How will party policy affect GPs?

Labour and the Conservatives go head to head on general practice policy with the election looming.

Andrew Lansley (left), Mike O'Brien (right)
Andrew Lansley (left), Mike O'Brien (right)

Why do you want to do away with GP practice boundaries?

Conservative shadow health secretary Andrew Lansley: We believe boundaries limit patient choice. At present, GPs are not allowed to accept patients beyond practice boundaries, even where an alternative location may be more convenient for the patient, and acceptable to the practice.

We don't think it should be up to the government to prohibit patient choice in these circumstances. However, a practice may adopt a range of approaches to home visits, including through contracts with urgent care providers.

Labour health minister Mike O'Brien: People should have the freedom to choose their own GP practice and not face artificial restrictions like practice boundaries.

Most people will be happy to remain with their current GP and this change will only help a limited number of people, but the issue of choice is fundamental.

We do not underestimate the challenges involved in allowing people to register outside traditional catchment areas, for instance in preserving access to home visits.

Our current consultation sets out proposals and options for how we meet these.

What role should GPs play in commissioning?

Lansley: We support powerful, clinician-led commissioning in primary care. Unlike practice-based commissioning (PBC), it should include real budgets, real chances to save and reinvest, and real control over contracts.

Clinician-led commissioning in primary care should combine the decision-taking responsibility for where and how patients are treated with the finances to support it.

The clinician's voice, on behalf of their patient, is strengthened because the clinician is responsible for the resources needed to support his or her judgment.

O'Brien: We need to find new ways to better engage GPs in commissioning. PBC has a key role but is not enough in itself.

A new relationship is needed between LMCs and PCTs, and managers need to understand that GP involvement is fundamental. The Mid-Staffs debacle taught us the importance of clinical engagement and the Ubani case the need for GPs to get more involved.

We are looking to develop closer involvement by ensuring PCTs build strong relationships and I am keen to ensure GP representation on PCT boards.

Should NHS providers be 'preferred'?

Lansley: No. Giving any provider a monopoly on the supply of a service removes the incentive for that provider to focus on meeting the needs and wishes of users.

Only where users have the power of exit through choice, and the possibility of alternative service through competition, do providers have an incentive to improve.

O'Brien: Where existing NHS services are delivering a good standard of care, there is no need to look to the market. We reject the Tory ideology of privatisation for the sake of it.

However, there will be no compromise over poor quality care and we must challenge underperforming services. In the right context, independent and third sector organisations can add capacity, improve quality, increase patient choice and drive innovative practice.

How will you attract GPs into commissioning or providing out-of-hours services?

Lansley: Most GPs I meet are frustrated by the process where PCTs hold the purse strings, while GPs make day-to-day commissioning decisions.

Many feel their clinical judgment is undermined by PCTs' focus on cost and volume. GPs are well paid, senior public service professionals. We believe they are willing and capable of taking on serious and senior responsibilities. We will give them the opportunity and resources to do so.

O'Brien: Greater involvement by GPs in making decisions and on PCT boards is something I am very keen to look at.

Patient safety is our top priority and PCTs have a clear legal responsibility to provide safe, high-quality out-of-hours care.

The quality of out-of-hours care for most people is better than it was in 2004, but some PCTs are not meeting their legal obligations. The DoH is determined to tackle this.

If your party takes office, does the Doctors' and Dentists' Review Body have a future?

Lansley: Yes. We recognise the importance of government receiving independent expert advice on appropriate pay levels.

O'Brien: Yes. The review body must have regard to the need to recruit, retain and motivate doctors and dentists, and the overall strategy that the NHS should place patients at the heart of all it does.

Do small or single-handed GP practices have a future?

Lansley: Yes. GPs are local, by definition, and the public need a choice of styles of GP.

We know that patients value a personal relationship with their GP. Single-handed GPs usually have strong links with their local community and good relationships with patients. They need to network so that they have access to diagnostics, and proper clinical governance.

But we have consistently opposed the government's attempts to force GPs into big polyclinics on the basis of their one-size-fits-all plans.

O'Brien: Yes. It would be wrong to abolish small practices, many of which provide an excellent service. There has been a move towards group practices but it is GPs themselves who have shaped the way this has developed over the years, seeing group practices as better suited to their aspirations.

Small and single-handed practices will continue to be an essential part of primary care and the wider NHS.

How can you speed up the transfer of services from hospitals into the community?

Lansley: We know that we need to find ways of moving more services into the community.

But (current government and PCT) plans to shift huge volumes of outpatient and A&E cases to primary care are based on flawed analysis of future finances, and heroic assumptions about the capacity of local GPs to take on this work. We don't believe that the facilities exist at present.

We would scrap these plans and launch a series of local consultations with GPs to work out which services can be commissioned in the community, rather than introducing top-down reforms.

O'Brien: Patients with long-term conditions often prefer to be treated at home.

We set out in our recent NHS policy statement, From Good To Great, how we will reform the NHS to enable patients to get better care at home.

This requires a greater focus on building community services and primary care in the coming decade.

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