a maximum size should be set to limit mergers between consortia - 42 per cent said 'yes' and 36 per cent said 'no'.

But Dr Dixon says the DoH is unlikely to perform a U-turn and tell GPs what size consortia should be.

'The desire for more guidance is simply down to not knowing what the ideal size is and that is part of our job at the NHS Alliance, to help.'

Two distinct sizes of consortia are emerging, he says, which fit the communities they cover: 'Small consortia, typically of around 100,000 patients, sensitive to local situations and flexible - and large ones, covering 500,000 patients, which have big leverage and interact with acute trusts.'

Fill in the gaps
The White Paper was deliberately light on detail, with health secretary Andrew Lansley inviting the profession to fill in the gaps.

But a split has emerged between the National Association of Primary Care (NAPC) and the NHS Alliance over the way consortia manage their member practices.

The NAPC believes GP consortia should hold contracts and should be able to expel poor practices, while the NHS Alliance disagrees and says GPs must work as collectives.

Most respondents to the survey think the NHS Commissioning Board should hold practice contracts (63 per cent) and 59 per cent say consortia should not be able to expel practices that underperform.

Despite the survey suggesting support for the reforms and some degree of progress, there are still pockets of resistance.

One GP in Gloucestershire complained: 'We have had no information, no encouragement, no framework and no interest locally.' Another remarked: 'The government comes over all nice to get us involved, then they'll blame nasty greedy GPs when it all goes tits up. No thank you.'

The GPC hopes it can articulate the professions' disparate views once more detail on the shape of consortia emerges.

GPC chairman Dr Laurence Buckman says once the Health Bill is published, 'we will have a shrewder idea of what we like and what we don't like.

'The profession can then ask itself what it thinks of this,' he says. 'At the moment it is all guesswork.'

The operating framework is due in the next month, and the Health Bill before the new year. GPs will get their questions answered, but may not like what they hear.

Click here for a breakdown of the GP/NHS Alliance survery in terms of GPs forming commissiong groups

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