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Warning over £80billion GP fund-holding plans

By Channel 4 News

Updated on 09 July 2010

The union representing 400,000 health workers tells Channel 4 News that coalition plans to put GPs in control of NHS purse-strings could result in more bureaucracy not less.

Doctor wearing stethescope (Getty images)

An NHS White Paper, to be published on Monday, is expected to announce the scrapping of stategic health authorities and primary care trusts in England, with their £80billion a year budget handed over to GPs.

GP practices would be expected to work together in local areas to commission services direct from hospitals or provide them directly themselves.

It's being described as one of the biggest shake-ups of the NHS in its 60-year history - despite the fact that the Conservative-Lib Dem coalition agreement promised to "stop the top-down reorganisations of the NHS that have got in the way of patient care."

The plans are aimed at giving family doctors and their patients more control over their treatment and - as well as handling the funding of hospital services - the GP groups are expected to organise more effective out-of-hours services.

The Daily Telegraph claimed that "tens of thousands" of administrative jobs in the health service would be lost as a result.

But Anne Mitchell, a spokesperson for the public sector workers' union, Unison, told Channel 4 News that the plans could result in the creation of a new tier of private management consultants.

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"GPs won't be able to do commissioning and treat patients at the same time and there is therefore a real risk that they will look to more private sector involvement and getting the free market in, opening the door to more and more privatisation," she added.

"At the moment there are 150 primary care trusts doing commissioning. This will mean 500 or so GP commissioning clusters instead, so there will be a huge increase in bureaucracy."

The NHS Confederation, which speaks on behalf of the primary care trusts and strategic health authorities, warned that the transition to the new system would entail some "quite significant risks".

The Confederation's acting chief executive, Nigel Edwards, said he expected GPs to recruit staff from the PCTs to help them cope with the extra workload.

"Obviously it is going to take time to implement this and the PCTs at the moment are the people who keep the lid on the performance and financial management of the system," he added.

Dr Steve Field, the chairman of the Royal College of GPs, said a lot of his colleagues were keen to become more involved in commissioning.

"GPs work at the heart of communities; we know our patients and we understand their needs," he said. "If this is properly delivered and properly resourced, patients can expect to receive far more personalised services, focused on their individual needs.

"By giving GPs real influence to control budgets and commission services, we will enable patients to receive high quality care and better continuity of care where they want it - close to where they live."

Katherine Murphy, director of the Patients Association, said there were "potential benefits" to the proposals.

"We support empowering clinicians, who can often have a better understanding of the experiences and needs of patients," she said.

"If the people in charge of commissioning see firsthand the outcomes for their patients, they will have powerful incentives to make sure services are delivering good results."

But she warned that the change would amount to "a huge experiment without much hard evidence" as to how they would work.

"There is a serious question of accountability," she warned. "Who is going to scrutinise the work of the GP commissioners?

"Who is going to step in if they aren't doing a good job? We need to make sure the accountability issue if thoroughly considered."

The independent health watchdog, the King's Fund, had similar concerns.

"The proposed independent commissioning board will not be able to hold to account 500–600 GP commissioning groups, and there will need to be a body sufficiently close to these groups in a position to ensure appropriate and effective use of resources," it said.

"Who will take on this role? What will be the consequences of failure, and who will ensure continuity of care for registered populations?

The Health Secretary, Andrew Lansley, was not expanding on his plans ahead of Monday's publication of the White Paper, but his Labour shadow, Andy Burnham, warned "if it ain't broke, don't fix it."

"Handing the budget over to GPs undermines the excellent partnership work around the country between PCTs and councils - work that is improving health outcomes," he said.

"Individual GPs simply do not have those practical relationships with their local authorities in order to carry on this work."

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